Loading...
HomeMy WebLinkAbout078-280-002` " ' " o 11 - .^- ^ ~~~� TRI STATE TESTING - JAE!\VHIS, TENNESSEE A CALIFORNIA APPROVED LISTING AGENCY ,``� *=�•.t'c''• sees TIE DOWN ENGINEERING CALIFORNIA APPROVED ANCHORING PRODUCTS MANUFACTURED HOUSING AND COMMERCIAL COA t/ INCLUDES SCHEDULES, DIAGRAMS FOR . SINGLE/DOUBLE/TRIPLE/QUADRUPLE WIDE UNITS ' } 1. PRODUCTS DESIGNED FOR A. SOIL ---1,000-4,000 AND UP PSF SOILS S D U TOR UE VALVE \fes r (CLASSES 1-4, 200-550 INCH POUND AN P Q �y (CLASSES. 1-5, UBC -CALIFORNIA) souCLASS(FICATtoN Af 10 DESCRIPTION OF SOILS Types of soil Blow Count Tatm Prob. 1 !ASTM D1586+ Torcue Value 2 ALLOWABLE PRESSURE I hard xo:k NA NA GENERAL DES (Pounds Per Square Foot) SOIL TYPE No allowance rnade for overburden based on theunifiedpressure, embedment depth, water dessilication system table height or settlement problems rock or hard an 4,000 and u0 Sand Gravel or Gravel 2.000 Sand, Sifty Sand, Clayey Sand, 1 500 Sity Gravel, or Clayey Gravel Clay, Sandy Clay, Sihy Clay, or 1,000 Clay. Silt Uncommitted Fill Special analysis is required. Peat or Organic Clays Soo M' I analysis is recuired. B. WIND—ZONE 1, 85 MPH EXPOSURE "C" ��c.iG�.v�f/4Ed r/Eo0WAI SYsr0in APPROVED SU ![C'� TO COR¢ECI(C't;5 NOTED Approvnl dors not .•:nF.orcc or cpprcve any omission or devic)ion Crum req:'iremenhs o: onpiicabie State lows and •etluloti�ns. Stoic of CaWornia Doprrie.ent of Huuairp send Ccmmvnity Development DIV:S!( t . Cr`%ES Ar+D 57ANCARDS t h'S Non r pi--irOvC: Ex,7, irCs.f C. SEISMIC—ZONE 4 214) Vary -d— aod'or • eaman:ed ,and+. coa•u G—al and cobbin. mora than pr.ieadad sifts. and clay, 44:7 SW tbs. Inch more than (b) Corals Coup 550 tbs. inch 3 itaca—eau. coa,. sa.-dy grads. vay iso to stiff fasts & day, 24.39 549 tbs. b h 4 Laos. to medium dmu ,ands. F .. to still days & 200 to ,its. alluvium 60 1:73 349 lbs. inch 5 Contex. slab Ten,icn•1g devien for use In cvntan ped. turner. tic. due be tated (same u anclhori) a -.d sped&.tion, es to FE.r and aa, tin of cont... r.Infac.mmt. s4.. and thiwru, of -.., s4. and dr3h of bah how. typ. and kind of shield a penrss34. htinimc•-h drat u ai which tensicbg device mn Its installed bom edgy a end of slab. pad. rurwe. I _ sins➢ Its tpeci5e: 6nszucaon skipped with each taucn'ug devc. .Rae .,dude N above. (a) TM tnt probe 4 a dMca ror mess ng de torque vale of sae, to assist In tvatuafng tM hotduhg capabIDty of the sags N h.9hich the anchor b plata. The tat probe has a heli. on t Th. —9 la,ghh of t., h.5rai section Is 10.75 'uhriha : de major dhunta Is 175 hears: the honor dum.:a b 0.81 Inches: Ch. pitch 1.75 h h.. T..hdt must Its of whabi iahgth for anchor (r,7c ' (h) A —a,— ,5-mtmous with mann: of a force 4— &.b .d around the shah d th. tot pmbs. , fc) Below thea vah-. a st o.Isionel sng — dm M its consulted a additional anchors add.& Design Wind -load Zones:. Standard Wind Zonel Hurricane Zone 11 Hurricane Zone III Note — psf: pounds per square foot 15 psf Horizontal 9 psf uplift t39 psf Horizontal 27 psf uplift =47 psf Horizontal 32 psi uplift ' net uplift 9661 13 0 ld30 :AvtU llfl9 3i1.R8 JO All-MQO Reference — Manufactured Home Construction and Safety Standards (MHCSS).24 CFR 3280.305(c)(2), latest edition - 2. CAPACITY OF ANCHORS - EACH GROUND ANCHOR, WHEN INSTALLED, SHALL BE CAPABLE OF RESISTING AN ALLOWABLE WORKING LOAD AT LEASE EQUAL' TO 3,150 POUNDS PLUS A 50 PERCENT OVERLOAD (4,725 POUNDS TOTAL) WITHOUT FAILURE. 