HomeMy WebLinkAbout064-340-038Q
'64=34-38: _
DON FURGASON
34 ElmiraCr, lot 121,PPIP4, Magalia
Con John Henry Const, Magalia
j Perintr 7-82P;E'(stil, MH_
ELEC
GAS 7-22-82
SUPPORT STRUCTURE
MPACTION TEST - RE .__ ` '
64-34-38 I
Contr: Richar,V" an^•-,STavern MH Ser
P rmit#24-90-83MHI -^
64-34-38
Egarage)
ete Fox Bldrs, Magalia
500-84B E .new
� .. ' ®�/a�detached
I I _
i
j
. I
I
f ���ii � 7. � 7 �' 1
����
fteturn to DrId
AGRICULTURAL'STATM11N+ OF ACKNOWLEDGEMENT
FOR RESIDENTIAL DEVELOPMENT 0 F F IC, A,
FlyUTt1;: CGI.
m,
Section 264.1 of the Butte County Code requires this-acknowled T151
be recorded prior to 'issuance of. a building permit. ,e JUN t 9 3
The property described herein is -adjacent to land or includ
within an area zoned for agricultural purposes, and residents otgra.%IaV
4
this property may be subject to inconveniences or discomfort arising
from the use of agricultural chemicals, ineluding, b6t not limited to herbicides,
pesticides and fertilizers; and from the pursuit of�',agricultural operations including,-.
but not 114ted to cultivation, plowing, spraying, pruriing, and harvesting which occa-
sionally generate dust, smoke, noise,. and odor. - Butte County has established agricul-
tural zones which have as a priority use for rp
productive agricultural purposes, i"
residents 'Within saidzones and on adjacent propprtyt..should be prepared to accept such
inconvenience or dinc, , omfort from normnl, Tieconsary fiarm operations.
All that real property situate in the County of Butte, State of California,
described as follows:
4T
Date:
102*41-01map entitled; -P 2IgE P U
iA the . office of Re
q0tolier I, 19?6.';1n,5ook,3of Lgoit
I
SLM that app owall lei,"" Oil
'''area
surface
..of
PROPERTY OWNERS:
State of C On this the J01 :day of atA 19-29./
SS. before me, the undersigned Notary Publ1c, personally
County of__:L1L4vI-10 (JaA appeared
Ct
OI.+7ICI A[, SFIAL -
1 2 known to me to be the,per-son(s) whose name(s)
ELIZA SALGADO! subscribed to the within instrument and acknowledged
NOTARY PUBLIC - CALIF,ORNIA that executed the same for the purposes
NTA CLARA COUNTY
10 - SANTA ( 185 therein cootained'.
My Commission Expires April 2, 15
fl IN WITNESS WHEREOF, I,hereunto set my hand and official
seal.
1410tarlPubli
Present A.P. NO,
i
)on-Purgason John Henry .Construction
-356 Sunbeam Circle P,O, Box 509
;an Jose, Ca. 95122 Magalia, Ca. 95954 I
X08-2?9-1917 191 h') Fi73-o��fi
- .,ot 121, Unit 'PP 4, Magalia, Ca., .95954 ;
_._ --- --- _ BUTTE COUNTY
BUILDING DEPARTMEN'�
j
�
APPROVED.
\4I W ith►n
• o,u Utility connections shall beither '
�. 4 ft. of the mobilehome,. rear
or within the
directly behind left) of the
half of the 'roadside
mobilehome.
from the -
i A setback of 5 it. a setback
S property lines an
-1-7d
ft: from the road
of 50 clear of
centerline shall be
ti ment exc
%A structures or eQu verhan9-
2'-
for
.2 ft. eaVe o
FOR Mp6Ct:FT y f
�l
jot the
�1d
e ;vitro obile4►o'me'
O m A errrt { th m
OUatioe
l
� r
(his set of pians and specifications MUST be
kept on the job, at all times and it 13 unlawful Ib
anges or alterations on . same=withodi
make any ch
written permisson from the De{3attm`�nT "df 'Pubtrc
Works. Count* b4 huit'e. ;
AME; DATE: j
a,
- t
,
is
18,2 7
shall
h
nections all be within
Utilit Y bim
lehoe, either
4 it. of the rno
behind or within the rear
directly, of the
half of the roadside (left).
mobilehorne.
ft.'from the.
p, setback of 5 and a setback
property lines
from the. road
of 50ft, clear of
centerline shall be
ent exc ..
sjuctures or eq o e hang
for a 2 it. eaVe
virga {or the
e q reehorme'
r
(his set of plans and specifications MUST be
kept on the job at all fimes and it It unlawful -�
make any changes or alterafions on. same _withodl
written permisson from the �De0&trK&v1 `df •Ptilir'
Works. COUMV' a�f uHe.
