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HomeMy WebLinkAbout030-461-031hPERMIT NO.-79t,P,E,M PERMIT EXPIRES OWNER Bill Pearsall • �, CONTR. owner 30-036-26 port. LOCATION (A.P. ) 20th St., Oroville i,. a: f y ij t t 1 P i }f Temp. Power Pole L �U .; Called PG&E _ Temp. Elec. Serv. t Called PG&E Temp. Gas Serv.`f Called PG&E • � OB FINALED Z (Date) 1 (Signature e ' 1. 1 A lkES11)LiNTIA1, F:NF:RC;Y Cc)N`-,hltvnTTord sTANDnRDS CONSTRUCTION COMPLIANCE Cf-AUTFICATE THIS IS TO CERTIFY THAT I.NERGY CONSERVATION REQUIRF..1IF.N'1S ILaVE BEEN 1.;JS'1':11,I.IJ) JN CONFOIu`L:UICF, W iTil- CURRL?NT ENERGY CONSERVA'T 1014 REGUL AT -CONS BJILDIM; L'I(I;ItI:'C NO. 0-7� A.P. NO. THE FOLLOWTNG HAVE BEEN INSTALLED AS PER APPROVED PLANS: (Chuck each item or write N/A if not applicable) INSUL.AT ION : S I.11) E k I J." C._ F(.In. Walls� Floors /J/A Ch�� t:: — Circulating Pipes GLAZING: Single Clazed AIA Special (Insulated) CERT. h 1.ABF:L:L•'D WDS. h SLIDING DRS, Ad WEn'T1u:Jsrr,T.PhF:1) DRS._ BACK DAMt)l-:I;I:D FANS illrcRI;lil,i."I'I-:i•i'1.' I:CNI11'I0N DISV I.CES CFR'. AI'I'I',IANCFS AW— I DF.Cl.,ARF THAT ALL REQUIRED ITEMS_ AS NOTED ABOVE HAVE BEEN L" MLI.ED IN ACCOIJ)ANCE WITH THE ENERGY CONSL'RVA'.I'TON RI?QUIRI:a°CI?NTS AND ACRIa: 'L'0 THE CO,lL'L.i:TUNFSS OF THIS CERTIFICATE AS SL1MITTE:D. n Insulation Applicator Name A1,01-okl4S' � 'sIZ� -Amp 6. 1I7C Signature of (please print) In:,ulatiun Applicator.� State Contractors License No. General Contractor/Owner Name (please print) Si.t;nat�trc of -„ Gen,•ral Contractor/Owner bate StaLc Contractors License No. "LII;',T TE ON FILE WITII T111'; I3tlll.DING D1sPt\R'LT11NT PR[M TO I21iC11;l:S'I'1 ;(; F'r2AL INSI'ECT-FON AND SHALL liii L'0;;'1'1:11. ;.N A CONSL':ICUOLIS LOCATION WITHIN Till: I)Wl'1.1•LNC. - COUNTY OF BUTTE 7 DEPARTMENT OF PUBLIC WORKS J7 County Center Drive — Oroville, California 95965 )) Telephone: 534-4541 APPLICATION AND PERMIT autnor(ze representatives or ine county or butte to enter upon the above-mentioned property for inspection purposes. X�..� r �� T.,Rd Date •ter /i�/i'� Signature of Permitee or Agent Receipt No. 3Z-7 3J 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 for which fees have been paid. % DIRECTOR OF PUBLIC WORKS By /r. �-i,.. ; 7`-/ Date Building permit expires Date BUILDING Owner { SQ. FT. OCC. BUILDING VALUATION Mailing Address c . [,�� t f � a 0 "7V Telephone No. 'S7 Z_ Contractor( - Mai I i ng Address /&, % CJG v, --j Fireplace Total Valuation Telephone.No. 4-74 �Z,, j Permit Fee { ! Building Address 1 t -.+l r_IE C_�t~j�l �T . �F PIanCheck ingFee &/or Penalty Permif-Fee PLUMBING No. @ FEE .� PERMIT FILING FEE $3.00 Each Trap „1:50 )(^ r C/ 1 (ZQ Repair drainage or vent piping 1.50 �i, A. P. No. '/t` 7Go - L� CFS I, i� Zoning & Planning Water piping w�� ~ Each gas water heater or vent .:iL 50- -Z, 6: J Fees W.C. Sanitation FireDep t. re Zone Use Permit Gas piping system 1 - 5 outlets ;1,:50' 60 EQA Parking Plans Parcel I Declaration +� ' I Parcel Map 60' R/W I Improvements Each additional outlet 30 Building sewer 5.00 vU `8g arra: v F31dg. Plans Recd ParceL�A proval Plans Approval Lawn sprinkler system 2.00 P Y NEW ® ADDITION ❑ UTILITIES ❑ OTHER ❑ lilt , r%i S Permit Fee $ T�'-'���) .