3. CAPACITY OF STRAPPING - TIE DOWN ENGINEERING GALVANIZED STEEL STRAP MEETS OR EXCEEDS THE NCSBCS/ANSI 225.1-1994 AND THE ASTM -D 3953-91 SPECIFICATIONS FOR 1-1/4"X.035 (MIN.) TYPE 1, FINISH B, GRADE HOT DIPPED GALVANIZED STRAPPING. CONFORMS TO SB -750 REQUIREMENTS SECTION 1336.3 OF THE CALIFORNIA CODE OF REGULATION TITLE 25, 18613.4 OF THE HEALTH AND SAFETY CODE. PAGE 1 Side Frame Ties' gust Be No More Than 2' From Each End Of Unit, Other Ties Spaced Evenly Thoughout The Length Of Unit, Side Ties —I I— 2' Max. —I (— 2' Max. Single Wide Unit End Ties Wind - Zone I (85 MPH - Exposure "C") Seismic - Zone 4 Required Number Of Tledowns For Each Side And Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tiedown Locations Side I End Side I End Single Wide Total Number oadorns 4 2 4 2 12 12 Side End Side End 5 2 6 2 14 16 . tl Side_ _End 7 2'- Side End 7 2 lG Side End 8 2 20 Side End 8 2 20 Side Q End 2 20 Side Frame Ties Must Be No More Than 2' From Each End Of Unit. Other Ties Spaced Evenly Thoughout The Length Of Unit, Side Ties —I I— 2' Max. —I I— 2' Max. Double Wide Unit. End Ties Wind - Zone I (85 MPH - Exposure "C") Seismic -' Zone 4 Required Number Of Tiedowns For Each Side And Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tiedown Locations Side End Side End Side I End Side EnT Side I End Side End Side I End Side I End Side End Single Wide 4 4 4 4 5 4 6 4 7 4 7 '4 8 4 8 4 8 4 Teda.nNumber OF 16 16 18 20 22 22 24 24 24 M w WARNING BEFORE BEGINNING GROUND ANCHOR INSTALLATION, MAKE SURE THE ANCHOR LOCATIONS WILL NOT BE CLOSE TO ANY UNDERGROUND ELECTRICAL CABLES, WATER LINES, SEWER LINES OR GAS LINES. FAILURE TO DETERMINE THE LOCATION OF ELECTRICAL CABLES OR GAS LINES MAY RESULT IN SERIOUS INJURY OR DEATH. 1. PARTIALLY INSTALL APPROPRIATE GROUND ANCHOR ALLOWING TENSION HEAD. -TO MAINTAIN APPROXIMATELY 14" TO 16" MINIMUM GROUND CLEARANCE. 2. USING OVERSIZED HAMMER, VERTICALLY INSTALL STABILIZER PLATE BETWEEN FRAME A.ND ANCHOR. THE TOP SECTION OF THE STABILIZER PLATE MUST BE DRIVEN FLUSH ' WITH THE GROUND TO INSURE SURFACE SOIL COMPACTION. 3. FULLY INSTALL GROUND ANCHOR UNTIL TENSION HEAD BOTTOMS OUT AGAINST STABILIZER PLATE. INSTALLER/CONTRACTOR CERTIFICATION I CERTIFY THAT I HAVE INSTALLED THE TIE DOWN ENGINEERING ANCHORING SYSTEM AS PER TIE DOWN'S INSTALLATION INSTRUCTIONS AND THAT NO MODIFICATIONS HAVE BEEN MADE TO THE ANCHORING SYSTEM OR BUILDING STRUCTURE. COMPANY NAME: DATE: CONTRACTORS LICENSE # SIGNATURE • PAGE 9 Side Frame Ties Must Be No More Than 2' From Each End Of Unit., Other Ties Spaced Evenly Thoughout The Length Of Unit, Wind - Zone I (85 MPH - Exposure "C°) Side Ties Seismic - Zone 4 —I I— 2' Max. —I I— 2' Max. Triple Wide Unit End Ties Required Number Of Tledowns For Each Side And Each End Unit Length 20' 30' 40' S0' " 56' .60' 62' 66' 70' Tiedown Locations . Side End Side End Side End Side End Side End Side End Side End Slde End Side End Single Wide 4 6 4 6 5 6 6 6 7 6 7 16 8 6 8 1 6 8 6 Totnl Number Of 20 Tledo.ns 20 22 24 26. 26 28 28 28 TT w Q a AUEE TES -I G SERVICES, INC. September 28, 1994 Mr. Locke M. Jones Tie Down Engineering 5901 Wheaton Drive Atlanta, GA 30336 Dear Mr. Jones: LISTING NUMBER: TIE -942609 Having completed the in-house audit of quality control, quality assurance, procurement, welding procedures, etc., Tri-State Testing Services in compliance with the rules and regulations of the Department of Housing of California lists the following products: MODEL NUMBER PART NUMBER M121-15/8 59080 M12H3/4 59085 M1225/8 59090 M1223/4 59095 MIT2 59115 MIJ2 59120 MICS2 59125 59250 59250 MRA�� 59110 MIC2 59096 59292 59292 MGRS 59145 MIDH 59100 MIS2 59105 DESCRIPTION 5/8" X 58" DOUBLE HEAD ANCHOR W/6" AUGER 3/4" X 48" DOUBLE HEAD ANCHOR W/6" AUGER 5/8" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS 3/4" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS 3/4" X 8" DOUBLE HEAD THREADED ROD PATIO ANCHOR 5/8" X 12" DOUBLE HEAD J -ROD SLAB ANCHOR PATIO ANCHOR W/EXPANSION BOLT 3/4" X 36" DOUBLE HEAD ANCHOR W/6" & 4" AUGER CROSS DRIVE ROCK ANCHOR 3/4" X 30" ROD 5/8" X 30" CORAL ANCHOR LATERAL STABILIZER PLATE GALVANIZED ROOF BRACKET DOUBLE HEAD ONLY SWIVEL ADAPTER HEAD 67 56 BUCKLES COVE MEmpFiis, TN 38 1 33 901-385-1 199 FAx 901-386-66 1 4 PAGE 10 D� M Side FroLme Ties Must Be No More Than 2' From Each End Of Unit. Other Ties Spaced Evenly Thoughout The Le'ng-th Of Unit. Wind - Zone I (85 MPH' - Exposure "C") Side Ties Seismic • — Zone 4 —I .I 2' Max. —I'. 