/ DATE:
)on-Fur6ason
John Henry
-Construction,
.356 .Sunbeam
Circle
P.O. Box:509.
;an Jose. Ca.
95122
Magalia,
Ca, 95954
F08-279-1917
(91h1 fi73-OE�h�
rot 121; Unit
PP 4. Magal.ia , • Ca. 9595.4
-
BLa TE cOUNTY
BUILDING DP-PARTMEN-
APPROVED.
is
18,2 7
shall
h
nections all be within
Utilit Y bim
lehoe, either
4 it. of the rno
behind or within the rear
directly, of the
half of the roadside (left).
mobilehorne.
ft.'from the.
p, setback of 5 and a setback
property lines
from the. road
of 50ft, clear of
centerline shall be
ent exc ..
sjuctures or eq o e hang
for a 2 it. eaVe
virga {or the
e q reehorme'
r
(his set of plans and specifications MUST be
kept on the job at all fimes and it It unlawful -�
make any changes or alterafions on. same _withodl
written permisson from the �De0&trK&v1 `df •Ptilir'
Works. COUMV' a�f uHe.
/ DATE:
• � PERMIT NO. 2500-84B ,E
PERMIT EXPIRES
OWNER DON FURGASON
CONTR.., Pete Fox Bldr.
ASSESSOR PARCEL 64-34'-38
LOCATION 14134 Mira -Circle, Magalia
X
1T
T:
_
.Temp. Power Pole
y..
Called PG&E
i'
LZ
'Temp. Elec. Service
Called PG&E
Temp. Gas Service
-
n
Cal led PG&E
g
JOB FINALED (Date)
/
la�
Signature
q
J =OK
0 = Not OK
= Not Applicable MOBILEHOMES
= Not Ready MISCELLANEOUS
,
` r
Date
MOBILEHOME UTILITIES (Plans) OK except N's•
1. Zoning Requirements -Setbacks -Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except IL's,
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.-Rfg.-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
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION. (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
Card -BI
Date
Date Card -BI Date -
POOLS (Plans) OK except q's -
1. Setbacks -Easements
2. Footings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability '
3. Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
4. Electricity; MH Test -Crossovers -Breakers -Clearances
4, Elec.; Receptacles and Lighting; Distances-GF1
5. Drain; MH Test -Fall -Flex Connector
6. Water; MH Test -Regulator -Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Water and Sewer Connected -C/0 to Grade -HD Approval
7• Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
8. Gas and Electricity Tagged
8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghig.
Boxes -Enc losures- Pane lboards-Ihs. to Main in Conduit
9. Exits; Insp.-Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B -I
Date Card -BI Date
Card -BI
Date Card -BI Date
V = OK
0 = Not OK
- = Not Applicable RESIDENTIAL (Single and Duplex)