$ 'S• r" Z- 71a ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 nC� Main service 600V OR LESS 100 AMP OR LESS 5.00 Single Family ®� Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'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 CONS. I DWELINGOR ADDNST %ACC`BL GS.CCUPAV-1 22sgft CONTRACTORS LICENSE LAW I am licensed under the provisions of Chapter 9, Div. 3, of the State of California Business & Professions Code under the name le of: style NEW RESID. BRANCH CI T NON.RESID. � BRANCH CIRCUITSJ 2.50ea NEW CONSTR. POWER APPARATUS &j NON.RESID. SINGLE OUTLET CIR. / Ex. OCCUD(OUTLETS OR FIXTIIRES) 5 L 25t I , Ex. Occup. FIXED APPLNS. OR p• OUTLETS (RESID.) EA) 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 License Classification /P Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ WORKMEN'S COMPENSATION INSURANCE I 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. 2,,I have placed on file with the County of Butte a certificate of Workmen's Compensation Insurance. r-11 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 "• uC' Heating IA,, o u Cooling Ventilation Hood 2.00 „i: %r✓ 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 Land Development Fee is TOTAL PERMIT FEE $ autnor(ze representatives or ine county or butte to enter upon the above-mentioned property for inspection purposes. X�..� r �� T.,Rd Date •ter /i�/i'� Signature of Permitee or Agent Receipt No. 3Z-7 3J 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 for which fees have been paid. % DIRECTOR OF PUBLIC WORKS By /r. �-i,.. ; 7`-/ Date Building permit expires Date MECHANICAL Check List ❑ Permit ® Underfloor Sta e ❑ Underfloor Supply Plenum: (1) One-story. (2) Clearances. (3) Combustible material. (4) Insulation and vapor barrier. (5) Access. (6) -Catch.. receptacles and registers. (7) Fire -stopping. (8) Boots. (9) -Supply ducts. (10) Gas lines and plumbing cleanouts. ❑ Ducts: (1) Size. (2)- Materials. (3) Support. (4) Fittings. (5) Wrapping. (6) 'Insulation. (7) Clearances - ground, crawlspace, cleanouts, plumbing, etc. ❑ Combustion Air: (1) Size. ❑ Refrigerant Piping: (1) Material. (2) Support. (3) -Fittings. (4) Insulation. ❑ Framing Stage ❑ Heating: (1) Approved appliances. (2) Accessibility. (3) Clearances. (4) Combustion air. ❑ Vent and Connector: (1) Approved..(2) Size. (3) Clearances. (4) Cap. (5) Termination. ❑ Ducts: (1) Materials. (2) Size. (3) Support. (4) Fittings. (5) Insulation►. (6) Fire Damper. ❑ Refrigerant Piping: (1) Material. (2) support. (3) Fittings. (4) Insulation. (5) Condensate drain. F inal Heating: (1) Accessibility. (2) Combustion air. (3) Safety. controls. (4) Electrical connection. (5) Fuel shut-off. Qeovting: (1) Accessibility. (2) Support. (3) Controls. (4) Pressure -relief valves. (5) Class 2 refrigerant. 5/79 P L U M B I N G Check List �rmit ❑ Underfloor Stage .W.V.: (1) Sizing. (2) Materials. (3) Fittings. (4) Grade & Support. (5) Cleanouts & Accessibility. (6) Clearances. (7) Rough -in Loe-ations. (8) Wrapping. (9) Test - including "Ts". (10) Additional test not required.* -Water: (1) Sizing. (2) Materials. (3) Support. (4) Test. (5) Wrapping. ❑* (6) Dissimilar metals. (7) Service regulator installed or not required.* —❑—@as: (1) Sizing. (2) Materials. (3) Support. (4) Log Lighter. (5) Wrapping. ❑ Framing Stage (Top Out D.W.V.: (1) Size. (2) Vent Area & Termination. (3) Materials. (4) Fittings. (5) Grade & Support. (6) Cleanouts. (7) Traps. (8) Nail Protection. (9) Plumbing Access. (10) Toilet Clearances. (11) Shower size. (12) Shower Pan Test. (13) Vents - turns, horiz., runs, loop, wet, etc. ❑* (14) Additional 2nd floor test not required.