Loading...
HomeMy WebLinkAbout030-211-02230-211-22 11 Delany 958 Qt St., Oroville Permit 7 5413,-79P,E (util . ,N4) ELEC. GAS�— SUPPORT STM'URE Ria COMPACTION TEST REQ. 0-21 - Contr: SF& - MH Ser, ® oW �e ,Permit 33- 79MHI 1 %' 30-211-22 (replace gas piping/SF) s 30-211-22 Contr : Watson Ele S,C� Permit#1998-87E(ele ser ch/SF) �- f 1 t� f 30-211-22 11 Delany 958 Qt St., Oroville Permit 7 5413,-79P,E (util . ,N4) ELEC. GAS�— SUPPORT STM'URE Ria COMPACTION TEST REQ. 0-21 - Contr: SF& - MH Ser, ® oW �e ,Permit 33- 79MHI 1 %' 30-211-22 (replace gas piping/SF) s 30-211-22 Contr : Watson Ele S,C� Permit#1998-87E(ele ser ch/SF) �- f 1 J COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. /9�, �= �7 ASSESSOR PARCEL NUMBER ZONING BUILDING PERMIT OWNER I , f Cr r"i lJ TELEPHONE 5.3-3 &Q, FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS j CONTRACTOR'S NAME TS 6C I 4 TELEPHONE CONTRACTOR'S MAILING ADDRESS zO 0 f0 l ett> or Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENLE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fel $ PLUMBING PERMIT Filing Fee 10.00 95 �. /, ,VL -� Each Trap 2.00 Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00' Each qas water heater or vent 5.00 USE OF STRUCTURE 1 SFt4 Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home Is 10.00 ea TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other Describe work: Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 8001 OR LESS 100 AMP OR LESS 1000 . r Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE_ LAW Itdeclare under penalty of perjury (check one): I y� I am licensed under provisions of Chapt. 9, Div. 3 of the Business 1— and Professions Code and my license is in full force and effect. License No. ���� Classification e- 1O ❑• I, as the owner, for my employees with wage`s�s their sole compen- sation,lwill`do the work,and the structure'is not intended or offered for sale. (Sec. 70 p) & ❑ I, as the owner, am exclusively contracting with licensed contract- ors.(Sec. 7044) ❑ .I)am exempt under Sec. %, ,.Business and Professions Code c_ for this reason e NEW CONST. / DWELL-ING occuP.�� yz¢sgft OR ADDNS. \ ACC. BLDGS. NEW CONSTR. ULTI.OUTLET 2,50 ea NON.RESID BRANCH CIRC ITS POWER APPARATUS eI SINGLE OUTLET CIR, EX. Occup( OR FIXTURES ALO 30 .220@030 Ex' Occup. our OUTLETS P(RESID )SEA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ s Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. NotAA to Applicant: If after making this statement, should you become subject to t e W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said County in consequence of the granting of this permit. �,/�/�n (y'� X Date h Signature of Applicant - Owner ❑ Contractorx Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ occuP. CONST.T7 I JFLOOOJPARCFLJ PD ND ssuE This permit is hereby issued under the applicable provi- sions of the Butte County. Code and/or resolutions to do work indicated above for which fees have been paid. JREC OR OFIPUBLIC WORKS By. ' /' Date PERMIT EXPIRES Date {-. ZL -inkheight. Receipt No.�� / WNIT!-D.P.W.. YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541 APPLICATION AND PERMIT PERMIT NO. y�- ASSESSOR PARCEL NUMBER D -Z Zv ZONING BUILDING PERMIT OWNERTELEPHONE If i s33 Z SO. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS CONTRACTOR'S NAME EG TELEPHONE CONTRACTOR'S MAILING ADDRE S 00 ot-flo Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS Permit fee $ PLUMBING PERMIT Filing Fee 10.00 s / Each Trap 2.00 �N ll Solar or heat pump water heater 20.00 LOT NO. SUBDIVISION NAME PARCEL MAP Water piping 5.00 Each qas water heater or vent 5.00 USE OF STRUCTURE SFV Duplex❑ Mobilehome❑ Other SPECIFY Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 Mobile Home S G W 110.0026 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Describe work: g,d, 4gnut, c. �_ Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 6001 OR LESS 100 AMP OR LESS 00 10.00 1 Main service EA. ADD'L 100 AMP 2.50 CONTRACTORS LICENSE LAW I declare under penalty of perjury (Check.one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professio s Code and my license is in full force and effect. License No. Classification G+�O ❑ I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONST. / DWELLING OCCUPM yzQsgft OR ADDNS. 