* = Not Ready I
Date
UNDE LOOR Plans OK exce t#'s
Date FRAMING Continued
1 oning requirements -Setbacks -Easements
Property Line Firewall & Openings
ain; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
457Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
Ftg., Garage; Soils -Steel- //'7i/" Ftg. Depth
-&0.-.94eirs; Width -Headroom -Rise -Run -Landing -Fire Protection
4- Fta. Perches & Decks; Soils -Steel- / /" Ftg. Depth
lywood on Roof Overhang -Attic Vents -Rafter Outriggers
Main; Steel-Blockouts-Wrapped-Slab
iding-Nailing-Veneer
U-ISternwalls, Garage; Steel -B lockouts -Wrapped -S lab
62_-Sweco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
- ep ace Ftg.-Steel
-G�y.. ng Area -Glass Protection -Skylights -Plastic
8. O.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test
9. Gas Pipe; Size -Anchors
55__Sb"r-Walls; Nailing -Bolts
10. Water Pipe; Test -Anchors -Regulator -Service Test
Electric; Underground
12. Plenums & Ducts; Clearance -Material -Support -Ins.
13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI Date 1811111 g LfCard-BI Date
Card -BI Date Card -BI Date
41
Card -BI Date Card -BI Date
Card -BI
' Card -BI Date
Datey/,
Date FINA Plans) OK except q's
Card -BI Date Card -BI Date
Date
PLUMBING (Permit) OK except q's
14. Water Ht.; Vent -Access -Combustion Air
15. Water Pipe; Test & Anchors -Nail Protection
Ext. Steps -Door & Sidelight Protection -Landings
6;-9m'oke Detector
58. furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
16. D.W.V.; Test-Fttngs & Anchors -Nail Protection
59 a+m-Exiting
17. Shower Pan; Test, First Floor -Tub Access
'60--er?"1-&-Bath Fixtures & Tub Access
18. Test Tub & Shower, 2nd Floor -Tub Access
ec. Trim & Subpanel; Breaker Sizes -Labels
19. Gas Pipe; Size & Anchors
62__jS1"s & Rails
lace or Stove; Clearances -Hearth
lec. Outlets at Wood Panel; Int. & Ext.
Card -BI
Date Card -BI Date
6& --Kit'-Flkt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date
Date Card -BI Date
ELECTRICAL Permit OK except q's
`B. eMbutlets & Receptacles at Kit. Counter
ge Fire Door; Swing -Landing -Closer
68-A.G-.-9uct in Garage -Damper
20. 'xture &Transformer Clearance -Ins. Protection
ao. wfr_ Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
Elec. Receptacles Spacing -Lights &Switches at Doors
24/x. Elec. & Mech. Equip. Listed for Location
Sze Boxes & No. of Conductors -Stapled
i(l�Aeceptacles in Garage; (G.F.I.)-Romex Protec.
d/F%mex Installed Close to Edge of Studs & C.J.
Z2.Jasu+etion- Foam- Looked in Attic E) Yes
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
73__C1uasd-Rails & Deck Construction -Post Caps
T4,Ftri-Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
-25:-2-A'p-pliance Circuits in Kitchen & Conductor Size
-+Q6r3ubfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral ❑Yes El No
56.Jze4+cwtng instld.: Drive ❑ Yes [-]No; Walks ❑ Yes ❑ No;
Planters ❑Yes 0 N
28. Service -Riser Conductors & Ground -Main Disconnect
70; Brown -Finish
29. Equip. Clearances; Panels-Motors-Mech. Equip.
Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
30. Clothes Closet Light -Shower Light
7Z -V409 -Above Roof; Plbg.-Appliance-Firepl.-Clearance to Opngs.
Ell; Disconnect, Electrical, Plumbing
xterior Elec. Trim; G.F.I. Receptacle -Underground
Card B -I
Date2,671 aCard-BI Date
8A__-ferkHation throughout House
98.•-9+as'T7`rotection
Card B -I Date Card -BI Date
Date
MECHANICAL (Permit) OK except q's
89. Oarreetions from Previous Inspections
8* Gee - rest -Meters Tagged; Gas -Electric
31. A.C. Ducts; Insulation & Support
$5 Waco. & Sewer Connected -C/O to Grade -HD Approval
32. Vent Fan; Exhaust above Insulation
86 Fnnex yCompliance Certificate -Other Certificates
33. Condensate Drain & Overflow; Size & Grade
34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet
35. Attic Access & Platform if Furnace in Attic
Card -BI Dat 4011 IJ& Card -BI Date
Card -BI
Date Card -BI Date
Card -BI Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI V Date Card -BI Date
Date
FRAMING(Plans) OK except N's
Comments at Final:
Sills; Proper Material & Anchors
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
78-Beering Walls over Girders & Floor Nailing
39. Draft_$top in Walls (rat proof)
Fire Sto s; Ceilings -Stairs -Chases -Tub
a40._
5MFurred
Header & Beam -Size & Bearing
ngers-Post Caps -Anchors -Connectors
Cing. Joist-Rftr. Ties-Purlin- Roof _Brac.-Truss-_Shthng_.-Rfn_g_._
- ^;='replace Ties or Type A Flue -Fireplace Throat
'4htt7rAccess; Size & Romex Protection -Draft Stop -Ins. Baffles
-46.-434rtrr"Windows or Exiting Doors -Sill Hgt. & Dimensions
d7 Garage Fire Protection Framing
(NOTE: Anentry must be made each time you visit jobsite)
t COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
V 7 County Center -Drive - Oroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT v
ASSESSOR PARCEL NUMBER
CONING
BUILDING PERMIT
O Wc±—.