* ❑ Water: (1) Pipe Test. (2) :Mixer Valves. (3) Support. (4) Roof drains. ❑ Gas: (1) Size. (2) Materials. (3) PR Valve Drain. Water Heater: (1) Vent. (2).Location: (3). PR Valve Drain. Final �D W.V.: (1) Connected to sewer system. (2) Special systems. Water: (1) Water Source. (2) Shut-off. (3) Anti -siphon Valves. Gas: (1) Test. (2) Connectors. Water Heater: (1) Location. (2) Accessibility. (3) Clearances. (4) Stability. (5) 18" Garage Floor. (6) Mechanical protection. (7) Combustion Air. (8)' Draft Diverter. (9) Vent Connector. (10) Vent. (11) Shut-off and connector. (12) PR Valve & Drain. tures: (1) Approved. (2) Stability. (3) Clearances. (4) Trapped. (5) Connections. (6) Cross -connections. (7) Dishwasher Air Gap. 5/79 RESIDENTIAL (Single and Duplex) D313 UNDERFLOOR Plans OK exe t N's Data FRAMING Continued 1. Zoning requirements -Setbacks -Easements X48 Property Line Firewall & Openings 2. Ftg., Klein; Soils-Steel-Elec. Grnd - " Ftg. Depth -''49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 3. Ftg., Garage; Soils -Steel- " Fig. Depth ---SSV Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- 0" Fig. Depth 5. Ste.mwatls, Main; Steel -B lockouts -Wrapped -Slab 6. Stemwalis, Garage; Steel-Blockouts-Wrapped-Slab 7. Piers -Fireplace Ftg.-Steel S. D.W.V.: Fall -Fittings -Test --2 way C/O -Sower Test �-61. Plywood on Roof Overhang -Attic Access -Rafter Outriggers 'X52. Siding -Nailing -Veneer Stucco Mesh -Drip Screed-Fdn, Vents-Underflr. Access, ---�d7 lazing Area -Glass Protection -Skylights --Plastic 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-Cripplas _ Card- bate .7 -t -%(Card E;l- Date Card -BI Date _ Card -CI Data e . , Card -81 Date Card -BI Date Card -BI Date Card -81 Date 'Date FINAL ans) OK except N's Card -BI Date Card -BI Date Date PLUMBING (Permit) OK except N's Steps -Door & Sidelight Protection -Landings �4 _ Slpoke Detector_ 14. Water Ht.; Vent -Access -•Combustion Alr SO, -Furnace; Vents -Clearance -Comb, Air -Connector - In rage; Above Fluor -Ducts -Meth. Protection 15. Water Pipe; Test & Anchors -Nail Pro(ection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 17. Shower Pan; Test, First Floor -Tub Access BOfaom Exiting fi6r­gA;PI. & Bath Fixtures & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access M Elec. Trim & Subpano); Breaker Sizes -Labels -621 -Stairs & Rails 19. Gas Pipe; Size & Anchors Card -81 Date Card -81 Date Card -81 Date Card -BI Data •68r Clearances -Hearth SRT E oc. Outlets at Wood Panel; Int. & Ext. _ Fixt. & Appliance; Grnd.-Air-&a Cooking Clearance - -Outlets &Receptacles at Kit. Counter 6+j /Garage Fire Door; Swing -Landing -Closer Data ELECTRICAL Penult OK except N's -68r-A *Duct In Gara o -Dam ei `-- W. Fixture & Transformr,r Clearance -Ins. Protection Elac. Receptacles Spacing --Lights & Switches at Doors-- (-tP. Size Boxes & No. of Conductors'-StapledAlo. Wtr. Hir.; Vents -Clearance -Comb. Air-Connector-P.R.V.- arage; Above Floor -Mach. Protection P)J3!'Elec. & Ktech. Equip. Listed for Location E Receptacles in Garage: (G.F.I. -Romex °tee. Romex Installed Close to Edge of Studs & C.J • Insulation -Foam -Looked in Attic es rd Rails & Deck Construction -Post Caps ^----2*� Equip. Ground made up w/Meth. Fasteners Bond Gas &--%a t 2 Appliance Circuits i Kitchen & C nduct Fdn: Vents & Crawl Hole Door -Drainage &Wood-Earttr Clearance Looked under Floor C1 Yes 26. Subfeed Wire Size / / ga: Cu o AI A.C. Wire Size / / ga. Cu or At 27. Range Circ. / / a. Cu o I ven Circ. / / ga. Cu or Al, Insulated Neutral Yes 75. Following instld.: Drive es C1 No; Walks es Cl No, P nters ❑Yes o; Creating Drug. Problems ❑ Yes 28. Service -Riser Conductors round ain Disconnect ,L_rvo Stucco; Brown -Finish Unit; Discan nect-CIrnces-Brkr. & Cond. Size -115V Outlet 29. Equip. Clearances; Panels -Motors -Meth. Equip. 