1-21 Max. Quadruple Wide Unit End Ties a Required Number OF Tledowns For Each Side And Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tledown Locations Side End Side I End Slde End Side End_ Slde End Side End Side I EndSide End Side End Single Wide 4 0 4 1 0 5 0 6 fl 7' 0 7 0 fl B_ 8 B I _ fl fl otul Nunber o.F Tledo.ns 24 24 "26 20 30 30 32 32 32 TIE DOWN ENGINEERING INDEPENDENT TESTING RESULTS ULTIMATE MODEL NO. DESCRIPTION OF TEST STRENGTH TEST DATE MI2H VERTICAL PULL-OUT IN MOIST SILTY CLAY. 6,133# 9/15/92 (5/8"&3/4-) TEST. PROBE TORQUE VALUE BETWEEN (AVG.) _ 200-349 INCH POUNDS - M122 VERTICAL PULL-OUT IN SILTY SAND AND GRAVEL . 5,733# (518"&3/4-) TEST PROBE TORQUE VALUE 550 INCH POUNDS (AVG.) AND MORE -j -- MRA . , VERTICAL PULL-OUT IN LABORATORY FDCTURES 5,567 FOR SIMULATION. UNCONFIRMED ROCK WAS NOT AVAILABLE. MICS2 VERTICAL PULL-OUT IN 2500 PSI CURED 5,200# CONCRETE. TEST STOPPED AT 5,200 POUNDS. MIJ2 VERTICAL PULL-OUT IN 2500 PSI CURED 5,200# CONCRETE. TEST STOPPED AT 5,200 POUNDS. - MIT2 : VERTICAL PULL-OUT IN 2,500 PSI CURED 5,200# CONCRETE. TEST STOPPED AT 5,200 POUNDS. MI2H64 VERTICAL PULL-OUT IN SILTY CLAY. TEST PROBE 5,200# (59250) TORQUE VALUE BETWEEN 200-340 INCH POUNDS ML 45 DEGREE PULL ON STABILIZER PLATE IN SILTY 6,067# (59292) CLAY: TEST PROBE TORQUE VALUE BETWEEN (AVG.) 200-349 INCH POUNDS - 9/15/92 3/2193: 3/24/94 3/30/94 3/30/94 10/6/93 NOTE: ALL ABOVE TESTS WERE CONDUCTED BY ATEC ASSOCIATES, PRODUCT TESTING, INC. AND GALLET & ASSOCIATES. THE INDIVIDUAL TEST RESULTS WILL BE MADE AVAILABLE UPON REQUEST. PLEASE FORWARD YOUR REQUEST FOR THIS INFORMATION TO: TIE DOWN ENGINEERING 5901 WHEATON DRIVE ATLANTA, GEORGIA 30336 PAGE 7 Engineering Calculations 85 MPH Wind EXP "C" P. LAT=(1.06)(1.3)(17)(1)=25.6 PSF W LAT=(25.6 PSF)(131)=333 PLF • .i 85: MPH Wind EXP ".C" Vs, Seismic Zone 4 th 333 PLF=0.186 1(32.5)( Or )+160] Lengthth a=50.8'=D 51' vwih Seismic Zone 4 V=0.186(DL) V=0.186 C(10 PSF)( Length )+(T +10 Psf)(Length )+(2 WALLS)(8')(10 PSF)] Wind - Zone 1 (85 MPH - Exposure "C") Seismic - Zo.ne 4 Width Length Load/Load Trans Trans Total Lond (Trans) Total Load (Long) 0Trans T.D. Side 'ries It Long T.D: End Ties Single 40 FT. 333/333 13,320 LBS. 4,662 LBS, 5 2 50 FT. __333/333_16,650 - LBS._ _4,662 LBS. 6 2 Wide To 14' 60 FT. 333/392 19,980 Lbs. 5,488 LBS. 7 ---- 2 , 70 FT. 333/453 23,310 LBS. 6,342 LBS. 8 2 40 FT. 333/333 13,320 LBS. 9,324 LBS. 5 4 Double Wide TO 28' 50 FT. 333/333 16,650 LBS. 9,324 LBS. 6 4 60 FT. 333/392 19,980 Lbs. 10,976 LBS. 7 4 70 FT. 333/453 23,310 LBS. 12,684 LBS. 8 4 Triple Wide To 42' 40 FT. 333/333 13,320 LBS. 13,986 LBS. 5 6 50 FT. 333/333 16,650 .LBS. 13,986 LBS. 6 6 60 FT. 333/392 19,980 Lbs, 16,464 LBS. 7 6 70 FT. 333/453 23,310 LBS. 19,026 LBS. 8 6 Quad Wide TO 50' 40 FT. 333/333 13,320 LBS. 16,650 LBS. 5 8 50 FT. 333/333 16,650 LBS. 16,650 LBS. 6 8 60 FT. 333/392 19,980 Lbs. 19,600 LBS.- 7 8 70 •FT. 333/453 23,310 LBS. 22,650 LBS, 8 8 co w Q a TIE DOWN ENGINEERING ANCHORING SYSTEM MI2H (5/8"-3/4") . 48" LONG ANCHOR NERAL STABILIZER PLATE :.MI22 (5/8"-3/4") ;`30" LONG ANCHOR PAGE 8 SIDE FRAME TIE (MBU) J J J J l MRA (ROCK ANCHOR) . o0 00 o� BUCKLEM STRAP (SIDE FRAME TIE) , MLFT (END FRAME TIE) If you have any questions or if we may be of further help, please call us. Sincerely, TRI-STATE TESTING. SERVICES, INC. William E. Jac son Manager TRI -OVAL TESTING SERVICES, II PAGE 11 Tie Down Engineering •` Page 2 September. 28, 1994 BCS 59175 CRIMPING SEAL FOR 1-1/4" STRAP MBU 59140 GALVANIZED STRAP BUCKLE . . MBUS 59139 SPECIAL GALVANIZED STRAP BUCKLE BISB 59135 SLOTTED BOLT AND .NUT MS33 59149 1-1/4" X 33' GALVANIZED STRAP MS35 . 