i
TELEPHONE
SO. FT. OCC. BUILDING VALUATI N
OWNER'S MAILING ADORES
�1 r
CO, • CTOR'S NAME
�^
TEL HONE
—0
CO TRACTO 'S MAI I• ADDRESS , (
1 L-' ��I -��`(
Fireplace
CONSTRUCTION'LENIJER
N
Total Valuation Is
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE ND.
Plan Checking Fee
$
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$ JI
BUILDING ADDRESS` L _� r �'
1
PLUMBING PERMIT
FilingFee
Filin Fee 10.00
Trap
2.00
Solar Water Heater
20.00
Water piping
5.00
LOT NO.
SUBDIVISION NAME�V�CEL MAP
v
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
5.00
USE OF STRUCTURE
SF ❑ Duplex ❑ Mobi lehome ❑ Other t—
SPECI F
Building sewer
5.00
Mobile Home S I G I W
10.00 e
TYPE OF WORK
New Addition❑ Remodel❑ Utilities❑ Installation El Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP ORV OR LESS10.00
Main service EA. ADD'L too AMP
2.50
NEW CONST.DWELLING O
OR ADDNS. ( ACC. BLDGS.
,2/ZQSgft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
R-1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and license is in fuforce and effect.
License No. y q J�
��m�LClassification r�
❑ 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 CONSTR ULTI.OUTLET/
NON-RESID BRANCH CIRC ITS
2.50 ea
NEW CONSTR ( POWER APPARATUS &)
NON -RES,D. SINGLE OUTLET CIR. /
20@50t
Ex. Occup(ouTLETs OR FIXTURES BAL®300
FIXED APLN S'
Ex. Occup. OUTLETS P(RESIIK
D EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $
Contractor
WORKMEN'S COMPENSATION IN
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
�I��iave 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, 'shou I d 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
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-saifd. ounty inc sequence of the granting of this ermit.
X �PCti� r- -
Date
Signa Wire of Applicant — Owner ❑ 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
T,Butte
occu P. GROuP
I TYPE OF CONST.
PARCEL
PD H
ISSOE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIREC R OF PUBLIC
BY
PE IT EXPIRES Date_./�U�
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
ry `l
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
APERMIT N0. 14.37r82P,E' (MH)
PERMIT EXPIRES�L�
OWNER DON FURGASON
CONTR. John Henry Const
ASSESSOR PARCEL644-34-38
LOCATION 14134 ElmiraCt,lot 121 PPlf4,Mag _
y
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called.PG&E:8 ".3 X."� �y� Gt/�'��J W 7
F. Temp-Gas Service
Cal led PG&E
JOB FINALED (Dat'
Signature
4.
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 /�/ �' +�� �Z-`for the following location: �/!- Q
l_1"aax 0- I��' �..� /-2/ f99.` f y
Owner J /"
Owner's Address
Mobilehome Mfg._ �� �*.•�+ t Model—1 I Year
Insignia No., - `' l / : + V Serial No. OR �3 ' "l� }3
sr
It is hereby certified for occupancy at the above described location and
may be occupied. _ 10, ,
Director of Publi crWorks
Date , 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, Oroville — Phone: 534-4541
Skyway and Elliott Road, Paradise— Phone: 872-2961, Ext. 57
CORRECTION NOTICE
BALDING OR PROPERTY ADDRESS'
A routine inspection indicates that the following violations of County rdinance
exist at the above address and should be corrected. Please notify his 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.
JP
J = OK
0 = NCjOK
- =.Not Applicable
Vit'-• 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.
4.
Ftg., Garage; Soils -Steel- / /" Ftg. Depth
Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth
50.
51.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
6. Stemwalls, Garage; SteeL-Blackouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access
7.
Piers -Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
8.
D.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
Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door & Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except #'s
14. Water Ht.; Vent -Access -Combustion Air
57.
58.
Smoke Detector
Furnace; Vents -Clearance -Comb. Air -Connector -
In Garage; Above Floor-Ducts-Mech. Protection
15. Water Pipe; Test & Anchors -Nail Protection
16.