1 ACC. BLDGS. NEW CONSTR. MULTI -OUTLET NO N.R ESI BRANCH CIRC ITS 2.50 ea /POWER APPARATUS tri (SINGLE OUTLET CIS. / / EX. OCCUp\OUTLETS OR FIXTURES 5AL030 200030 EX. OCCUp. OUTLETS (RESID.)FIXED APPLNS REA.) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 o Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ❑ I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Not to Applicant: If after making this statement, should you become subject to t e W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue againat said Qounty i consequence of the granting of this permit. (/ X Date % b ^� Si na re of Applicant — Owner g pp ❑ Contractor Agent ❑ An OSHA permit is required for excavations over 5 deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PERMIT FEE $ OCCUP. CONST.TYPC I F1O..J PARCEL PD No ISSUE This permit is hereby issued under sions of the Butte County. Code and/or work indicated above for which REC R PUBLIC By PERMIT EX ARES Date the applicable provi- resolutions to do fees have been aid. p WORKS Date Receipt No. WHITE-O.P.W., YELLOW-AS2L350R. PINK -INSPECTOR, GOLDENROD -APPLICANT zy� s s�-in 7--T- w� r .rla T 77 i vEn IAI. G C / "2- ,f1.47p SL�7LE iQ ,-% E6FEq' I j/ ) 4A -JP' File No. I BUTTE COUNTY (For Action 1, 2, 31, 1 I Public Works Dept. (For Information ✓ Director Dep. Dir. Sec. Rd. & Br. Mtce: Shop & Yards Bldg. Insp. Admin. 1 Design Engr. Bridge Engr. Constr. Engr. Surveys Mapping er_ T ran sp. i FLond Dev. g. /S.I.b. & Pcl. Mapsrmits dr. eve I q4jklf #0L Bill Delany 7749 Occidenal Palermo, 'CA ., 95968. Dear Mr.,Delany:. 538-7541 January 26, 1987 ,RE: Building Permit A.P. #30-211-22 With reference to the above subject, we have been advised by one of our building inspectors that you have not obtained the required permits and inspections from this office for the work you are doing as follows: A travel trailer is being occupied in the right-of-way in front of your property at 958 18th -Street, Oroville Since this is not a permitted use in public right-of-way, please have the travel trailer removed within ten days of the date of this letter. If relocated on pr&vete property and used for living, permits are required from this office and the Health Department. Your cooperation in resolving this matter would certainly be appreciated. Should you have any questions concerning this matter, please contact this office. Yours very truly, Will*= Cheff Director of Public Works Or'ginrrai //signer E ¢ Y y J. - r-1^nAai J.F. Glander JFG:aam Chief Building Inspector cc: Building Inspector - Oroville 0 Complaint -Daae /-2' a ' ��= S^ 3 �� - S- 3 3 C ❑ Oct;sr-Date BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS SPECIAL INSPECTION REPORT ZONING Owner: /IDil A.P. # Address ! % �/ �G'�� .� Date of Inspection Tenant: Inspector Building Location I - Type of Inspection requested: Housing / / 2. Financing / / 3. Change of Occupancy to (�[ 4. Work W/O Permit / / 5. Other (specify) Present use of building:.� A. Sanitation (Housing) (/ 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities: 7. Natural light and ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: 12. Connection to water supply: 13. Rubbish and garbage facilities: 14. Stairs:(Rise, Run, Headroom, 1HR, Tolerances,Handrails) 15. Couimcnts : B. Structural 1. Piers and footings: 2. Floor construction: 3. Wall construction: _ 4. Ceiling and roof construction: 5. Fireplaces: 6. Comments: C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments: v PT -Complaint -Date 0 Qt4er-Date Owner: Address J 47-t= Tenant: �GY 5 3 3. -s -33C BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS SPECIAL INSPECTION REPORT ZONING A.P. # 30- ail- 9, Date of Inspection Inspector Building Location: Type of Inspection requested: 1. Housing / / 2.' Financing / / 3. Change of Occupancy to 4. Work W/0 Permit / / 5. Other (specify) Present use of building: A. Sanitation (Housing) 1. Water closet: 2. Lavatory: 3. Bathtub or shower: 4. Kitchen sink: 5. Hot and cold water to fixtures: 6. Heating facilities: 7. Natural light and ventilation: 8. Room and space requirements: 9. Bedroom window or door for second exit: 10. Infestation of insects, vermin, or rodents: 11. Connection to sewage disposal: 12. Connection to water supply: 13. Rubbish and garbage facilities: 14. Stairs:(Rise, Run, Headroom, 1HR, Tolerance$,Handrails) 15. Comments: B. Structural 1. Piers and footings: 2. Floor construction: 3. Wall construction: 4. Ceiling and roof construction: 5. Fireplaces: 6. Comments: C. Electrical 1. Service and ground: 2. Receptacles: 3. Fusing: 4. Comments: 0 E. F. a xr � Plumbing 1. Fixtures connected and vented: 2. Gas water heater: 3. Gas heating vents: 4. Comments: Other 1. Maintenance and repair: 2. Fire hazards: 3. Safety hazards: 4. Weather.protection: 5. Underfloor and attic ventilation: 6. Energy:. 