59150 1-1/4" X 35' GALVANIZED STRAP MS37 59155 1-1/4" X 37' GALVANIZED STRAP MS42 59160 1-1/4" X-42' GALVANIZED STRAP MS60 59165 1-1/4" X 60' GALVANIZED STRAP MS600 - - 59 t70 1-1/4" X 600 GALVANIZED STRAP MHT6 59185 1-1/4" X 6' FRAME TIE W/HOOK . MHT7 59190 1-1/4" X 7' FRAME TIE W/HOOK MHT8 59195 1-1/4" X 8' FRAME TIE W/HOOK MHT10 59210 1-1/4" X 10' FRAME TIE W/HOOK MHT12 59211 1-1/4" X 12' FRAME TIE W/HOOK MHT15 59050 1-1/4" X 15' FRAME TIE W/HOOK ' MBU6 59137 1-1/4" X 6' FRAME TIE W/BUCKLE MBU7 59141 1-1/4" X 7' FRAME TIE W/BUCKLE MBU8 59142 1-1/4" X" 8' FRAME TIE W/BUCKLE MBU10 59.138 1-1/4" X 10' FRAME TIE W/BUCKLE MBU12 59144 1-1/4" X 12' FRAME TIE W/BUCKLE MBU15 59143 1-1/4" X 15' FRAME TIE W/BUCKLE If you have any questions or if we may be of further help, please call us. Sincerely, TRI-STATE TESTING. SERVICES, INC. William E. Jac son Manager TRI -OVAL TESTING SERVICES, II PAGE 11 STATE OF CALIFORNIA - BUSINESS. TRANSPORTATION ;NO HOI.:SING AGENCY PETE WILSON Governor DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT DIVISION OF CODES AND STANDARDS o 1800 THIRD STREET, Suite 260 P.O. Box 1407 SACRAMENTO, CA 95812-1407 (916) 445-9471 FAX (916) 327-4712 TDD 800-735-2929 F?. " .� ,lJ September 29, 1994 O C T 0 5 1994 William E. Jackson, Manager—U-j-� (j.� J Tri-State Testing Services, Inc. ______------------------- 6756 -__._.___----.__6756 Buckles Cove Memphis, TN 38133 Dear Mr. Jackson: This is to confirm that the California Department of Housing and Community Development has approved your funis application to become an approved testing and listing agency for load bearing supports and structural components used with manufactured homes, mobilehomes and commercial coaches. This approval is for the listing and labelling of structural components used in the manufactured housing industry in accordance with the standard established by your f=. Please note the Department may require design calculations and test data be submitted to substantiate a design when the listed system or component does not appear to conform to your approved standard. We may also request this information for the purpose of routine monitoring or.complaint investigation. Revisions to your approved standard as well as listed designs may be necessary in the future as a result of amendments to current statutes and/or regulations. Thant: you for choosing to become an approved listing and testing agency. If in the future you have any questions or need to discuss a particular issue, you may contact either myself at (916) 445-9471 or Mike Rosenberg at (916) 255-2501. Sincerely, Chris L. Anderson Mobilehome Parks Program Manager cc: Mike Rosenberg PAGE 12 It -0 23 036 023-006 PERMIT#95-2424 5-2424 BIGELOW, Steven - 0 0 [3050 Oro -Bangor Hwy03 Oroville Mo j Mobilehome Installation 7 -7143 1-f - Uu57 OFFICE COPY Address---------- ------ GAS Da Meter By ELECTRIC Meter By D te w COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION + 7f Gaanty Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMITS"` ASSESSOR PARCEL NUMBER 036-023-006 ZONING BUILDINGPERMIT OWNERS7T.M BIGEL& _ T X4-141 SO, FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS PO BOX 2751 OROVILLE, 95%5 NAME ^R TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 3050 ORO BANGOR WY /�/ L PERMITFEE PERMITFEE $ 00 - OROVIi.I,E, 95%6 Filing Fee 20.00 Each Trap 7.00 LOT NO. 7sUBDNI310N'S NAME PARCEL MAP ,Solar or heat pump water heater 23.00 USEOFSTRUCTURE ` SF`❑ .Duplex ❑ MobilehomeM Other 1- SPECIFY I: Water piping 15.00 Each gas water heater or vent 15.00 Gars- piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation !] Other ❑ Describe Work: iTT/ 43y .�7y3 Y Mobile Home I S I GI W 1 920.00 PERMITFEE $ Contractor ELECTRICAL PERMITFilin Fee 20.00 .a -.eoovsOR LESS Main Service ( zooA OR LESS ) 23.00 _R ff�'s•.. ) Main Service ( 200A To I000A ) 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 d effectr'`.. y., License Class Llc. No. 'r2..: ` OWNER=BUILDER DECLARATION "�;, . i 1 herebyaffirm under penalty of perjury that I,am exem t from thel.Contractors License P tY P J rY P Law fo�,the following red -soy"' t s Q2 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 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 NEW CONST. / DWELLING OCCUP. SO. OR ADDNS. \ 3 ACC. BUDS. ) 3.50 FT. NEW CONST. / MULTI.OUTLET NON-RESIO. \ BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) ,, SINGLEERePAROUTLET S Ex. Occup. (OUTLET OR FIXTURES) 20 Q I.00 BAL 50 FIXED APPLNS. OR EX. Occup. (OUTLETS (RESID.) EA ), 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMITFEE $ Contractor 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 Xof one hundred dollars ($100) or less.) 