D.W.V.; Test-Fttngs & Anchors -Nail Protection
59.
Bedroom Exiting
17.
18.
Shower Pan; Test, First Floor -Tub Access
Test Tub & Shower, 2nd Floor -Tub Access
60.
G.F.I. & Bath Fixtures & Tub Access
61.
Elec. Trim & Subpanel; Breaker Sizes -Labels
19.
Gas Pipe; Size & Anchors
62.
Stairs & Rails
63.
Fireplace or Stove; Clearances -Hearth
Card -BI
Date Card -BI Date
64.
65.
Elec. Outlets at Wood Panel; Int. & Ext.
Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
67.
Elec. Outlets & Receptacles at Kit. Counter
Garage Fire Door; Swing -Landing -Closer
Date
ELECTRICAL Permit OK except N's
68.
A.C. Duct in Garage -Damper
20.
Fixture & Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
In Garage; Above Floor-Mech. Protection
21. Elec. Receptacles Spacing -Lights &Switches at Doors
22.
Size Boxes & No. of Conductors -Stapled
70.
Plb., Elec. & Mech. Equip. Listed for Location
23.
Ramex Installed Close to Edge of Studs & C.J.
71.
Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
24.
Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water
72.
Insulation -Foam -Looked in Attic E) Yes
25.
2 Appliance Circuits in Kitchen &Conductor Size
Guard Rails & Deck Construction -Post Caps
-
26.
Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
74.
Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance
Looked under Floor ❑ Yes
27.
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At,
Insulated Neutral ❑Yes ❑No
75.
76.
Following instld.: Drive El Yes _ E)No; Walks ❑Yes ❑ No;
Planters El Yes ❑No
Stucco; Brown -Finish
28. Service -Riser Conductors & Ground -Main Disconnect
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 -I
Date Card -BI Date
81.
Ventilation throughout House
Card B -I
Date Card -BI Date
82.
Glass Protection
Date
MECHANICAL (Permit) OK except p'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 k's
36.
Sills; Proper Material & Anchors
_
37.
Walls; Studs -Nailing, Spacing & Bracing -Plates -Sound
38.
Bearing Walls over Girders & Floor Nailing_
39.
40.
Draft Stop in Walls (rat proof)
Fire Stops; Furred Ceilings -Stairs -Chases -Tub
_
41.
42.
43.
44.
Header & Beam -Size & Bearing
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Ritr. Ties-Purlin-Roof Brac.-Truss-Shthnq.-Rfnq.
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)
J = OK
0 = Not OK -
- = Not Applicable MOBILEHOMES I MISCELLANE0111r y�
* = Not Ready
Date MOBItEp(IME UTILITIES (Plans) OK except a's
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OIC except H'
1. oning Requirements -Setbacks -Easements
1, Zoning Requirements -Setbacks -Easements
2. ,Soil_§.; Special MH Support -Sketch
2. Footings; Size -Depth -Spacing -Connectors
3. kewgr.�tocation-Test-Fall-C/0-Concrete
3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails
4. -!!�tr; Location -Test -Easement Needed (Sketch)
4. Wood Awn.; Posts-Beams=Rftrs.-Connec.-Shthg.-Rfg.-Bracing_
lectricity; Location-Clearances-Grnd.-/ / Amp -Concrete
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
`, Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG
6. Carports; Windows -Doors
Utility Clearance '
7. Elec.
Card -BI ate -'/ •S—Xard-Bl Date
Card -BI
Date Card -BI Date
Card -BI Dat and -BI Date
Card -BI
_
Date Card -BI Date
Date BIS.EHOME INSTALLATION (Plans) OK except k's
Date
_
POOLS (Plans) OK except k's
Zo ' g Requirements -Setbacks -Easements
1. Setbacks -Easements
ootings; Size -Spacing -Marriage Line
2. Soils; Compaction -Structure Stability
.tea- Gas; MH Test -Demand -Valve -Connector
3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining
Iect 'city; MHTeol---Crosqgmert-BreieAwKces
_
4. Elec.; Receptacles and Lighting; Distances-GFI
5. ain; MH Test -Fall -Flex Connector
5. Elec.; Pool Lighting; 15 volts-GFI
6. ter; MH Test -Regulator -Connector
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7 ter and Sewer Connected -C/O to Grade -HD Approval
7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater
and Electricity Tagged
B. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg.
