HomeMy WebLinkAbout027-240-029027-24-0-029 98-0283 E
RODRIGUEZ, Andres
Daly Avenue, Palermo
(elec well and fut lot dev)
Beymer & Son
r #' 027=24-0-029
f Y•
RODRIGUEZ "- ' .981"`0 83wE ,r.. s
Daly . ven.ue p t
(elec well alermo
• ' � � and - •.
Beymer'& Son fut lot dev)'� r;
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COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center; Drive - Oroville, California 95965 - Telephone (916)`538-7541 PERMIT_NO.
(Rev. 12/96) APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER ,
�., �.. ,
ZONING
BUILDING PERMIT
OWNER
N
TELEPHONE
SO. FT. OCC. ` - BUILDING VALUATION
OWNERS MAILING ADDRESS `
CONTRACTOR'S NAME
TELEPHONE
741--1971
CONTRACTORS MAILING ADDRESS
7590 RFT) HILL WAY, BROWNSVILLE CA 95918 —
CONSTRUCTION LENDER
[Fireplace
LENDER'S MAILING ADDRESS
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee
$ 20.00
Permit Fee
$
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDING ADDRESS DALY AVENUE. PALERMO
Energy Plan Checking Fee
$
PERMIT FEE
$
LOT NO.SUBDNISION'S
NAME
PARCEL MAP
-
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other _
SPECIFY
Each Trap
E
7.00
Solar or heat um water heater
23.00
Water
Water piping
15.00
Each gas water heater or vent
15.00
TYPE OF WORK
�
New ❑ Addition ❑ Remodel Utilities ❑ Installation ❑ Other 13,, n,
Describe Work: ELEC/sWF>< L AND MME Ir DEV
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home S I G W
@20.00
PERMIT FEE
$
ELECTRICAL PERMIT
Fling Fee 20.00
}
eoov LEss
Main Service zaoA ooRR LEss
23.00 23.00
ICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of'Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Profession's Code,
and my license is in full force and effect.n p f
License Class (7 " T '7 Lic. No. A C 6
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO I000A
46.00
NEW CONST. DWELLING OCCUP.
OR ADDNS. ( a ACC. BUDS.
so
3.50FT.
N" WRESID MULTI.OUTLET
97.50
POWER APPARATUS
6 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES
20 @ I'00
64L @ .so
NS
Ex. Occup. o, Ens RES D.OEA
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PRE INSP
23,00
PERMIT FEE
$ 66.00
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
Performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My work e 'compensation insurance carrier and policy number are:
Carrier .-,Ut L tea/ �5AsA r
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply .with those provisions.
X _. _ Date -�_� _
Signature of Applicant - D <Fwner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 5'0" deep and demolition or constructiontl
of structures over 3 stories in height.
MECHANICAL PERMIT
Fling Fee 20.00
Heating
Cooling
Hood
T 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection Fee Is
Occ
CONST. TYPE
TOTAL FEE $
HAZ.
D. FEES IMP
FLOOD
CDF
PARCEL
PD
HD
(SSU
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
,
By " ' ' F 1
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
'
Date
/
%S J
Date
Receipt No.
WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE
BUILDING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
411 Main Street, Chico, CA - (916) 891-2751
7 County Center Drive, Oroville, CA - (916) 538-7541
t'.= :
CORRECTION NOTICE
_L-t7C
PERMIT N
A routine inspection indicates that the following violations of Butte County Ordinances exist at
the above address and should be corrected. Please notify this office when correction of work
is completed. If you have any questions pertaining to this matter, or need additional explanation,
please contact this office immediately. r
d NL \,l 40lV�
—o
O av 1) U c, 779 2S C -.d Ai/1/oT G
M
Date —3Inspector
REV 10/92
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES
BUILDING DIVISION
AUTHORIZATION
TO CONNECT
Address
GAS
Meter By Date 7 Y
ELECTRIC
Meter By D�t 4
DETACH FOR SERVING UTILITY
��
Address �/ ) /
GAS
Meter By Date
ELECTRIC `
Meter By Da
OFFICE COPY
Address
GAS k ---�
Meter ByDate
ELECTRIC
Meter By
Ln
LAND DEVELOPMENT
BUILDING/ ENV4RQNMENTAL HEALTH —)PERMIT CLEARANCE Building Peimimo.
