The URL can be used to link to this page

Home My WebLink About078-180-048X66 _P,ERMIT#95-0760 WILSON, David & Victoria 5296 Walmer Rd,., Oroville Cont, Tom Warner -Install Woodstove/SF 4 05-2413 WILSON 5296 WALMER RD, OROVILLE Cont: GEORGE ROOFING RE ROOF BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS 24 HOUR INSPECTION #: (530) 538-7636 (OROVIILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 A FEE WILL BE REQUIRED AT TIME OF APPLICATION APPLICANT SIGNATURE X hole re -A ent or George For office use only: OWNER Name Joanne Romero Address 5296 Walmer Rd. cit' Oroville State CA Z'P 95966 Phone 534-1761 Fax E-mail Lic.# APPLICANT SIGNATURE X hole re -A ent or George For office use only: CONTRACTOR Name GEORGE ROOFING Address 6810 Lincoln Blvd City Oroville State CA Zip Phone (530) 533-6393 Fax (530)533-0287 E-mail dan@abcgc.com Lic.# Class dan@abcgc.com 452266 1 C39 APPLICANT SIGNATURE X hole re -A ent or George For office use only: ARCHITECT/ENGINEER Name N/A Address 6810 Lincoln Blvd City Oroville State CA Zip Phone (530)533-6393 Fax E-mail dan@abcgc.com State License Number APPLICANT SIGNATURE X hole re -A ent or George For office use only: APPLICANT NAME Name GEORGE ROOFING Address 6810 Lincoln Blvd City Oroville State CA Zip 95966 Phone (530)533-6393 Fax (530)533-0287 E-mail dan@abcgc.com APPLICANT SIGNATURE X hole re -A ent or George For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const.` __ I i"t if lin Subdivision Name Map Book Page f i , 1 ;Lot -#-------- PlannerDate Approved:) I i �! S `. F, LOCATION AP# `76-006 Property Address 5296 Walmer Rd. Oroville, Ca. 95966 Cross Street PERMIT NO. NO. BP 05-2 L// BIN # WORKERS COMPENSATION Policy Number 272-596-02 Carrier STATE FUND If hiring anyone other than license 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 Overlay - House - BUR Sq. Footage 18 Squares ❑ Structure Built Without Permits ❑ Proposed Change of Occupancy (Note previous use): EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fee will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the person who paid the fee. The request must be made prior to the expiration of the permit and no construction work has been done. Filing fees, plan check fees for work plan checked and other department costs are not refundable. Received by: Amount: / / (/ Bldg SRA Receipt #: Sheriff �A SMIP r� r I��• Other ; 1I �I �,s •___�� BUTTE COUNTY PLANNING DIVISION I � Total REV: George Roofing BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. BP052413 PERMITS BECOME NULL AND VOID 1 YEAR FROM THE DATE OF ISSUANCE, OR IF WORK IS DONE IN VIOLATION OF ANY COUNTY OR STATE LAWS. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and Issued Date: 09/08/2005 APN: 036-176-006-000 effect. License Class License Number: ASaZ e�(p(p Date: " contractor: Site Address: 5296 WALMER RD ORO — —O S Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Description: re roof 18 squares Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior WILSON DAVID LEE JR &VICTORIA L to its issuance, also requires the applicant for such permit to file a Owner: signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 5296 WALMER RD she is exempt therefrom and the basis for the alleged exemption. Any OROVILLE, CA violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): 95966 O 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, Applicant: GEORGE ROOFING provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of 6810 LINCOLN BLVD proving that he or she did not build or improve for the purpose of sale.). OROVILLE, CA 95966 O I, as owner of the property, am exclusively contracting with (530) 533-6393 licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contraclor(s) licensed pursuant to the Contractors' State License Law.). Contractor: GEORGE ROOFING ❑ 1 am Exempt under Article 3 of the Business and Professions Code 6810 LINCOLN BLVD Date: owner: OROVILLE, CA 95966 WORKERS' COMPENSATION DECLARATION (530) 533-6393 1 hereby affirm under penalty of perjury one of the following declarations: O 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the License #: 452266 Labor Code. for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code. for the performance of Architect: the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Engineer: Carrier: Asa L& , yet,� Policy #:_ a %2 — 5 q to Total Square Ft: 0 S. F. O 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to Valuation: $0.00 become subject to the workers' compensation laws of California, Census Code: and agree that if I should become subject to the workers' - compensation provisions of Section 3700 of the Labor Code. I shall forthhwwith comply with those provisions. Date: L Applicant: WARNING: Failure to secure workers' compensation coverage is (� unlawful, and shall subject an employer to criminal penalties and one t/f hundred thousand dollars ($100,000), in addition to the cost of ` compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This permit is reby issue der a applicable provisions of the Butte County Code and/or I hereby affirm that there is a construction lending agency for the Resolutio o do work dicaled ov r which fees have been paid. performance of the work far which this permit is issued (Sec 30.37 Civ.) - - - .7-9-05-1 Name: BY Date: Address: PERMIT EXPIRES ON: 9 16_o( j Date ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code. which regulate the storage, handling and use of hazardous materials. ❑ - Notification in accordance with Section 19827.5 of California Health 8 Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state Tawe relating to building construction. I acknowlOdge It In unlawfO to ollor the 1WpU101160 of 11hy Pfllolyl form or 0gawmpnl of RON (Pawnly. I hprohy 441horlAm rsplawltllivsll al pulls GaHnly la dnlor 1411011 kis 044v!1 ?"PAIl9nliq pinpl+/fy Ipr II1hpeollam PwrPoens Print Name: Sit /�� TiC E LL� Signature: Date: C — "C9 r Q Owner O Contractor X Agent for Owner 0 Agent for Contractor .,.:,.