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
ba, -Exits; Insp.-Sketch
;V' Carl. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B -196C Date Card -BI Date
Card -BI
Date Card -BI Date
Card B-1 Dat Card -BI Date
Card -BI
Date Card -BI Date
L2(
Oh
�w 17 o�
CS - ;�339---.A 13
v'
sj
� � .. •1�i� ,
t
t
COUNTY OF BUTTE - DEPARTMEN,T OF PUBLIC WORKS
7 County Center Drive - Oroville, Califoni?T� 65 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT NO.r/
—
ASSESSOR PARCEL NUMBER
6!54_.
ZONING
BUILDING PERMIT
OWNER
�6A/ filli-6-4,soIII,/
TELEPHONE
SQ. FT. OCC. BUILDING VALUAT'
OWNER'S MAILING ADDRESS
CONTRAC OR•SNAME
c S /i9. ��oeurCE
TELEPHONE
�i2-o34 �
CONTRACTOR'S MAILING ADDRESS
1,%-30 C1qP_® LL 1,0, R Q/SG Cts-.
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Q
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS -
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ /91 06
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUyI DING ADDRESS ,,��11�� (SAL
i `tl3 L G Le M4
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
LOT NO.
SUBDIVISION NAME PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 - 5 outlets
USE OF STRUCTURE
SF ❑ Duplex❑ MobilehomeEg""Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ InstallationK Other ❑
Describe work:
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100 AMP OR00V OR LESS5.00
Main service EA. ADD'L 100 AMP
2:50
NEW CONST. (DWELLING OCCUP.sI
OR ADDNS. ACC. BLDGS.
2¢sgft
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
134�1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force
fj�and effect.
License No: 3'7r���' Classification - T 1
❑ 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 CONSTR. U TI.OUTLET 2.50 ea
NON•RESID BRANCH CIRC ITS
NEW CONSTR. ( POWER APPARATUS &I
NON-RESID. SINGLE OUTLET CIR,
EX. Occup OUTLETS OR FIXTURES 50@25
IxeD APP LNS. OR
Ex. Occup.(OU TLETS (RESID) EA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 7.50
Permit Fee $
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
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 shal I be deemed revoked.
Heating
Cooling
Hood
3.00
Ventilation
Permit Fee
$
Contractor
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 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
against p'idf�County in consequence of the granting of this permit.
tom—
XRdaJ x Lja,--Date 9-22-X3
Signature of Applicant — Owner E]]Contractor [vf 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 $ ai
TOTAL PERMIT FEE 9O'�
occUP. GROUP
I TYPE OF CONST.
PARCEL
PD
HD
55
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRE PROF BLIC
.�
BY
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
i Qi
Date a7
/ i
Receipt No. ��f,�9�
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT OFoPUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILL'E,,CALIFORNIA 95965 - TELEPHONE: 916/534-4541
PERMIT APPLICATION DATA SHEET -
Permit No.
OWNER r) uj F UA ft 6#q.s oA) A. P. No. ;6 F5
Proposed Building Use
Permit Fee.,Based Upon: Complete Contract Price DPW Valuation
Other (Explain)
Building InspectorDate
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or issuance: DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . . . . .
2. Plot plans in duplicate./triplicate. . . . . . . . .
3. Complete plans in duplicate./triplicate. . . . . . . . .
4. Complete engineered plans and calcs. . . . . . . . . .
5. Plans with Energy Design Compliance Statement. . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ , . , . . , , ,
9. Letter of signature authorization. . . . . . . . . . .
10. Sanitation approval from Health Dept. . .
11. Planning approval for (A) Use: (B) Parking: .
12. Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner, Mail to ownerEl)
15. 1.. provements may be required. nn.. rr ,
6 Mobilehome Installation Data. �P�. .�1"r1ltU•, 1-F7 -Iks
17. Pre -Inspection for RequiredPre-Inspec. request to , Building Inspector (Date)
18. Other
When you issue the permit, process as follows: Mainto owner. Mail to contractor.
Telephone 272-o2en 5- and hold for pickup at&� ffice. Deliver w/inspector.
Other
Applicant -,9424 Date-
Copy
ate Copy of plans sent Health Dept., Fire Dept., Other Date
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of application, circle item.)