7. Comments: Commercial Buildings 1. Roof covering: 2. Distance to property lines: 3. Physically handicapped: _ 4. Restroom floors and walls: 5. Exits: 6. Improvements: 7. Zoning: 8. Comments: G. Field Problems or Violations 1. Proem or violation give complete description): j % �� p G(/ 2. What action t ken (give complete description): � ✓VikI Yr -A i I e r' 3. What action recommended: A. Information only - file. B Hold for ten days, then write letter. %% C. Write letter. / / D. Other: PERMIT NO. PERMIT EXPIRES OWNER CONTR.. ASSESSOR PARCEL LOCATION J t OFFICE COPY f` Address GAS %" Date�� lO aK l MeteV,y ELEC a et F • r Temp. Power Pole_ Called PG&E _ Temp. Elec. Service Called PG&E Temp. Gas Sei Called PC JOB FINALE[ Signature J = OK O = Not OK - = Not Applicable MOBILEHOMES MISCELLANEOUS * = Not Ready Date MOBILEHOME UTILITIES (Plans) OK except N's Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except H's 1. Zoning Requirements -Setbacks -Easements 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/0 -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts- Beams- Rftrs.-Connec.-Shthg.-Rig.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat.or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date MOBILEHOME INSTALLATION (Plans) OK except q's 1. Zoning Requirements -Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 3. Gas; MH Test -Demand -Valve -Connector 4. Electricitv: MH Test -Crossovers -Breakers -Clearances Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date POOLS (Plans) OK except q's 1. Setbacks -Easements 2. Soils; Compaction -Structure Stability 3. Pool Structure; Steel -Connections -Thickness -Dead Men-Lini 4. Elec.; Receptacles and Liqhtinq; Distances-GFI 5. Drain; MH Test -Fall -Flex Connector 6. Water; MH Test -Regulator -Connector 7. Water and Sewer Connected -C/O to Grade -HD Approval 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes- Enc losures- Pane lboards- Ins. to Main in Conduit 9. Exits; Insp.-Sketch 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card -BI Date Card -BI Date Card B-1 Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date I 0 = OK = Not OK • = Not Applicable = Not Ready RESIDENTIAL (Single and Duplex) Date UNDERFLOOR Plans OK except #'s Date FRAMING Continued 1. Zoning requirements -Setbacks -Easements 48. Property Line Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel -Blackouts -Wrapped -Slab 52. Siding -Nailing -Veneer 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 7. Piers -Fireplace Ftg.-Steel 53. 54. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access Glazing Area -Glass Protection -Skylights -Plastic 8. U.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; Underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date FINAL (Plans) OK except k's 56. Ext. Steps -Door & Sidelight Protection -Landings Card -BI Date Date Card -BI Date PLUMBING (Permit) OK except q's A If 57. Smoke Detector 14. Water Ht.; Vent- Access-QQnbustn Yi4 ( Z 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor-Ducts-Mech. Protection 15. Water Pipe; Test & Ancho s Nail r 16. D.W.V.; Test-Fttngs & A ors- ai Pr t ti 59. Bedroom Exiting 17. Shower %n; Test, j_ir t oor- ub Acce 60. G.F.I. & Bath Fixtures & Tub Access 18. Test Xq& Shower, oor- u Acc s 61. Elec. Trim & Subpanel; Breaker Sizes -Labels Card -BI 19. Ga ip ; Siz@ Whors ,411 Date Z ar - 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. 65. Elec. Outlets at Wood Panel; Int. & Ext. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance Card -BI Daterd- I Date 66. Elec. Outlets & Receptacles at Kit. Counter Date ELECTRICAL Permit. 0 e pq 67. Garage Fire Door; Swing -Landing -Closer 68. 