'El 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. Date,��_ � Signature of Applicant - titre' 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 Is 100.00 Energy Inspection Fee $ Occ CONST. TYPE TOTAL FEE $ Y 143.00 HA2. D. FEES IMP FLOQD .V/ cDF rp c PO V/ ISSUE V/ This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to co work indicated above for which fees have been paid. r //- , BY ///"`444«< + i - t� ., 1Datey PERMITEXPIRESON (Date) Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT I$#' :- •'(P,i r. ':.ti;i v t•„4o .pl.. :i F_: f ,p, ' i •-c° ;4= +�wr': rn :. :r Vii. i. _y"•Ly.".'..`i.Tr. :r i i f MOBILEHOME INSTALLATION ACCEPTANCE COUNTY OF BUTTE DEPARTMENT 'OF DEVELOPMENT SERVICES ` BUILDING DIVISION --7 COUNTY CENTER DRIVE OROVILLE, CA 95965 --PHONE (916) 538-7541 APN: =�o�� PERMIT NO:: a Owners: % /� 6e:1r—•� �(/ Name: Owners: Address: Mobilehome {� S>r`I Year of (� Manufacturer /V at) W 0 / w Manufacture: Serial number Insignia or o 14 or V.I.N. UD number: la y Official approving installation: / Date: If the mobilehome is moved or relocated, the mobilehome installation acceptance shall become invalid. This form shall not be used when the mobilehome is installed on a foundation system. 513B White -Owner, Yellow -Installer, Pink -Bldg., Gold -Assessor COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - 7 County Center Drive - Oroville, ,California 95965 - Telephone APPLICATION AND PERMIT BUILDING DIVISION (916) 538-75,�6-_ Z? ,PIR T NO. ASSESSOR PARCEL NUMBER 036-023-006 ZONING BUILDING PERMIT OWNER STEVEN BIGELO[d T534NE1414 SO. FT. OCC. BUILDING VALUATION OWNERS "UNG ADDRESS BO BOX 2751 OROVILLE, 95965 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTORS MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNIDJOWN Total Valuation Is Filing Fee $ 20,00 LENDER'S MAILING ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS 3050 ORO BANGOR MN PERMITFEE PERMITFEE $ 43.00 OROVILLE, 95966 Filing Fee 20.00 Each Trap 7.00 LOT NO. SUBDNISION'SNAME PARCEL MAP Solar or heat pump water heater 23.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehomey 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 ❑ Ulil'Ities ❑ Installation Other ❑ Describe Work: i` �/ `!(� Mobile Home IS I GI W1 920.00 PERMITFEE $ Contractor ELECTRICAL PERMIT Filina Fee 20.'00 r k-Ae �� /, y</ Main Service EoOV OR LESS ( zooA OR LESS ) 23.00 Main Service ( zooA To I000A ) 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 herebyaff" m under penalty of perjury that I am exempt from the Contractors License ,r p ty p) ry p Law fo a 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 SO. OR ADDNS. ( 8 ACC. BLDS. ) 3.50 FT. NEW CONST. MULTI.OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 ( POWER APPARATUS ) 8 SINGLE OUTLET CIR. Ex. Occup. (OUTLET OR FIXTURES ) 2L t I•50 BAL 50 Ex. Occup. ( OUTELETS(RRES6.)EA) 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 Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Polis Number eabove sections need not be completed if the permit is for work of a valuation of one hundred dollars 0) or less.) 41 I certify that in the per ma ce of the wor for which this permit is issued, I shell ny p son i any manner. o as to become subject to workers' cla of Calif rnia, and a e that if I should become subject to the nks' pe cation rovisions o section 3700 of the Labor Code, I shaop with tho a pro 'si s. X ____ Date �O'�-- Signature of Applicant —fid w er ❑ Contractor ❑ gent 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 $ 00 Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ g4work HAZ. D. FEES P FLOQo .Y/ cOF c ,// This permit is hereby issued under the applicable of the Butte County Code and/or Resolutions t indicated above for which fees have been paid. BY Asi Dipite PERMITEXPIRESON (Date) Receipt No. WHITE-D.D.S.