0. Clothes Closet Light -Shower Light . Vents Above Roof; Pibg.-Appliance-Flrepi.-Clearance to Opngs. -f -_WdFer Well; Disconnect, Electrical, Plumbing exterior Elec. Trim; G.F.I. Receptacle -Underground Card B-1 Data Card -BI Date Ventilation throughout House -62� Glass Protection cam B -I Date Card -81 Date Data MECHANICAL (Permit) OK except N's- .&ir Co rections from Previous Inspections GTest-Meters Tagged; Gas -Electric -�- 31. A.C. Ducts; Insulation & Support 5 er &Sewer Counseled -C/O to Grads -HD Approval 32. Vent Fan; Exhaust above Insulation 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vont-115V outlet Energy Compliance Certificate -Other Certificates 35. Attic Access & Platform if Furnish in Attic Card -BI Date r1 -BI Data �O_Card-BI Card -BI Date Card -BI Date Card -BI Date Date _ Cera -BI Date Card -BI Date Card -BI Date Card -BI Date Date FRA-MING(Plans) OK except N's Comments at Final: �,. Sills; Proper Material & Anchors Malls; Studs -Nailing, Spacing & Bracing -Plates -Sound _ _`----37. Bearing Wells over Girders & Floor Nailing Draft Stuo in Walls (rat proof) ��II^Fire Stops; Furred Ceilings -Stairs -Chases -Tub Header & Beam -Size & Bearing IC -"42. Hangers -Post Caps -Anchors -Connectors ,r--43. Cing. Joist-Rttr. Ties -Purling -Roof Brat.-Truss-Shthng.-Rfng. =.4. Fireplace Ties or Type A Flue -Fireplace Throat -=..5. Attic Access: Size & Romex Protection -Draft Stop -Ins. Ballets Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions ___-47. Garags Fire Protection Framing r COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS BUILDING INSPECTION RECORD mUa1Lenvmt U i ILi tits ----Efec. Service Elec. Pedestal ' Water Piping ' ' Sewer Gas Piping BILEHOME INSTALLATI - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS 3 (NOTE: An entry must be made on this form each time you visit the job site.) f. BUILDING B LDIN (Co 'd) PLUMBING Setback VA -32- Firewall Soil Piping 3 Forms Parapets 09 A1st Floor Main Bldg. Restroom Finish 2nd Floor Footings—Windows/3 3rd Floor StemwaI l Siding To out Slab v Roof Sheathing c -4!f- Water Piping Piers Roofing Sewer ZS/ Garage Fdn. Vents V Fixtures 2 Footings Stemwall V4 Garage Vent Insulation Z Water Htr. Heaters Slab Carport Footings Prov, for ph sically handica ed Conformance of ex. -sivigtore Appliances Gas Piping & Tests Temp. Gas Slab Fina S on Patio IRE ACE FIn 2- Footings Footin EL CTRIC L Masonr Walls Throat Rough 41 Relnf. Steel Final Fixtures CIA -712- Bond Beam FIRE SPRAKLERS Motors Framing - I Test Water Htr. Stucco Final Subpanels Z Mesh �5�� MEC"AICA Grd. Fault Prot. Z _ Scratch Heating Service Brown Cooling Temp. Pole FinishDucts oGe Under round Interior Lath „ o I V.ea.Wetion Befmanent mUa1Lenvmt U i ILi tits ----Efec. Service Elec. Pedestal ' Water Piping ' ' Sewer Gas Piping BILEHOME INSTALLATI - - - - - - - - - - - - - Support Elec. Continuity Water Piping Drainage Gas Piping DATE REMARKS OR CORRECTIONS 3 (NOTE: An entry must be made on this form each time you visit the job site.) f. 1 COUNTY. -OF BUTTE — DEPARTMENT OF PUBLIC WORKS ..7 County Center Drive — Oroville, California 95965 Telephone: 534-4541 APPLICATION AND PERMIT 91 authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X�Date�' Signature of Pergi.e or Agent Receipt No. 3 12 K: -l3 / 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 for which fees have been paid. DIRECSOR OF PAJBLIC WORKS Building permit expires Date `� 7 BUILDING Owner l LL_ 6,es X1,1--1_ SQ. FT. OCC. BUILDING VALUATION Mailing Address Telephone No. Contractor (�/ J, %J6Wa64 ,- Mailing Address J,(J©,ej-7yy 4(115 Fireplace Total Valuation �O6 \ / / �} p Building Address w Cow,� `�!