69. A.C. Duct in Garage -Damper Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor-Mech. Protection 20. Fixture & Transforme learance-Ins. Protection 21. Elec. Receptacles Spacing -Lights &Switches at Doors 70. Plb., Elec. & Mech. Equip. Listed for Location 22. Size Boxes & No. of Conductors -Stapled 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 23. Ramex Installed Close to Edge of Studs & C.J. 24. 25. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 2 Appliance Circuits in Kitchen &Conductor Size 72, Insulation -Foam -Looked in Attic ❑Yes73. Guard Rails & Deck Construction -Post Caps 26. 27. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al, Insulated Neutral ❑Yes 0 N 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑Yes ❑No 28. Service -Riser Conductors & Ground -Main Disconnect 76. Stucco; Brown -Finish 29. Equip. Clearances; Panels-Motors-Mech. Equip. 77, A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 30. Clothes Closet Light -Shower Light 78. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs. 79. Water Well; Disconnect, Electrical, Plumbing 80. Exterior Elec. Trim; G.F.I. Receptacle -Underground Card B-1 Date Card -BI Date 81. 82. Ventilation throughout House _ Glass Protection Card B-1 Date Card -BI Date Date MECHANICAL (Permit) OK except q's 31. A.C. Ducts; Insulation & Support 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 85. Water & Sewer Connected -C/O to Grade -HD Approval 32. Vent Fan; Exhaust above Insulation 86. Energy Compliance Certificate -Other Certificates 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Comments at Final: Date FRAMING Plans OK except q's 36. Sills; Proper Material & Anchors 37. Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound 38. Bearing Walls over Girders & Floor Nailing 39. Draft Stop in Walls (rat proof) 40. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. Header & Beam -Size & Bearing 42. Hangers -Post Caps -Anchors -Connectors 43. 44. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shth_ng.-Rfn_g_.__ Fireplace Ties or Type A Flue -Fireplace Throat 45. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles 46. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 47. Garage Fire Protection Framing (NOTE: An entry must be made each time youvisit jobsite) COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, CaliforrRa 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT PERMIT NO. 0 1/1 ASSESSOR PARCEL NUMBER0,ZONING BUILDING PERMIT O WN TELEPHONE �2 SO. FT. OCC.1 BUILDING VALUATION OWNER'S MAILING ADDRESS 717 L!, 9 DC C 94A—a) Am 9 or I'm CONTRACTOR'S N METELEPHON r CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 10,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEERLICENSE No. Plan Checking Fee $ Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ BUILDING ADDRESS PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 © -o Water piping 5.00 LOT NO. SUBDIVISION NAMEPARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 / USE OF STRUCTURE SF L�' Duplex ❑ Mobi lehome ❑ Other SPECIFY Building sewer 5.00 Mobile Home JSJGJWJ __10.00e TYPE OF WORK New ❑ Additi ❑ Remodel ❑ U 'lities ❑ Instal lation❑ Other Describe work: n — O S1 Permit Fee $ S �� Contractor ELECTRICAL PERMIT Filing Fee 10.00 OR LE Main service 1000 AMP ORSLESS 10.00 Main service EA. ADD'L too AMP 2.50 NEW CONST.// DWELLING OCCUP.& OR ADDNS. l ACC. BLDGS. 2/20sgft CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification RI I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ElI, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CONSTR ULTI.OUT,LET 2,50 ea NEW.CON o R. (POWER &) NON.RESID. \SINGLE OUTLET CIR. . Occu zo@soe ExOccup( p\OUTLETS OR FIXTURES 5AL@30 FIXED APPLNS. OR EX. OCCUp. OUTLETS (RESID.) EA.) 1 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 15.00 Permit Fee $ Contractor WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. ® I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. MECHANICAL PERMIT FiIingFee 10.00 Heating Cooling Hood 3.00 Ventilation permit Fee $ Contractor I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the Countyot Butte to enter uponthe above-mentioned property for inspection purposes. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against said Count in consequence of the granting of this permit. X �/ Signature of Applicant — 67w4ner Er Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Mobile Home Installation Fee $ TOTAL PERMIT FEE OCCUP. GROUP I TYPE of CONST. PARCEL PD HD SSUE This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. IR T OF PUBLIC WORKS BY s�9'(% Da� �—© ' V 7 PERMIT EXPIRES ate Receipt No. 3 /-3S WHITE-D.P.W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT Temp: Power Pole Called PG&E Temp. Elec. Serv. A 1 ' Called PG&E/—/ I Temp. Gas Se Alp Called PG&E 3 JOB T7(DaT7ED te) (Signatu r t O k `f I }PERMIT NO. S r PERMIT EXPIRES - a OWNER Bill DeLany i CONTR. owner 30-211-22. ` .LOCATION (A.P) 958 18th St., Oroville d1 y' f �A ft •r t . { •1 Temp: Power Pole Called PG&E Temp. Elec. Serv. A 1 ' Called PG&E/—/ I Temp. Gas Se Alp Called PG&E 3 JOB T7(DaT7ED te) (Signatu r t `f I S r . - a Temp: Power Pole Called PG&E Temp. Elec. Serv. A 1 ' Called PG&E/—/ I Temp. Gas Se Alp Called PG&E 3 JOB T7(DaT7ED te) (Signatu BI Ste wall Slab Piers Garage Footings Stemwal I Slab Carport Footings Slab Patio Footings Masonry Walls Reinf. Steel Bond Bea Framing Stucco COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD BUILDING BUILDING (Cont'd) A PLUMBING a Finish Siding Roof She hint Roofing Fdn. Vents Garage Vents Insulation Prov. for ph sica handicaooed 11 Conformance of ex. Throi Final IRE SPRINK CE auy raping 1 Floor 2ndNf loor 3rd Nor To out Water PI I Sewer Fixtures Water Htr. Heaters Appliances Gas Piping & Test TemD. Gas Final Fix Mesh MECHANICAL X Grd. FaiAt Prot. Scratih HeatIA Servi EIrqAn Cooing TAP. Pole F Ish D is ' nder round In rior Lath entilation Permanent Ifoor Closer Final ; Inal MOBILEHOME UTILITIES - - - - - - - - - - - - - - - - - - Elec. Service! _ d _ Elec. Pedestal Water Piping /0—J2 --7Z C49 Sewer D Gas Piping BI EH ME IN TALLATION - - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS- - Y1h JIA�� i c o. - j, i (NOTE: An entry must be made on.this form each time you visit the job site.) i COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 7 COUNTY CENTER DRIVE OROVILLE, CALIF. - 534-4541 CERTIFICATE OF OCCUPANCY This mobilehome has been installed in accordance with the requirements of the California Administrative Code, Title 25, Chapter 5, under permit number for the following location: j r Owner✓�/'s/ �% / /,.�.t�• .a.! s Owner's Address "— el Mobilehome Mfg. ,1414�zlll, -% Model Year L -4F Insignia No. •? U 7 Serial No. It is hereby certified for occupancy at the above described location and may be occupied. Director of.Public Works Date /A � / ,e�J By THIS CERTIFICATE IS VOID WHEN MOBILEHOME IS RELOCATED White - Owner, Yellow - Installer, Pink - D.P.W. COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-4541 Skyway and Elliott Road, Paradise— Phone: 872-2961, Ext. 57 CORRECTION NOTICE BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this matter, or need additional explanation, please contact this office immediately. Inspector /rt --�-�� Date 1 MOBILEHOME ,,INSTALLATION INSPECTION CHECK LIST 1. Is the mobilehome located with � quired separation from lot lines and buildings and generally conform to plot plan? Yes &No` 2. Does the mobilehome have required clearances above ground? (Sec.5085)' YesNo 3. Are footings and supports properly sized, spaced, and braced as r approved plans? (Note possible variation at spring shackles.) (Sec. 5082 & 5083) YesNo 4. Is the mobilehome level? (Sec. 5088) Yes No 5. If more than a single unit, are crossover connections properly installed? (Sec. 5088) YesL-1--1No .6. Water A. Is flee'ble connector of adequate size and properly installed (1/2" ID min.)? (Sec. 5566) Yes Y No B. Test - Does water piping withstand working pressure or 50 lbs, air test? Yes.,-9-�No C. Backflow - If coach is not StMe California approved, does station have backflow davits and pressure -relief valve? Ye 7. Wastes and Drains A. Is connection made with Schedule 40 DWV and have flex connectors at each end? Yes`/No B. Does it have minimum" per foot slope and is it properly supported? Yes— No C. Are any leaks detected in drainage system after running 3 -gallons of water through each fixture including washing machine standpipe? Yes Nol�- D. If coac� State of California approved, does station have required trap and vent? Yes , 8. Gas Piping and Gas Vents A. Connector - Is mobilehome connected to the gas supply with an approved 3/4" minffts mobilehome connector not more than 6 ft. long? Note: All piping is to.bi at lest as: large as the mobilehe gas line irilet without reductions other then the to tlsbAia* connector. Yes ✓No B. Test OK as per following procedure? Yes_ No 1. Open all appliance connector valves. 