-E.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION z DEPARTMENT OFDOVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 N CORRECTION NOTICE 4U->T-ERMIT NO. A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work IS complet d. If you have any questions pertaining to this matter, or need additional explanation, please ntact this office immediately. .c- ,y!\ 11 V .► 7 / G: ii /z, 11 . / _ . —�-� l / 1 Date r" —( Inspecto REV 10192 i TRI STATE TESTING - MEMPHIS, TENNES?EE A CALIFORNIA APPROVED LISTING AGENCY '�Sj:1T,E779• ems,, ,�•;r.`.; j'�, - TIE DOWN ENGINEERING CALIFORNIA APPROVED ANCHORING PRODUCTS% 1�i A MANUFACTURED HOUSING AND COMMERCIAL CO - V. INCLUDES SCHEDULES, DIAGRAMS FOR _ SINGLE/DOUBLE/TRIPLE/QUADRUPLE WIDE UNITS. ~'✓f s+ .,; `,' o . r , •.�' mow• • 't.' `i:` 'T::` .ilii e -a:, :tush'.,. %.. _.• 1. PRODUCTS DESIGNED FOR A. SOIL ---1,000-4,000 AND UP PSF SOILS H pOUNDS AND UP TOR TM VALVE (CLASSES 1-4, 200-550 INC Q �y (CLASSES 1-5, UBC -CALIFORNIA) SOIL CLASSIFICATION P f o GENERAL DESCRIPTION OF SOILS Blgw count ALLOWABLE PRESSURE (Pounds Per Square Foot) SOIL TYPE No allowance made for overburden based on the unified pressure, embedment depth, water classification system table height or settlement problems rock or hard pan 4,000 and u Sandy Gravel or Gravel 2.000 Sand, Silty Sand, Clayey Sand, 1,500 Silty Gravel, or Clayey Gravel preioadad silts. and clays Clay, Sandy Clay, Silly Clay, or 1.000 Clayey Silt Uncommitted Fill Spectral analysis is required. Peat or Organic Clays Soecial analysis is required. B. WIND—ZONE 1, 85 MPH EXPOSURE "C" APPROVED SUCaECT TO CORr,EC1ICINS NOTED APDrov^r s al do( -5 not .•;nVori. coreve any omission o, cie-;CtFar. from regv6rmcn:s of coriNcable State lows and •esiulOiicn;. Sfule of C Aifornio Detsartment of Housing a„d Community Develepmem DIWSIU d COC` S A;eD S7ANDARDS / l✓ Cote.Zty�/- Z_/Z (siynatu: e) .SPA tiG. — 11 7IN”, Phan Ap,-,r-)vcz! Expires- li2 /� - C. SEISMIC—ZONE 4 s. Types of Soil Blgw count Test Probe 1 !ASTM D15861, Torque Value 2 1 Hard rock NA NA 21.) Ve -dend'. cemented sends. coa.•s. grand cobbles, avel more then preioadad silts. and clays 40 -up 550 lbs. tach more than Ib) Corals 40..p SW lbs. Inch 3 hkdtumdmu cosi,. sands. sandy gravels, uery• 350 to stiff 0"8: 1 yt 2:39 549 Its. tech 4 Laos. to medium dans. ., sands. I to stillclays & 200 to alluvium U1423 349 lbs. inch 5 C—.,. slab Tali-ing device for use I, =—,;a pad, new. ec, aW be tested (same as anchors) -d specificadon. as to PSI and age time of concrete, ronfort.—I. size, and thick,:., of onna.te, size and depth of bob We. type and kind of shield If permissible. Mir— distance at which tmsionb,g device can be 6uianed from edge or end of -slob. pad. rvr,ne. etc. shall be tpaci5e1— It. -cont shipped with each tensioning dew`s fisn v,c!vde the abw.. - (a) The test probe Is a device for maasuv t; the torque value or foes to assist In evaluating the holdv,g capability Of the saes n which the anchor Is placed. The tet prose h:s a her. - h. The —an_ of :he hall.! .ado. Is 10.75 inches: the rr m dumte, . It 125 inches; the minor e.-mra b h,c 0.81 hd—: the pitch 1.75 as. The shalt must be of suitable length for anchor de-;:t, (b) A measure tynon,mous with ,ewes,+ of a force w h— dbulbuted around the shaft of the test probe. ow ' (c) Belthese .1—. a profeftioriai engirx should be c—. -tad or additional anchors added. Desion Wind -load Zones:. Standard Wind Zone I Hurricane Zone II Hurricane Zone III Note -- psf: pounds per square foot 15 psf Horizontal 9 psf uplift' X39 psf Horizontal 27 psf uplift -47 psf Horizontal 32 psf uplift net uplift 566 0 1 3 0 1d30 ClNiaiine 3111'38 AO AIM100 Reference — Manufactured Home Construction and Safety Standards (MHCSS) 24 CFR 3280.305(c)(2), latest edition 2. CAPACITY OF ANCHORS - EACH GROUND ANCHOR, WHEN INSTALLED, SHALL BE CAPABLE OF RESISTING AN ALLOWABLE WORKING LOAD AT LEASE EQUAL TO 3,150 POUNDS PLUS A 50 PERCENT OVERLOAD (4,725 POUNDS TOTAL) WITHOUT FAILURE. 