OWNERS
NAME: )DfLl L�LAP I- ��ID�G�� / NUMBER: o- �_—Z`il-)'�OZ�
PRINT LAST NAME FIRST
ADDRESS / LOCATION:
COUNTY ZONING nn
DESIGNATION; /'T FLOOD ZONE: X FLOOD MAP: 4C90 a
APPROVED: CONDITIONALLY APPROVED: � ; RESOLVE PROBLEMS PRIOR TO APPROVAL:
PARCEL CREATION BY DEEDS OR MAP
DEED INFORMATION:
DATE OF CREATION: DEED REFERENCE:
LEGAL ACCESS PROVIDED: YES NO
COMPLIES WITH COUNTY STANDARDS FOR DEED CREATION:
COMMENTS/CONDITION
MAP INFORMATION:
DATE OF RECORDING
LEGAL ACCESS REQUIRED:
YES NO
YES NO
LOT Z 131-4 (Z9 BOOK �,�//�c c� !f'L� SSI
PAGE
COMPLIANCE WITH OLD SUBDIVISION LOT ORDINANCE REQUIRED? (MAP RECORDED PRIOR TO BOOK 17 OF MAPS AT
PAGE 23): YES Y_ NO . IF YES, MARK APPROPRIATE ITEM(S) BELOW:
A. Construct road to B. Meet parcel size required by zone. C. Meet current E.H.D. requirements.
CHECK SPECIAL CONDITIONS WHICH APPLY TO MAP: ALL FEES TO BE PAID TO THE BU/LD/NG DIVISION UNLESS OTHEOW/SE NOTED.
Maintain a 50 ft. building setback from centerline of road.
_ 2. Maintain a ft.building setback from right-of-way/centerline of
_ 3. Comply with Zoning code for building setback from road.
—4. Maintain a 100 ft. leachfield setback from all existing wells.
5. Maintain a ft. leachfield setback from
6. Pay water tender fees in the amount of $ to Battalion Number of the Butte County Fire Department.
7. Meet the Fire Safe Regulations of Butte County and P.R.C. 4290.
_'8. Connect to a public water supply.
9. Connect to a public sewer system.
_ 10. Automatic fire suppression sprinkler systems shall be installed in all residential structures in accordance with the National
Fire Protection Association Standard for the installation of sprinkler systems in one and two family dwellings and mobile
homes, NFPA Standard 13D, unless a pressurized community water system, with hydrants that meet Fire Department
specifications, serves the parcel.
_ 11. Pay T.D.D. (Thermalito Drainage District) fee in the amount of $
_ 12. Meet the requirements of the Department of Fish and Game for the preservation of oak trees. (See phone number below)
13. Obtain approval from the Department of Fish and Game for vegetation removal. Contact Fish & Game at 916-355-7010.
_ 14. A traffic mitigation fee for each new or additional living unit shall be paid. Pay the amount of $ as stated
in the Oroville Area Traffic Mitigation Fee Agreement. Payment to be made to the Planting Division.
_ 15. All new residential buildings shall be constructed to comply with the requirements of the Uniform Building Code for seismic
safety. Mobile homes shall be constructed on a permanent foundation system which complies with the Seismic Zone 3
requirements of the Uniform Building Code.
16. Deer Mitigation fees are to be paid, if such fees have been adopted by the Butte County Board of Supervisors.
X 17. Pay school impact mitigation fees.
X 18. A development impact fee for sheriff facilities shall be paid pursuant to the provisions of Chapter 3, Article II of the Butte
County Code.
19. Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission requirements of the California
Clean Air Act of 1988 as amended.