�,; »:�.-,.;agryy�: ±Y.iDPrr'�'?"Z..�•,�-a`'�:Y°.Pi w"bray:'�:µ`,iM�.'4il-�PiIYS"` .;��.""a«.-.r�,f{�: r.,;� ,. .r. .a.oaa..�.y.. H,,�.�+>r•-a'�"rJ!'K�++'�iC".�;,'cr'-.rs.:::g-.rr.':-..•v:r:s•'f tY 036-176-006 PERMIT#95-0760 WILSON, David &Victoria.` 5296 Walmer Rd., Oroville -Cont; Tom,Warner � / Install •Woodstove/SF, ` A111 9G0 r R t ts. COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION '� 7 County Center Drive - Oroville, Cilifornta 95965 - Telephone (916) 538-754'�IJ -C) 'PERMIT NO. APPLICATION AND PERMIT 4f-) ASSESSOR PARCEL NUMBER 036-176-006 ZONING BUILMING PERMIT OWNER T• OWNER' MAILING ADDRESS 5296 r. CA 9-5066 CONTRACTOR'S NAME „ Tom a +tU,589-2069 TELEPHONE TELEPHONE SO. FT. OCC. BUILDING VALUATION CONTRACTOR' MAILING ADDRESS Fireplace A 1500 CONSTRUCTION LENDER UN OWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 35.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS 5296 Walmer Rd., Oroville PERMITFEE $ 55.00 PLUMBINGPERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar Or heat pump water heater 23.00 USEOFSTRUCTURE SF Q Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other'.€j ' twJJ: woodatove D'es Mobile HomeS G W @20.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filinq Fee 20.00 Main Service EOOV OR LESS ( 2ooA OR LESS 23.00 Main Service ( 200A TO 1000A 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ( License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. JM. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason - NEW CONST. DWELLING OCCUR SO. OR NS. ( 8 ACC. 3.5¢ FT. NEW CT CONST. MULTI-OUUTLETLE NON-RESID. ( BRANCH CIRCUITS 97.50 ( POWER APPARATUS 8 SINGLE OUTLET CTR. Ex. Occup. (OUTLET OR FIXTURES) 20 Q 1.00 BAL .00 Ex. Occup. (OFIXED OUTLETS D.OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier , MECHANICAL PERMIT• Filing 9 Fee 20.00 Heating , Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) �) 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 Workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X \ k, L I` l.. Date L� / (t Signature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 55.00 HAZ. I D. FEES I IMP I FLOOD CDF PARCEL PD HD ISSUFL This permit is hereby issued under ime applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. } / BYk),,,-+ � � Date `f/ y1 1 r // � ' PERMITEXPIRESON �. (Date) Receipt No. WHITE-D.D.S.-B.D.CANARY-ASSESSOR PINK -INSPECTOR GOLDENROD•APPLICANT J COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California .95965 - Telephone (916) 538-7541 ERMIT NO. APPLICATION AND PERMIT ASSESSOR PARCEL NUMBER 36 176 006 ZONING BUI ING PERMIT OWNE OWNERS MAILING ADDRESS CONI CT R -Ile, CA 9=5966 'S .11 TELEPHONE NE -2068 SO. FT. OCC. BUILDING VALUATION CONTRACTORS MAILING ADDRESS Fireplace A 1500 CONSTRUCTION LENDER UNKNOWN Total Valuation Is Filing Fee $ 20.00 LENDER'S MAILING ADDRESS Permit Fee $ 35.00 ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS 5296 Walmpr Rd. Oroville PERMITFEE $ 55.00 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF Q Duplex ❑ Mobilehome ❑ Other SPECIFY Water piping 15.00 Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other )0 Des&%%t*": woodstove Mobile Home I S I G IN 1 920.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filina Fee 20.'00 Main Service OOOV OR LESS ( 200A OR LESS ) 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. $� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUR OR ADONS. ( d ACC. BLDS. ) So. 3.5¢ FT. NEW) MULTI -OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) 8 SINGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES) 00 20 Q 1.00 BAL .50 Ex. Occup. FIXED PLNS. OR ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 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 workers compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1 ,( ' A 1lng��__ Date-- QX nature of Applicant - ❑ Owner ❑ Contractor ❑ Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 55.00 HA2. I D. FEES I IMP I FLOOD CDF PARCEL PD HD ISSU This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions indicated above for which fees have been B P MITEXPIRESON (D provisions to do work paid. DateZell9f_ e) Receipt No. I WHITE-D.D.S.-B.D. CANARY -A SESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTYOF BUTTE - DEPARTMENTOF DF-VELOPMENTSERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE (916) 538-7541 OWNER Proposed Building Use PERMIT APPLICATION DATA SHEET Building Inspector A. P. No. Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: 1. All items have been submitted. 2. Plot plans, 3/4 sets, signed by preparer of plans. 3. Complete plans, 3/4 sets, signed by preparer of plans. 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. 