1. Index permit for above Items No. %(a
2. Additional items required:
(Ctr ��signe ,
Plans checked by
Plans approved bytt
Other:
iCopy—DPW
advised of above required
By—
elephone
Date
Date
-Mail Other
Dated
MOBILEHOME SUPPORT DATA
Mobilehome Mfr.
If other than single wide,
furnish Setup, Model No. I 13 Year
Width
(ft.) Box Length
(ft.) Tagalong or Expando Size ft. x ft:
(SHOW SUPPORT DETAILS BELOW)
On all mobilehomes manufactured after
October 7, 1973; furnish manufacturer's installation
manual and structural setup sheets (if
not on file with the County of Butte).
All center supports measured from front of
t r' ' '"' 4
mobilehome unless otherwise specified,
Footings (check one)
Single. Wood either
pressure treated or
(,��
foundation grade..
LS L `" J
Z x3 0
(ft.)(in:)
(in.) (in:)
-
0 2. Other (specify)
Center support
locations*
Center support
footing sizes.
Supporia (check one)
)
in.
Concrete block:
'
2 Other (specify)
(in.) (in.)
,F.
4(- ---Tagalong 'or Expando,'
show support details.
(.in.) (in.)
Typical Support
(in.) (in.) Footing Size-..
(ft.)(in.)
(in.) (in.)
O �j
-- Max. Pier Spacing
0 -
(ft.)l(in.)
(in.) (in.)
(ft.)(in.)*
BUTTE COUNTY
BUILDING •0EPA-PTMENT
P ' ` O `f E ' ' ,
•
.If center piers
are other than drawn above,
11Y7T.] {Tl.1 n/.7 }•I AAC
OA7/. tT1R e7T1f� l�9ThGTCtAhC '
'BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA.
PHONE: 534-4541
MOBILEHOME INSTALLATION SHEET
L . Cn,--er's name: n
2. Installer's name: Ric -OAA -0 V A"j Sr4vc eA) AX, At—3�5"f(//C L:
3. Is the site currently under permit? Yes No / / •
(If yes, furnish permit number ) OR
Is the site an existing site? Yes / / No
(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? ----------------------- CJ Amps
6. What is the mobilehome site service rating?---------------------� Amps
7. What is the mobilehome site circuit breaker rating? ------------- - r S O Amps
8. Is there any other electric load to be served by the mobilehome
siteservice? --------------------------------------------------- Yes No/�l
(If yes, identify the load and size:
(Load) --
(Amps)
ca
What
is the mobilehome site gas pipe size? ----------------------
10.
What
is the type of gas service? -----------------------------
Natural /%
LPG
11.
What
is the gas pipe length from meter or tank to
the mobilehome?
(ft.)
12
What
is the mobilehome gas demand.
�
(BTU)
(This information not required if pipe length
less than 6 ft. on natural
gas
or less than 50 ft.. on LPG.)
OWNER
PERMIT'�k
MH UT IL . CLEARANCEDATE
INSPECTOR
ELECTRIC
GAS
Support Compaction
Struc. Test.Req.
Service
Size
-Other
Load
Type
Pipe
Size
Length
YESI NO YES NO
s � ,
COUNTY OAF BUTTE.- DEPARTMENT OF PUBLIC WORKS PERMIT NO.
J .- - - .
7 County Cen�fer Drivellbroville, California 95965 - Telephone 916/534-4541
APPLICATION AND PERMIT AA1A h>,
ASSE SOR PARCE NUMBER
ZONING
T
BUILDING PERMIT
OWNEIA
Don Fur ason
TELEPHONE
SO. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADDRESS
CONTRACTOR'S NAME
John HenryConstruction
TELEPHONE
1873-0668
CONTRACTOR'S MAILING ADDRESS
P.O. Box 509 Magalia Ca. 95954
Fireplace
CONSTRUCTION LENDER
NONE
UNKNOWN
IFiling
Total Valuation $
g Fee
$ 10.00
LENDER'S MAILING ADDRESS
Permit Fee
$
ARC¢IITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
.$'
Penalty
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Permit fee
$
BUILDING ADDRESSC,
PLUMBING PERMIT
FiIingFee 10.00
^�,
, /
Each Trap
2.00
Repair drainage or vent piping
5.00
Water piping
l Q
LOT NO.
l2l
SUBDIVISION NAME
PP Ma alfa Ca
PARCEL MAP
Each qas water heater or vent
5.00
Gas piping system 1 -5 outlets
USE OF STRUCTURE
SF ❑ Duplex-[] MobilehomeER Other
SPECIFY
Building sewer
Lawn sprinkler system
5.00
TYPE OF WORK
New KI Add ition❑ Remodel❑ Utilities❑ Installation EJ Other ❑
Describe work: lot development_
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100V OR
00 AMP ORSLESS
5.0& -
Main service EA. ADD'L 100 AMP
2;50
NEW CONST. DWELLING OCCUP.5i
OR ADDNS. ACC. SLOGS.