_ 20. If any cultural resources are encountered during ground disturbing activities, all work shall cease in the area of the find
pending examination of the site by a professional archaeologist. This person would then be able to assess the site
significance and suggest appropriate mitigation measures.
21
22
23
24
25
26
LD 5/97
C:\M051XF0F*AS.KWLDGKF M.CIA
COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES- BUILDING DIVISION
1. 7 County Center Drive - Oroville, California 95965 -Telephone (916) 538-75
PERM L O.
(Rev.12/96) APPLICATION AND PERMIT �` a
n
ASSESSOR PARCEL NUMBER ,
ZONING
BUILDING PERMIT
OWNER
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS MAILING ADDRESS
CONTRACTOR'S NAME
REYMF.R ANT) SON
TELEPHONE '
1741-1971
CONTRACTORS MAILING ADDRESS
7590 RED HILL WAY, BROWNSVILLE CA 95918
CONSTRUCTION LENDER
LENDER'S MAILING ADDRESS
Fireplace
Total Valuation $
ARCHITECT OR ENGINEER
LICENSE NO.
—Filing Fee $
20.00
Permit Fee $
ARCHITECT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee $
BUILDING ADDRESS
DALY AVENUE, PALERMO
Energy Plan Checking Fee $
$
PERMIT FEE S
LOT NO.
SUBDIVISION'S NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
SF ❑ Duplex ❑ Mobilehome ❑ Other SLI'
SPECIFY
Each Trap
7.00
Solar or hest' um water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ly
Describe Work: ELEC/WELL AND FUTURE LOT DEV
Gas piping system 1 - 5 outlets
15.00
Building sewer
15.00
Mobile Home IS I GI W1
920.00
PERMIT FEE S
ELECTRICAL PERMIT
Fling Fee 20.00
LEss
Main Service a2aoovoAoRoR Less
23.00 23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000 of Division 3 of the Business and Professions Code,
( g )
and my license is in full force and effect.
License Class C— ? j "] Lic. No. � d� S �� �/
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
Main Service 200A TO 1000A
46.00
NEW CONST. DWELLING OCCUR
OR ADDNS. ( s ACC. BLDS.
so
3.5¢FT;
NEW CONST. MUI.OUTLET
LT
NON•RESID. C CU
7.50
POWER APPARATUS
8 SINGLE OUTLET CIR.
Ex. Occup. OUTLET OR FIXTURES
20 0 1.00
SAL @ .50
Ex. Occup. ouTLEEDTs AESID.0E0.
5.00
Temporary Service
23.00
Mobile Home Facilities
20.00
Misc. Wiring
23.00
PRE INSP
23.00
PERMT IFEE $
66.00
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
erformance of the work for which this permit is issued.
/Iphapensation, as provided for by section 3700 of the Labor Code, for the
,eand will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workeA' compensatio insurance carrier and policy number are:
Carrier [�1,6Hai 1JA9-71
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
w ke11 rs' com5nnprovisions of section 3700 of the Labor Code, I shall
fo te provisions.
X Date � _ ��_�
Signature rier ❑Contractor ❑ Agent
An OSHA pcavations over 5'0" deep anddemolition or construction
of structures over 3 stories in height.
MECHANICAL PERMIT Filing Fee 20.00
Heating
Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee Is
Energy Inspection Fee Is
occ
CONST. TYPE
TOTAL FEE $
HAZ.
I D. FEES IMP
I FLOOD
I CDF
PARCEL PO
HD
ISSU
This permit is hereby issued under the applicable
of the Butte County Code and/or Resolutions
indicated above for which fees have been
By
PERMIT EXPIRES ON . r9-HITE-D.D.S.-B.D.
provisions
to do work
paid.