3. CAPACITY OF STRAPPING - TIE DOWN ENGINEERING GALVANIZED STEEL STRAP MEETS OR EXCEEDS THE NCSBCS/ANSI 225.1-1994 ,4ND THE ASTM -D 3953-91 SPECIFICATIONS FOR 1-1/4"X.035 (MIN.) TYPE 1, FINISH B, GRADE HOT DIPPED GALVANIZED STRAPPING. CONFORMS TO SB -750 REQUIREMENTS SECTION 1336.3 OF THE CALIFORNIA CODE OF REGULATION TITLE 25, 18613.4 OF THE HEALTH AND SAFETY CODE. PAGE 1 Side Frame Ties Must Be No More Than 2' From Each End Of Unit, Other Ties Spaced Side Ties Evenly Thoughout The Length Of Unit, 2' Max. -I I- 2' Max. t I J End Ties Single Wide Unit Wind - Zone I (85 MPH - Exposure "C") Seismic Zone 4 Re ulred Number Of Tiedowns For Each Side And Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tledown Locations Side End Side End Side End Side q2t Side ,.End_ _ , Slde End Side End Slde End Side End Single Wide 4 2 4 2 Total Number Of Tiedowns 12 12 5 2 6 14 16 c 7 2 18 1 7. 2 1 18 8 2 20 8 2 20 8 2 20 M w Side Frame Ties Must Be No More Than 2' From Each End Of Unit. Other Ties Spaced Evenly Thoughout The Length Of Unit. Side Ties —I I— 2' Max. —I I— 2' Max. _. Double .Wide Unit 3 End Ties Wind - Zone I (85 MPH - Exposure "C") Seismic - Zone 4 F Required Number Of Tiedowns For Each Side And Each End Unit 'Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tiedown Locations Side I End Side I End Side I End Side End Side End Side I End Side End Side I End Slde End Single Wide' 4 1 4 1 4 S 1 4 6 1 4 7 4 7 1 4 8 4 8 1 4 8 TNumber of 16 16 18' 20 22 22 24 24 24 �edo Tledowns 4 Side Frame Ties Must Be No More Than 2' From Each End Of Unit., Other Ties Spaced Evenly Thoughout The Length Of Unit, Wind - Zone I (85 MPH - Exposure "C") Side Ties Seismic - Zone 4 —I I—'2' Max. —I �-- 2' Max. Triple Wide Unit End Ties Required Number Of Tledowns For Each Side And Each End 56' .60' 62' 66' 70' Unit Length 20' 30' 40' 50'=Fs=i Tledown Locntlons Stde End Side End S dde End Side de End Side. End Side End Side End Side End Single Wide 4 6 4 6 5 6 6.. 6+ 7 - 6 7• 6 8 6 8 6 8 6 Total Number OF 20 20 22 24 26 _ 26 28 28 28 Tledowns W Q Ia. Side Frame Ties Must Be No More Than 2' From Each End Of Unit, . Other Ties Spaced Evenly Thoughout The Length Of Unit, m Wind - Zone I (85 MPH - Exposure "C") Side nes Seismic - Zone 4- 2' Max. —I I— 2' Max. . . 1 t f f -Quadruple Wide Unit ti / End Ties Required Number OF Tledowns For Each Side And'Each End Unit Length 20' 30' 40' �— Frame —7 i 56' 60' 62' ;> L- Frame t• ..—J.. 70' ry� 4 Frame Side 4 End 8 L Frame _ End 8• _ •Side 6 : End 8 _ Side 7 `.I End 8 -Quadruple Wide Unit ti / End Ties Required Number OF Tledowns For Each Side And'Each End Unit Length 20' 30' 40' 50' 56' 60' 62' 66' 70' Tledown Locations Single Wide Side End 4 8 Side 4 End 8 Slde 5 _ End 8• _ •Side 6 : End 8 _ Side 7 `.I End 8 Side 7 End- Side 8 i B End B Side 8 End 8 Side 8 End 8_— otal Number Of Tledorns 24 24 26 28 � 30 30 ' 32 32 _ 32 • �,�. .e; ., i. I tri.. fi�i(i� : a:.: Engineering Calculations' 85 MPH Wind EXP °C" 85 MPH Wind EXP 'T" Vs, Seismic Zone 4- P LAT=(1,06)(1,3)(17)(1)=25.6 PSF 333 PLF=0.186 1(32.5)( V�h)+160] W LAT=(25,6 PSF)(13')=333 PLF ` r =50.8'=D 51Will' Seismic Zone 4 V=0,186(DL) V=0.186 C(10 PSF)(`,`, M31 +10 Psf>(� b, )+(2 WALLS)(8')Q0 PSF)] Wind - Zone 1 (85 MPH - Exposure "C') Seismic - Zo.ne 4 Width Length Load /Load Trans Trans Totnl Lond , <1'rnns) Total Load - (Long) tt Tr nns T.D. Side 71es B Long T.D. End Ties 40 FT. '333/333 13,320 `LBS. 'A662 4,662 LBS. 5 2 Single 50 FT. 333/333 16,650 LBS. 4,662 LB'S.. 6 2 Wide To 14' C 60 -F -T.`__ -_ �. _ _ ___�__ 333/392- - 19,980 Lbs..._5,488_ LBS.