/ 'z�sgft
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; 346997 Classification A
❑ 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
NON.RESID R BRA NCHCIRCLET Ts 2.50 ea
.NEw NON -CONSTR RESID. SINGLE OUTLET CIR. POWER APPARATUS a
Ex. Occup OUTLETS OR FIXTURES a �@1
00
FIXED APPLNS. OR
Ex. OCCup.(OUTLETS (RESID.) EA. 2.00
Temporary service 10.00
Mobile Home Facilities 15.00 S�
Misc. Wiring
7.50
Permit Fee
$ 7,^
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
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 authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agr to save, indemnify and k p harmless the County of Butte against
all li I 'es, judgment osts, xpenses which may in any way accrue of this permit.
ag d County i on que e t e granting
%� Date �a J /��-
Signature of Applicant — Owner ❑ 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
TYPE OF CONST.
PARCEL PD
HD SSUE
/
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECT OF PUBLIC
B Y
PEWT EXPIRES Date _
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date �—
6^�
Receipt No. K' t 7 S
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
i
COUNTY 0173-BUTTIE - DEPARTMENT OF PUBLIC WORKS -BUILDING DIVISION
_ 7 COUNTY CENTER -RIVE - OROVILLE, ,CA-LIFORNIA 95965 - TELEPHONE: 910534-4541
PERMIT APPLICATION DATA SHEET r
Permit No. ,
OWNER 1 ,, A. P. No. (o V 3t/-
r
Proposed Building Use /��/z M
Permit Fee Based Upon: Complete Contract Price _T—DPW Valuation
Other (Explain)
Building Inspector Date S D7 �-Z
At time of permit application, I was advised the following data must be submitted prior to permit processing
and/or Issuance: DATE RECEIVED APPROVED
1. All items have been submitted. . . . . . . . . . .
2. Plot plans in duplicate./triplicate. . . . . . . . . . .
3. Complete plans in duplicate./triplicate. . . . . . . . .
4. Complete engineered plans and calcs. . . . . . . . . .
5. Plans with Energy Design Compliance Statement. . . . . .
6. State Energy Forms No.
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . . . . . .
9. Letter of signature authorization. . . . . . . . . . .
4/ 10. Sanitation approval from 1/24 ti,fX_ Health Dept. . . W
11. Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Compensation Insurance. . . . . .
13. Contractor's License Information (no., name style, classif.)
14, Owner -Builder Verification (Given to owner[], Mail to owner ❑ )
15. Improvements may be required. . . . . . . . . . . .
16. Mobilehome Installation Data. . . . . . . . :ection for Required,• . .
Pre-Inspec. request to _4D ate)
17. Pre -Ins
D
,PBuilding Inspector p 6
X 18. Other_0 I��
When you issue the permit, process as follows: Mail to owner., Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other
A p p I (cant Date
Copy of plans sent Health Dept., Fire Dept., Other Date
During the plan checking process, the following data must be submitted prior to permit issuance.
(For required items not checked above at time of uplication, circle item.)
1. Index permit for above Items No.
2. Additional items required:
(Contractor, Designer, Owner) was advised of above required data by Telephone Mail Other
By Date
Plans checked by_
Plans approved by
Other:
Copy–DPW
Date
Date
To: Building Department.
L ,
From: Environmental Health
Subject: Sanitation Clearance
bbd Cu p q 6-S[ LcA 1'2-1, UNIA PP. 4
OwNer Location AP#
Plans approved for: Sewage Disposal Water Supply
Hold.final for: Water Supply
Final Clearance O.K. for: Water Supply-
Clearance for bedroom mobile home. Other
Clearance for addition of
Note**
Eli r&ff I��Z
Sanitarian Date