5. Hazardous Material Form. 6. Energy Design Compliance and supporting documentation. 7. Statement of Intent for Non -Heated and A/C Buildings. 8. Engineered truss details and layout in duplicate (required prior to plan check). 9. Mobilehome data and manufacturer's installation instructions, 2 sets. 10. Fees of $ 11. Impact fees as shown on attached schedule. 12. California Department of Forestry plan approval/fees. 13. Flood elevation letter (100 year flood) by California Engineer. 14. Sanitation and plot plan approval Health Department. 15. City of Chico plumbing permit. 16. Plot plan and business license approval from City of Biggs/Gridley. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. 19. Driveway permit (construction approval required prior to occupancy). 20. Pre -inspection for required. 21. Contractor's license information. (No., Name Style, Classification). 22. Certificate of Workmans Compensation Insurance. 23. Owner -Builder Verification (Given to owner , Mail to owner �. 24. Recorded copy of Agricultural Acknowledgement Statement. 25. Letter of signature authorization. 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. 27. Letter of intent on building use. 28. Mobilehome utility clearance. 29. Documentation of legal access. 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements. 31. Existing violations/expired permits. 32. Plan check list. 33. 34. When you issue the permit, process as follows: Mail to owner Telephone and hold for pickup at Other Mail to contractor. office. Deliver with inspector. Applicant Date EXPIRATION OF APPLICATION Applications for which a permit has not been issued, will expire by limitation one year after date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. FEE REFUNDS Refunds can only be made upon writtten request by the person who paid the fee. The request must be made within one year from the date of fee payment on permits not issued, and one yearfrom the date of permit issuancefor permits issued; however, on issued permits refunds can only be made if no construction work has been done. Filing fees, plan checking fees for work plan checked and other department costs are not refundable. Original - Applicant .. .. � ._._r, -.-,..,...v�l�..v..,,�.Mv'C��'•�.-�.J".'ti''✓V'J'wr'tis"4�'t'"c�..n'}.r.•�"►Y+�•T1Trlr��.-�.-�.r-,,,,.,,;�+r�^�Le,�r�;.ia - ,��-n•r"F•`.r-^rY,.�'.. COUNTYOF BUTTE - DEPARTMENTOF DEVEL OPMENTSERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALI'FORNIA95965 - TELEPHONE(916)538-r754,1- PERMIT ELEPHONE(916)538-754 -PERMIT APPLICATION DATA SHEET OWNER A. P. No. Proposed Building Use Building Inspector Date At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED BY 1. All items have been submitted........................................ . 2. Plot plans, 3/4 sets, signed by preparer of plans. ......................... . 3. Complete plans, 3/4 sets, signed by preparer of plans. ..................... . 4. Engineered plans and calcs, 3/4 sets, with wet signature on plans. ............. 5. Hazardous Material Form............................................. 6. Energy Design Compliance and supporting documentation . .................. 7. Statement of Intent for Non-Heated and A/C Buildings. ...................... 8. Engineered truss details and layout in duplicate (required prior to plan check). ... . 9. Mobilehome data and manufacturer's installation instructions, 2 sets. ........... 10. Fees of $ ......................................... . 11. Impact fees as shown on attached schedule. .............................. 12. California Department of Forestry plan approval/fees. ....................... . 13. Flood elevation letter (100 year flood) by California Engineer. ................. . 14. Sanitation and plot plan approval Health Department. ............ 15. City of Chico plumbing permit.......................................... ; 16. Plot plan and business license approval from City of Biggs/Gridley. 17. Planning approval for (A) Use: (B) Parking: 18. Contact Land Development about (A) Improvements (B) Drainage. .......... . 19. Driveway permit (construction approval required prior to occupancy). Pr Aspection request 20. Pre-inspection for required. . to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification). .............. 22. Certificate of Workmans Compensation Insurance. .......................... 23. Owner-Builder Verification (Given to owner , Mail to owner . .......... . 24. Recorded copy of Agricultural Acknowledgement Statement. .................. 25. Letter of signature authorization......................................... 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . 27. Letter of intent on building use.......................................... 28. Mobilehome utility clearance........................................... 29. Documentation of legal access. f 30. Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements. . A ............ 31. Existing violations/expired permits....................................... 32. Plan check list . ..................................................... 33. 34. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation Acreage Applicant Date Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. p 2. Additional items required: Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder f Copy - Department of Public Works