to J
to
receiptNo. 231798
CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT
PRE -INSPECTION
nwNF.R- 40,JrPs
LOCATION: oa l V d e
CONTRACTOR: /� l F y iY� ►� ��l
------------------------------------------^---------
---------------------------------------------
PRE-INSPECTION FOR:
DATE�o�
A. P.
ZONING
ill IL
DATE TO INSPECTOR
------------------------------------------------------ --
PERMIT HISTORY: NONE AS FOLLOWS:
TYPE OF OCCUPANCY W
---------------------------------------------
FIELD - INFORMATION
BUILDING USAGE:
TENNANT:
0 OCCUPIED D HAS ELECTRIC
Q HEATED -COOLED
OTHER COMMENTS:
HAS GAS [::]HAS SANITATION FACILITIES
L_j PERSON CONTACTED
ACTIO RECOMMENDED:
ISSUE HOLD FOR
i
OTHER:
I
(Rev.12/96)
COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION
7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO.
APPLICATION AND PERMIT
ASSESSOR PARCEL NUMBER O
ZONING
BUILDING PERMIT
OWNER
r
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNERS UNG ADDRESS _�
a r win C,4
CONTRACT 'S NAME,J
i T2
T LEPHONE '
-
CONTRACI �NG AD S r`l-fes. Lr/l� �PowNS
��(!/ J
CONSTRUCTION LENDER
[Fireplace
LENDER'S MAILING ADDRESS
otal Valuation $
ARCHITECT OR ENGINEER 7717
NO.
—Filing Fee
$ 20.00
Permit Fee
$
ARCWMCT OR ENGINEERS MAILING ADDRESS
Plan Checking Fee
$
BUILDINGADDRESS
Energy Plan Checking Fee
$
Y -M
PERMIT FEE
$
LOT NO.
SUBDIVISIONS NAME
PARCEL MAP
PLUMBING PERMIT
Filing Fee 20.00
USEOFSTRUCTURE
%
SF ❑ Duplex ❑ Mobilehome ❑ Other L� [Z
Le:
SPECIFY
Each Trap
7.00
Solar or heat um water heater
23.00
Water piping
15.00
Each as water heater or vent
15.00
TYPE OF WORK
llation ❑� gOther ❑ /
New ❑ Addition ❑ Remodel ❑ Utilities IVOW
Describe Work: C_� r r r A) C_ `
tJ 41 (f—n
Gas piping system 1 - 5 outlets
15.00
Buildingsewer .
15.00
Mobile Home S G W
@20.00
PERMIT FEE
S
ELECTRICAL PERMIT
Fling Fee 20.00
Main Service z�o.OR LEss
23.00
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.POWER
License Class Lic. NO.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License
Law for the following reason:
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project.
❑ 1 am exempt under Sec. Business and Professions Code for this
reason
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of work for which this permit is issued.
My workers' compensation insurance carrier and policy number are:
Carrier
Policy Number
(The above sections need not be completed if the permit is for work of a valuation
of one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to workers'
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
X Date
Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent
An OSHA permit is required for excavations over 60" deep and demolition or construction
of structures over 3 stories in height.
Main Service TO L 46.00
WEE200A
NEW CONST. DWELLING DCS. SO
U
OR ADDNS. ( a ACC. elns. 3.5¢x;
=R.0.DT' MULTI.OUTLET
97,50
APPARATUS
.11N..
SINGLE 0.CIR.
EX. OCCu OUTLET OR FDrTURES SAL @ .5IED0
R.
Ex. Occup. OFlxuT rsRa 1 E 5.00
Temporary Service 23.00
Mobile Home Facilities 20.00
Mis Wiring 23.00
ERMIT FEE $ �%•
MECHANICAL PERMIT Filing Fee 20.00
Heating
—Cooling
Hood 6.50
Ventilation
PERMIT FEE $
Mobile Home Installation Fee $
Energy Inspection' Fee $
OCC
CONST. TYPE
TOTAL FEE $
HA2.
D. FEES IMP
FLOOD
I COF
PARCEL
PD
HD
ISSUE
This permit is hereby issued under
of the Butte County Code and/or
indicated above for which fees have
By
PERMIT EXPIRES ON
the applicable provisions
Resolutions to do work
been paid.
Date
Pare
Receipt No.