2. Shut off appliance burner and pilot valves. 3. Air test with manometer to 10"-14" water column, or test with slope gauge (minimum 6oz.-maximum 8 oz.) calibrated in tenth pound increments. Test for 10 min. without drop. 4. Connect gas meter to mob.ilehome with connector, turn on gas, test connections with soapy water. C. Are all appliance vents properly installed? Yes!' No_ i - _--- fib✓ ��/ 3'i_ '7£/33 �9 t 9. Electrical- A. Is service large enough to provide adequate amperage -to mobilehome (must equal rating of mobilehome with a minimum of 1000amp) and other. facilities on lot, i.e., water pumps, garage, cabana, etc.? Yes t;1 B. Is there proper clearances around panels? Yesy No C. Is power supply cord or feeder assembly properly fused? Yes �o D. Is continuity test satisfactory as per the following procedure? Yes No 1. De -energize electrical wiring system of the mobilehome at the pedestal. 2. Make sure that the power supply cord*or feeder assembly conductors, including neutral conductor, have been disconnected. 3. Switch all breakers and switches in the mobilehome to the "on" position. 4. Connect one lead of a test instrument to the mobilehome grounding conductor and apply the other lead to each mobilehome supply conductor, including neutral. 5. All non-current, carrying metal parts of the mobilehome (aluminum siding, gas line, water line), including fixtures and appliances, shall be tested for continuity from such equipment and the grounding conductor. 6. Upon completion of the above procedure, the power supply cord or feeder assembly conductors shall be connected to the site service -equipment. A further continuity test shall then be made between the grounding electrode and the chassis of the mobilehome. Upon satisfactory completion of the electrical tests, the lot or site service equipment may be approved for energizing. 10. Is job card signed by Health Department for water and sanitation? 11. If everything okay, sign off card and tag services. t MOBILEHOME DATA j Manufacturer and/or Namestyle W S Length_ Width (7-X !O i�� V—m% A) Vehicle Serial No. i State Identification No. 9 Q-:�_ O 7 Additional Information or Comments: a COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive OroviIle, California 95965 Telephone: 534-4541 APPLICATION ANI]ITERMIT authorize representatives of the county OT ttutte to enter upon the above-mentioned property for inspection purposes. ry X Date Signature of Permitee 4A,gent C Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above,W, which fees have been paid. _-DI-REG404 OF PUBLIC WORKS Building permit expires Date �� BUILDING Owner ?nu, Dc LAn1Y SQ. FT. OCC. BUILDING VALUATION Mailing Address q,50-;, 1 S4,1 (. QS ,/bS li/ lephon T �J r Contractor 0 U-) M C V_ Mailing Address Fireplace ' Total Valuation Telephone No. Permit Fee Building Address q 12> I g44^ S-� Plan Checking Fee&/or Penalty Permit Fee PLUMBING No. @ FEE PERMIT FILING FEE $3.00 3joe, Each TraD 1.50 U000lLL6 Repair drainage or vent piping 1.50 A. P No. 8o- V - 22 ?1 Zoning 8 Planning Water piping /(�•tl(� Each gas water heater or vent 1.50 es I V/C. f Fb7KtonJFire Dept. I Fire Zone Use Permit Gas piping system 1 - 5 outlets -4-64 /0800 EQA Parking pans Parcel Declaration Parcel Ma 60' R/W Improveme Each additional outlet .30 Building sewer !(7'OL Bldg. Zn. Recd Parcel A royal Pons Approval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES OTHER ❑ permit Fee $ 33,00 $ 3�e70 ELECTRICAL No. @NFEEPERMIT FILING FEE $3.00Main service 100 AMP ORV OR SLESS5.00Single Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADD'L 100 AMP 2:50 Main service OVER 25.00 100 AMPP OR LESS O Main service EA. ADD'L 100 AMP 1.00 NEW CONST DWELIN. OR ADDNS. ( ACCLBLDGS.CCUP. k� 22sgft CONTRACTORS LICENSE LAW 1 am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name style of: NEW CONSTR. MULTI.OUTL T 1 NON.RESID BRANCH CIRCUITS/ 2.50ea NEW CONSTR. (POWER APPARATUS e NON.RESID. SINGLE OUTLET CIR. Ex. OCCUD(OUTLETS OR FIXTIIRES B L@; FIXED ALNS Ex. Occup.