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HomeMy WebLinkAbout068-160-00368-16-3 ROBERT PARK 2620 Oro Quincy Rd, Oroville Cantr: Robinson Const, Oro P^rmit#2255-83B(grading) -93 B07-2618 068-166-003 -'MISCELLANEOUS, Electric Panel • ELECTRICAL SERVICE UP -GRADE 2620 ORO QUINCY. HWY : , PARK ROBERT E &' ELVA; o_ Z BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #:(530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #:(530) 538-7541 FAX#: (530) 538-2140 WEBSITE: www.buttecounty.net\dds PROJECT INFORMATION Site Address: 2620 OROHWY UINCY Q Owner: Permit No: B07-2618 APN: 068-160-003 PARK ROBERT E & ELVA, Issued Date: 12/20/2007 By TMP Permit type: MISCELLANEOUS 2620 QUINCY ROAD Subtype: Electric Panel OROVILLE, CA 95966 Expiration Date: 12/19/2008 Description: ELECTRICAL SERVICE UP -GRAD' (530) 534-7889 Occupancy: Zoning: AR Contractor Applicant: Square Footage: MARAZZO JIM ELECTRIC MARAZZO JIM ELECTRIC Building Garage Remdl/Addn 299 PLUMAS DRIVE 299 PLUMAS DRIVE OROVILLE, CA 95966 OROVILLE, CA 95966 Other Porch/Patio Total FEE INFORMATION DBE Single Phase Service-Resid $58.00 Total Charged: $58.00 _ Fees Paid: $58.00 Balance Due: $0.00 Receipt No: B5748 LICENSED CONTRACTOR'S DECLARATION OWNER / BUILDER DECLARATION Contractor (Name) _ State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License MARAZZO JIM ELECTRIC C669681 / / 04/30/2009 Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed I HEREBY AFFIRM UNDER PENALTY OF PERJURY that 1 am licensed under provisions of Chapter 9 loom encing with Section 7000) of Division 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in force and effect. of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 12/20/2007 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contra is Signature Date ❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR WORKERS' COMPENSATION DECLARATION OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements ❑1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED ❑ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors License Law.). Carrier: Policy Number: Exp. Date: (This section need not a competed if the permit is for one hundred dollars ($100) or less.) ' ❑ I AM EXEMPT under Section B. & P.C. for this reason: 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 Workers' Compensation laws of California, and agree that if I should become subject to the workers' X_ 12/20/2007 compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those _ Owner's Signature Date prow ns. X ( 12/20/2007 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building SignatureDate WARNING: URE TO SECURE WORKERS' CO ENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL BJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE injury, including death, and property damage caused arising out of, or in any way connected with HUNDRED THOUSAND DOLLARS $100,000, IN ADDITION TO THE COST OF COMPENSATION, ( ) the issuance of this permit. I hereby acknowledge thatt is issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND use or occupancy of any sidewalk, street, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above mentioned property for inspection purposes. I hereby certify that I am the property o r uthorized t ct on lhqproperty owners behalf. lr JAM.�� 7WM /2 CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for me of Permittee [SIG14y I Print Date the performance of the work for which this permit is issued. (3097 civ. code) 1c—�r Owner y�l Contractor OR DAgent for Owner Agent for Contractor /�` FILE COPY Lenders Address City State Zip BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION" OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICA TION Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. 130? BIN if "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Last Name 1 ^ First Name Mailing Address City C L i�' Stte,4 Zip S� Phone s 3 ` % 5 Fax E-mail CONTRACTOR Name � Address Z 1; 47 P L Vl1­1 /4 5 �� City Ok.0yttiL"c_ State G— Zip,15— S4�g, Phone �^ Fax E-mail Lic. # Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name City Address Zip City Fax State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address City State Zip Phone Fax E-mail APPLICANT SIGNATURE X '\NAA,� n I PROJECT LOCATION Property Address City v WORKER'S COMPENSATION Policy Number Carrier if hiring anyone other than licensed contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK: e�lleela fu e? Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. Type Const. 