WHITE-D.D.S.-B.D. CA ARY-ASSE SOR PINK -INSPECTOR GOLDENROD -APPLICANT
COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION
- 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541
PERMIT APPLICA TION DA TA SHEET
OWNER: ASSESSOR PARCEL NUMBER: / ` -
Proposed Bui ding Use:Building Inspector: Date:
At time of permit application, I was advised the following data must he submitted prior to permit processing;040,6an or issuance:
Date Received By
❑ 1. All iiems have been submitted.-------------------------------------------------------------------------------------
❑2. Plot plans, 3/4 sets, signed by the preparer of plans. ------------------------------------------------------------
❑ 3. Complete plans, 3/4 sets, signed by the preparer of plans. -----------------------------------------------------
04. Engineered plans, 3/4 sets, with wet signature on plans. All engineering must be shown on plans. --------
❑ 5. Engineered truss details and layout in duplicate (required prior to plan review) No faxes! ------------------
❑ 6. Energy Design Compliance and supporting documentation. ----------------------------------------------------
❑ 7. Statement of Intent for Non -Heated and A/C Buildings. ---------------------------------------------------------
❑ 8. Hazardous Material Form. ------------------------------------------- -----------------------------------------------
❑9. Manufactured Home data and installation instructions including Tie Down Specifications -------------------
0 10. Fees of $-------------------------------------------------------------------------------------
❑ 11. Impact fees as shown on the attached schedule.-------
1112.
------
❑12. California Department of Forestry plan approval/fees.
❑ 13. Flood elevation certificate. ----------------------------------------------------------------------------------------
❑ 14. Sanitation and plot plan approval Health Department. -------------------------------------------
❑ 15. City of Chico plumbing permit. -----------------------------------------------------------------------------------
❑ 16. Plot plan and business license approval from the City of Biggs. ----------------------------------------------
❑ 17. Planning approval for (A) Use: (B) Parking: --------------------------
❑ 18. Contact Land Development about ❑ Improvements, ❑ Drainage, ❑ Legal Parcel. -----------------------
❑ J. . Encroachment Permit for dri ewa constcuc ion a o al prior to occupancy) - --------
_ � Y1( PP P P Y)�---------------- -- -
20. Pre -inspection for Ca le C. (f i c / (,d I r inquired. Request to Building Inspector on (Date)
❑21. Contractor's license information. (Number, Name Style, Classification). ---------------------- =-------------
❑22. Workers' Compensation carrier and policy number. ------------------------------------------------------------
023. Owner -Builder Verification (Given to owner ❑, Mailed to owner ❑). =-------------------------------------
024. Letter of signature authorization. -------------------------- =-----------------------------------------------------
❑25. Recorded copy of Agricultural Acknowledgment Statement. --------------------------------------------------
026. Letter of intent on building use. -----------------------------------------------------------------------------------
❑27. Manufactured Home utility clearance. ---------------------------------------------------------------------------
❑28. Existing violations and/or expired permits. ----------------------------------------------------------------------
❑29. 0433 A, ❑Grant Deed, ❑ M.H. Title, ❑ Check to H.C.D $---------------
--------------
030.
❑30. Other: -------
When you issue the permit, process as follows ❑ Mail to owner, Ymail to contractor.
lWelephone and hold for pickup at ff'ice. De er with inspector.
APP lican Date:
Copy of Haz-Mat form sent ❑ Health Department, ❑ Fire Department, ❑ Air o 1 ion D : By:
Copy of plans sent ❑ Health Department, ❑ Fire Department, ❑ Other: ate: By:
1. Index permit application for the above items numbered:
❑ Plan Check List
2. Additional items required:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by
Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by
Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by
Date:
Contractor, designer, owner, was advised of the above required data by ❑ phone, ❑ mail, ❑ Building Division counter, by
Date:
Plans reviewed by: Date: Plans approved by: Date:
Sets of plans on hold in ❑ Plan Cabinet, ❑ A.P. folder. Note transfer by: Date: _
Yellow Copy - Department of Development Services, Building Division