(OUTLETSP(RESID)REA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 /57,00 License No. Classification Misc. Wiring 6.25 ® I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ z S SC MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ❑I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. ❑I 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 the Workmen's Compensation Laws of California. PERMIT FILING FEE $3.00 Heating Cooling Ventilation L2.00 Hood Permit Fee $ $ 1 certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances- and State Laws relating to building construction, and hereby ' Land Development Fee $ 25 !)O ( authorize representatives of the county OT ttutte to enter upon the above-mentioned property for inspection purposes. ry X Date Signature of Permitee 4A,gent C Receipt No. White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above,W, which fees have been paid. _-DI-REG404 OF PUBLIC WORKS Building permit expires Date �� COUNTY -OF BJTTE — DEPARTMENT OF PUBLIC WORKS 7 County Center Drive — 5 le, California 95965 OF -7 Telephone: 534-434-4541 APPLICATION AND PERMIT authorize representatives of the County of Butte to enter upon the above>fnentioned property for inspection purposes. X . �y�s Date)"- A ,4k, Signature of Permitee or Agent Receipt No. _531t I I White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above which fees have been paid. D., A+Dat WORKS B Date Building perexpires �-!� - �0 BUILDING Owner �[—;LAll% SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor �' lu Mir3iLL. /-Ones S �W 15 Mailing Address 5srx) C)L,( va 1,4wy 9 :33 Fireplace Total Valuation ele hone No. ��j.•'�Q10 Permit Fee Building Address qgO 1 S% Plan Checking Fee&/or Penalty Permit Fee PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 Each Trap 1.50 Repair drainage or vent piping 1.50 A. P. o.�0 "gy�pp 41 --�Z, Z Zoning & Planning Water piping 1.50 Each gas water heater or vent 1.50 F s C. uon Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets 1.50 EQA Parking Plans ParcelEach Declaration I Parcel Map 60' R/W I Improvements additional outlet .30 Building sewer 5.00 Bldg. Plans Recd Parce proval P pproval Lawn sprinkler system 2.00 NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER Permit Fee $ $ {-{ Q 1.7P y/3 -7 ELECTRICAL No.1 @ FEE PERMIT FILING FEE $3.00 Main service 600V OR LESS 100 AMP OR LESS 5.00 Single. Family ❑ Duplex ❑ Mobil Home Others ❑ Main service EA. ADO'L 100 AMP 2.50 Main service OVER 600V 25.00 100 AMP OR LESS Main service "EA. ADD'L 100 AMP 1.00 NEW OR ADDNST % ACC`BLDGSLING CCUP. Y\ 20Sgft I CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professio s Code under the name style of— 1 . NEW CONSTR BRANCHCIR-OUTLET NON-RESID (MULTI BRANCH CIRCUITS)'2.50ea NEW CONSTR. /POWER APPARATUS e NON-RESID. SINGLE OUTLET CIR. Ex. OccuD{OUTLETS OR FIXTURES) 5 L � FIXED APPLNS. OR EX. Occup. OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 / License NA %:59—t4 8 Classification C 6 Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ WORKMEN'S COMPENSATION INSURANCE 1 am aware of the provisions of Section3700 of the California Labor Code which requires every employer to be insured against liability for Workmen's Compensation. ced on file with the County of Butte a certificate of Workmen's Compensation Insurance. ❑I 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 the Workmen's Compensation Laws of California. MECHANICAL No. @ FEE PERMIT FILING FEE $3.00 Heating Cooling Ventilation Hood 2.00 Permit Fee $ $ I certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby Laiid Bevelawment Fee, -Pr AT $ (_10 ©L TOTAL PERMIT FEE $ pt authorize representatives of the County of Butte to enter upon the above>fnentioned property for inspection purposes. X . �y�s Date)"- A ,4k, Signature of Permitee or Agent Receipt No. _531t I I White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant This permit is hereby issued under the applicable provisions of the Butte County Code and/or resolutions to do work indicated above which fees have been paid. D., A+Dat WORKS B Date Building perexpires �-!