1 j, 5% 00 PERMIT NO. 2255-83B r PERMIT EXPIRES �L �//a / OWNER ROBERT PARK CONTR. Robinson Const d. ASSESSOR PARCEL 68"16-3 LOCATION 2620 Oro Quincy Rd, 0 oville ,t t� I; r: n , 9 A Temp. Power Pole 3 Called PG&E Temp. Elec. Service Called PG&E _ -Temp. Gas Service Cal led PG& E I i 0 fi JOB FINALED (Date) i Signature J• = OK O = Not OK - = Not Applicable MOEILEHOMES * = Not Ready MISCELLANEOUS Date MOBILEHOME UTILITIES (Plans) OK except N's r 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except p's 1. Zoning Requirements -Setbacks -'Easements _ 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/O -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 _ Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except N's 1. Zoning Requirements -Setbacks -Easements Card -BI Date Date Card -BI Date _ POOLS (Plans) OK except it'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-GFI 5. Drain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Water and Sewer Connected -C/O 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 Lghtg. Boxes -Enclosures -Panel boards -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 B -I 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 = Not Ready RESIDENTIAL (Single -and Duplex) )ate UNDERFLOOR (Plans) OK except N's 1. Zoning requirements -Setbacks -Easements 2. Ftg., Main; Soils -Steel -Elea Grnd.- / /" Ftg. 3. Ftg., Garage; Soils -Steel- / /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. C 5. Stemwalls, Main; Steel-Blockouts-Wrapped-Slab 6. Stemwalls, Garage; Steel-Blockouts-Wrapped-Slab 7. Piers -Fireplace Ftg.-Steel 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 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-Criooles Card -BI Dale Card -BI Date 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 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 17. Shower Pan; Test, First Floor -Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access 19. Gas Pipe; Size & Anchors Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date ELECTRICAL (Permit) OK except q's 20. Fixture & Transformer Clearance -Ins. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors _ 22. Size Boxes & No. of Conductors -Stapled 23. Romex Installed Close to Edge of Studs & C.J. 24. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water 25. 2 Appliance Circuits in Kitchen & Conductor Size 26. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or At 27. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or At, Insulated Neutral ❑Yes [I No _ 28. Service -Riser Conductors & Ground -Main Disconnect T 29. Equip. Clearances; Panels-Motors-Mech. Equip. 30. Clothes Closet Light -Shower Light Card B -I _ Date_ Card -BI Date Card B -I _ Date Card -BI Date Date MECHANICAL (Pertr,it) OK except N's 31. A.C. Ducts: Insulation & Support 32. Vent Fan: Exhaust above Insulation 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 Date FRAMING (Continued) Card -BI Date Card -BI 48. Property Line Firewall & Openings Date FRAMING(Plans) OK except q's 49. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits 50. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 51. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers _40: 52. -Siding-Nailing-Veneer 41. 42. 43. 44. 45. 46. 47. 53. Stucco Mesh -Drip Screed-Fdn. Vents-Underflr. Access 54. 55. Glazing Area -Glass Protection -Skylights -Plastic Shear Walls; Nailing -Bolts (NOTE: Anentrymust be made each time youvisit jobsite) Card -BI Card -BI Date Card -BI Date Date Card -BI Date Card -BI Date Card -BI Date Date FINAL (Plans) OK except q's 56. Ext. Steps -Door & Sidelight Protection -Landings 57. Smoke Detector 58. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Meth. Protection 59. Bedroom Exiting 60. G.F.I. & Bath Fixtures & Tub Access 61. Elec. Trim & Subpanel; Breaker Sizes -Labels 62. Stairs & Rails 63. Fireplace or Stove; Clearances -Hearth 64. Elec. Outlets at Wood Panel; Int. & Ext. 65. Kit. Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance 66. Elec. Outlets & Receptacles at Kit. Counter 67. Garage Fire Door; Swing -Landing -Closer 68. A.C. Duct in Garage -Damper 69. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- In Garage; Above Floor -Meth. Protection 70. Plb., Elec. & Mech. Equip. Listed for Location 71. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec. 72. Insulation -Foam -Looked in Attic C] Yes 73. Guard Rails & Deck Construction -Post Caps 74. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 75. Following instld.: Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters Dyes ❑No 76. Stucco; Brown -Finish 77. A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet 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 81. Ventilation throughout House 82. Glass Protection _ 83. Corrections from Previous Inspections 84. Gas Test -Meters Tagged; Gas -Electric 85. Water & Sewer Connected -C/O to Grade -HD Approval 86. Energy Compliance Certificate -Other Certificates -•- Card -BI -- Card -BI - -- ---- - - Date'_ Card -BI - Date Date Card -BI Date Card -BI Date Card -BI Card -BI Date Card -BI Card -BI Date Card -BI Comments at Final: Date FRAMING(Plans) OK except q's 36. _Sills; Proper Material & Anchors 37. 38. 39. Walls; Studs -Nailing, Spacing_ & Bracing -Plates -Sound Bearing _Walls over Girders & Floor _Nailing __ _ - Draft Stop in Walls (rat proof) _40: _Fire Stops; Furred Ceilings -Stairs -Chases -Tub 41. 42. 43. 44. 45. 46. 47. 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 Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles Bdrm. Wind or Exiting Doors -Sill Hgt. &Dimensions _ Garage Fire Protection Framing _ (NOTE: Anentrymust be made each time youvisit jobsite) Date �j COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO. 7 County Center Drive - Oroville, Cali.fo`rnia 95965 - Telephone 916/534-4541 S� APPLICATION AND PERMIT X ASSESSOR P RCEL NMBER g-14 - 3 ZONI-WG 1 BUILDING PERMIT OWN�� WT p� TELEPHONE SQ.FT. OCC. BUILDING VALUATIO `� t OWNER'S MAILING ADDRESS C )�jR/(.//Z �O A E ® COpQ o TQ,RO'S MAILI & ADDRESS © ^ 1u6 I V,`W' !7/� /`JF//ly /V!'1 Fireplace CO/(N/'S'TVmRUC�`T//I'ON LEN DyF/ ADDRESS UNKNOWN Total Valuation Is "IFfling Fee $ 10.00 LENDER'S MAILING Permit Fee $ .4.0 ARCHITECT OR ENGINE LICENSE NO. Plan Checking Fee .$ ZC%,Sbp Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $ 2 60 BUILDING ADDRESS �t7 PLUMBING PERMIT Filing Fee 10.00 Each Trap 2.00 Solar Water Heater 20.00 Water piping 5.00 LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 USE OF STRUCTURE ! SF � Duplex ❑ Mobi lehome ❑ Other 40424& P6 // 9F,ECIFY Building sewer 5.00 Mobile Home JSJGJW 10.00 e TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation[] Other Describe work: — Permit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING O OR ADDNS. ( ACC. BLDGS.CCUP.& ) 1 t 220sgft CONTRACTORS LICENSE LAW I declar under penalty of perjury (check one): I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions XY�y(r(ode and my license is in full forf{e and effect. License No.---! 06/ Classification /`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 MULTI -OUTLET 2,50 ea NON-RESID BRANCH CIRCUITS) NEW CONSTR. POWER APPARATUS &\ NON-RESID, (SINGLE OUTLET CIR. / Ex. Occup(OUTLETS OR FIXTURES BA 50 300 FIXED APPLNS. OR EX. OCCup. OUTLETS (RESID.) EA.� 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 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 ag to save, indemnify and keep harmless the County of Butte against all Iia i es, judgments, costs, and expenses which may in any way accrue again s Id County i sse uence o ,hee grantin of th s permit. X1 '�"� '�� /�Da��"� p� Signature of Applicant — Owner ❑ Contractor At 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. PARCE P ND 1550E This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DIRE OF PUBLIC BY P EXPIRES Date the applicable provi- resolutions to do fees have been paid. WORKS Date%—Zf —,F3 7 Receipt NO. 6.1o60 WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT COUNTY OF BUTTE - DEPARTMENT.OF PUBLIC WORKS - BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROV11E±- , CALIFORNIA 95965 - TELEPHONE: 916/534-4541 PERMIT APPLICATION DATA SHEET Permit No.. OWNER A. P. No.44?-16"3 Proposed Building Use C 64L�l i.)La Permit Fee Based Upon, Complete Contract Price DPW Valuation Other (Explain) Building Inspecto Date 7 " ��- 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: . certificate of Workmen's Compensation Insurance. . . . . . ontractor's License Information (no., name style, classif.) 14. Owner -Builder Verification (Given to owner❑, Mail to ownerE]) 15. Improvements may be required. . . . . . . . . . . . 16. Mobilehome Installation Data. . . . . . . .. 17. Pre -Inspection for •Pre-Inspec. request to Required. Building Inspector (Date) 18. Other When you- issue the permit, process as follows: Mail to owner. Mail to contractor. �elephone!F�4- 7arQ hold for pickup atm=rteoffice. Deliver w/inspector. Other A p p I icant�, 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 application, 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 By Date Plans checked by Date Plans approved by Date :2-7-f Other: Copy—DPW Other