—j-r, Plan Checkigg Fee /or Penalty Permit Fee ►..tR-vW 5 G. PLUMBING No.1 @ FEE PERMIT FILING FEE $3.00 �JZ� Each Trao .40 Repair drainage or vent piping 1.50 P _ A. P. NO. ` � �d3�9 " Z6 C��� �,._ZZZon'sPlannin g Water piping " p d Each gas water heater or vent 7,0t)Fees � W/.6. I S i ion Fire Dept. Fire Zone Use Permit Gas piping system 1 - 5 outlets Z•Ov EQA arFi PPlans Declaration 60' R/W Improvements Each additional outlet .30 Building sewer 5.00 . oo //�� 1Z> �Pla s Ree' Parc rovaI Plans Approval Lawn sprinkler system 2.00 NEW IN. ADDITION ❑ UTILITIES ❑ OTHER ❑ Permit Fee $ $ ELECTRICAL No. @ FEE PERMIT FILING FEE $3.00 Main service 100 AMP OR00V OR LESS5.00 Single Family. Duplex ❑ Mobil Home ❑ Others ❑ Main service EA. ADD'L too AMP 2.50 OVER Main service OVER s00vPOR LESS 25.00 AM Main service EA. ADD'L 100 AMP 1.00 NEW CONST.DWELLING OC OR ADONS. ( ACC. BLDG S.20sgft CONTRACTORS LICENSE LAW I 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 NON.RESID. (BRANCH CIRCUITS 2.50ea NEW CONSTR. POWER APPARATUS a NON.RESID. (SINGLE OUTLET CIR. EX. OCCUD(OUTLETS OR FIXTtIRES, BAL� FIXED APPLNS. OR Ex. Occup.(0 'TLETS (RESID.) EA) 2.00 Temporary service 10.00 - Mobile Home Facilities 15.00 License No Classification Misc. Wiring 6.25 ❑ I am exempt from the Contractors License Laws of the State of California. Permit Fee $ $ MECHANICAL No. @ FEE WORKMEN'S COMPENSATION INSURANCE I 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. Rhave 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 3,Ou Heating &A t_ G Cooling Ventilation Hood 2.00 �7 Permit Fee $ C%•0 d $ R 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 Land Development Fee is -- TOTAL PERMIT FEE $ authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. X�Date�' Signature of Pergi.e or Agent Receipt No. 3 12 K: -l3 / 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 for which fees have been paid. DIRECSOR OF PAJBLIC WORKS Building permit expires Date `� 7 This set of plans and specifications MUST be kept on the job al all times and it is unlawful to mop mnv changes or alterations on some without written permission from the Department of Public Works, County ol. Buffe. NOTE:=All Ma 1'eria'Is & Workmanship Shall Be in • Accordance wifli Recognized Good Practices and of a qualify pre! c.,iLqd for the Specified use in the A setback of 5 - ft. from the property lines and a setback of 50ft. from the' road centerline shall be 'clear of structures or equipment'excep .for a 2 ft. eave overhang..' Uniform. Bui,,J-- ing, Plumbing & Mechanical Codes and the National Electrical Code.' PIA4 73_Al . A4 9 4 C_ C. Oil VO 7-E Peco IDE -OZ")%U7e4l .J 7-0 A:i2 V 4JZ:>,4 MAJ. 4- 110 See Master Plan onfili.46i. Oul 1 plot s. 511-L t�-W4�r 4i 9'O, < A -BUTTE BUILDING EPA TALENT p A FT. 10 V ED .t o T�/ , Tit EET o T L 1 #e*1 &A THERMALITO IRRIGATION DISTRICT 410 GRAND AVENUE OROVILLE. CALIFORNIA 95965 TELEPHONE 533-0740 1.532 CSA 26 SEWER SERVICE APPLICATION AND CONNECTION PERMIT r� Service Address: � / Owner's Name: t 7�—C- '.' Date:' T'`i Address: i<-' L �—'� %' ' Acct. No: Phone: ' A.P. No.: -457 No. Units: Applicant/Agent: Agents Proof: Address: Fees: Phone: Application $ Preliminary Review By: Date: 2 Arrearage CSA 26 Remarks: SC -OR 7,, 1st mo. S.C. Other Total Fees Collected By: Date: r Field Review By: Date: Remarks: 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). Q� 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