� - �0 1 ` MOBILEHOME SUPPORT DATA l7� o I d r� '4)aS I If other than single wide, Mobilehome Mfr. I uQ,Sfia. furnish' Setur Model -Vo. Year ,,,Width _(ft.) Box Lengt(ft) Tagalong -or Expando Sizeft. x t t ft. (SHOW SUPPORT DETAILS BELOW) On all mobilehomes manufactured after. October 7-;:,1973,. futpish manufacturer's installation manual and structural setup sheets (if not'on'fi.le' with the County of Butte). All center supports measured from front of mobilehome unless otherwise specified.'" Footings.(check one) Single fl /ci 1. Wood either k b pressure treated or 1 foundation grade. x - _ IJLLV (ft )(in:) (in.) (in.)` 2. Other (spec-ify) MI Center su port Center su ort location * footing s zes Supports (check one) (in.) 1: Concrete block; 2: Other (specify) (ft.)(in.) (in.) (in.) 4 --Tagalong or Expando,' show support details. 77771 (ft.)(in.) in. in. x -- Typical Support (in.) (in.) Footing Size (ft.) (in.) (Lin .) (in.) 5' 6`!•' -- Max. Pier Spacing x �� C)ti -- Max. Overhang (ft.) in.) (in.) (ft.)( in.) BUTTE COUNTY 9UILDING DEPARTMENT APPROVED* *If center piers are other than drawn above, _%� A 4n,.l nt-nf inn-- --Tlnrina .-.nnA A4moncinna 'moi 1. Owner's name: 2. Installer's na BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS . 7 County Center Drive, Oroville, CA. PHONE: 534-4541 ` MOBILEHOME INSTALLATION SHEET 3. Is the site currently under permit? Yes 777 No ( If yes, furnish permit number 7 ) OR t Is the site an existing site? Yes / / No / T (If yes, furnish two (2) plot plans.) 4. Will the mobilehome be located at least 5 ft. away from septic tank and leach fields and clear of all setbacks and easements? Yes No (If no, clarify ) • 5. What is the mobilehome electrical rating? ----------------------- 00 Amps 6.. What is the mobilehome,site service rating? ---------------------C9 Amps 7.. What is'the mobilehome site circuit breaker rating? ------------- Amps 8. Is there any other electric load to be served by the mobilehome (This information not require if pia length less than 6 ft. on natural gas or less than 50 ft. on LPG.) r� � a Qom_ siteservice? --------------------------------------------------- Yes No / / (If yes, identify the load and size: (Load) (Amps) 3/��r (in•) 9. What is ,the mobilehome site gas pipe size? ----------- --------- 10. What is the type of gas service?, ------------- -------------- Natural =77 LPG 11. What is the gas pipe length from meter o tank to the mobilehome? (ft.) 12. What is the mobilehome gas demand? ----------------------------- (BTU (This information not require if pia length less than 6 ft. on natural gas or less than 50 ft. on LPG.) r� � a Qom_ I i ' f f This set of plans and sp .ificatiiavts Mit kept on the job at all t+mes and its is unlaYvful make any changes or alterc+t ons on Sarn6 veldt written permission from the epdr jment of Pul Works, County of Butte. I I All utility connections s Iccated within 4 ft. outside gird ser ,tio_ �j of tl~e rrab S on the le£: �:c -= side Qr tr home. and loc, inch d Butte Lo,,tt r> CG -r i as - 11 A E .� be reui or }he • , home - 01 the m WOT�--Afl Materials Work ansngp with Re�9ni�ed and Practices and A 'bed. for the pecitied use in the ®f a iy Plumbing & M Mani;al Codes and WgvrM But1d";ng, i4te, Kationat E1ecf.r cC& Code. ` shall be ft. Vine and 5 ft. fr a rte* r ittin� side PTO road, Pe b WOW �n{erhne o{ tine oVerli n9 eave MUM of a Ze sements. I outof.CA -- lie r _<_I_-#3 BUTTE COUNTY BUILDING DEPARTMW APPROVED �, AL THERMALITO IRRIGATION DISTRICT 410 GRAND AVE#N•UE OROVILLE, CALIFORNIA 95965 TELEPHONE 533-0740 CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT Service Address: Owner's Name: ti Date: Address: - Acct. No: A. P. No.: Phone: - �'r"' No. Units: Applicant/Agent: Agents Proof: i Address: Fees: Phone: Application $ Arrearage Preliminary Review By- Date: CSA 26 Remarks: i, t��z lc .�� ��y t3c/J �a1�'� SC -OR 1st mo. S.C. Other Total Fees Collected By: Date: Field Review By: Date: Remarks: _ I MONTHLY SERVICE CHARGES WILL COMMENCE AUTOMATICALLY UPON: ❑ Date of TID approval of completed building sewer (early connection). ❑ 30 days after date above, or on date of D.P.W. approval of completed building sewer, which ever comes first ("existing construction", prior to Mar. 5, 1974). '0 180 days after date above, or on date of D.P.W. approval of completed building sewer, which ever comes first ("new construction", after Mar. 5, 1974). DISTRIBUTION: WHITE - TID, YELLOW - APPLICANT, PINK • DPW, GOLDENROD - DPW to TID