____ _ _ 7 - - - - 2 70 FT. 333/453 23,310 LBS. 1 6,342 LBS. 8 2 Double 40 FT. 333/333 13,320 LBS. 9,324 LBS. 5 4 50 FT. 333/333 16,650 LBS. 9,324 LBS. 6 4 Wide Wi28' 60 FT, 333/392 19,98Q Lbs. '10,976 LBS. 7 4 70 FT, 333/453 23,310 LBS. 12,684 LBS. 8 4 40 FT. 333/333 13,320 LBS. 13,986 LBS. 5 6 Triple Wide To 42'60 50 FT, 333/333 16,650 LBS. 13,986 LBS. 6 6 FT. 333/392 19,980 Lbs. 16,464 LBS, 7 6 70 FT, 333/453 23,310 LBS. 19,026 LBS. 8 6 40 FT. 333/333 13,320 LBS. 16,650 LBS. 5 8 Quad Wide Wi50' 50 FT. 333/333 16,650 LBS. 16,650 LBS. 6 8 60 FT. 333/392 19,980 Lbs. 19,600 LBS.- 7 8 70 FT, 333/453 23,310 LBS. 22,650 LBS. 8 8 TIE DOWN ENGINEERING INDEPENDENT TESTING RESULTS ULTIMATE MODEL NO. DESCRIPTION OF TEST STRENGTH TEST DATE MI2H VERTICAL PULL-OUT IN MOIST SILTY CLAY. 6,133; 9/15/92 (5/8"&3/4") TEST -.PROBE TORQUE VALUE BETWEEN (AVG.) __ 200-349 INCH POUNDS- MI22 VERTICAL PULL-OUT IN SILTY SAND AND GRAVEL . 5,7-33#r 9/15/92 (5/8"&3/4") TEST -PROBE TORQUE VALUE -550 INCH POUNDS (AVG.) AND MORE- MRA. VERTICAL PULL-OUT IN LABORATORY FIXTURES 5,567; - 3/2/93 FOR SIMULATION. UNCONFIRMED ROCK WAS NOT AVAILABLE. MICS2 VERTICAL PULL-OUT IN 2500'PSI CURED 5,200n 3/24194 CONCRETE. TEST STOPPED AT`5,200 POUNDS. MU2..• VERTICAL PULL-OUT IN 2500:PSI CURED 5,200 3/30/94. CONCRETE. TEST STOPPED AT 5,200 POUNDS. ' MIT2 VERTICAL PULL -O' UT IN:215b(r�PSI CURED 5,200f 3/30/94 CONCRETE. TEST STOPPED AT 5,200 POUNDS. - M12ZH64 1 VERTICAL PULL-OUT IN SILTY CLAY. TEST PROBE, 5,200; 10/6/93 (59250) TORQUE VALUE BETWEEN 200-340 INCH POUNDS ML � 45 DEGREE PULL ON -STABILIZER PLATE IN SILTY - 6,067 8/57.92y (59292) CLAY: TEST PROBE TORQUE VALUE BETWEEN (AVG.) 200-349 INCH POUNDS - NOTE: ALL ABOVE TESTS WERE CONDUCTED BY ATEC ASSOCIATES, PRODUCT TESTING, INC. AND GALLET & ASSOCIATES. THE INDIVIDUAL TEST RESULTS WILL BE MADE AVAILABLE UPON REQUEST. PLEASE FORWARD YOUR REQUEST FOR THIS INFORMATION TO: TIE DOWN ENGINEERING 5901 WHEATON DRIVE ATLANTA, GEORGIA 30336 PAGE 7 TIE DOWN ENGINEERING ANCHORING SYSTEM ITERAL STABILIZER PLATE MI22 (5/8"-3/4") 30" LONG ANCHOR MI2I3 (5io°-3/4 48" LONG ANCHOR MRA (ROCK ANCHOR) . o0 00 o� BUCKLENV STRAP (SIDE FRAME TIE) MLFT (END FRAME TIE) WARNING BEFORE BEGINNING GROUND ANCHOR INSTALLATION, MAKE SURE THE ANCHOR LOCATIONS WILL NOT BE CLOSE TO ANY UNDERGROUND ELECTRICAL CABLES, WATER LINES, SEWER LINES OR GAS LINES. FAILURE TO DETERMINE THE LOCATION OF ELECTRICAL CABLES OR GAS LINES MAY RESULT IN SERIOUS INJURY OR DEATH. 1. PARTIALLY INSTALL APPROPRIATE GROUND ANCHOR ALLOWING TENSION HEAD-- TO MAINTAIN APPROXIMATELY 14" TO 16" -MINIMUM GROUND CLEARANCE. 2. USING OVERSIZED HAMMER, VERTICALLY INSTALL STABILIZER PLATE BETWEEN FRAME AND ANCHOR. THE TOP SECTION OF THE STABILIZER PLATE MUST BE DRIVEN FLUSH WITH THE GROUND TO INSURE SURFACE SOIL COMPACTION. 3. FULLY INSTALL GROUND ANCHOR UNTIL- TENSION HEAD BOTTOMS OUT AGAIINTST STABILIZER PLATE. e mb 2) INSTALLER/CONTRACTOR CERTIFICATION I CERTIFY THAT I HAVE INSTALLED THE TIE DOWN ENGINEERING ANCHORING SYSTEM AS PER TIE DOWN'S INSTALLATION INSTRUCTIONS AND THAT NO MODIFICATIONS HAVE BEEN MADE TO THE ANCHORING SYSTEM OR BUILDING STRUCTURE. COMPANY NAME: - / CONTRACTORS N # DATE: SIGNATURE /It PAGE 9 U °AU IE TESTYNG SERVICES, INC. September 28, 1994 Mr. Locke M. Jones Tie Down Engineering 5901 Wheaton Drive Atlanta, GA 30336 ` Dear Mr. Jones: LISTING NUMBER: TIE -942609 Having completed the in-house audit of quality control, quality assurance, procurement, welding procedures, etc., Tri-State Testing Servicesdin compliance with the rules and regulations of the Department of Housing of California lists the, following products: MODEL NUMBER PART NUMBER DESCRIPTION M12H5/8 59080 5/8" ? 58" DOUBLE HEAD ANCHOR W/6" AUGER M12H3/4 59085 3/4" X 48" DOUBLE HEAD ANCHOR W/6" AUGER M1225/8 59090 5/8" X 30 DOUBLE HEAD ANCHOR W/2-4" AUGERS M1223/4 59095 3/4" X 30 DOUBLE HEAD.ANCHOR W/2-4" AUGERS MIT2 59115 •t 3/4" X 8" DOUBLE HEAD THREADED ROD PATIO ANCHOR MIJ2 59120 5/8" X 12" DOUBLE HEAD J -ROD SLAB ANCHOR MICS2 59125 PATIO. ANCHOR W/EXPANSION BOLT 59250 59250 3/4" X 36" DOUBLE HEAD ANCHOR W/6" & 4" AUGER MRA% 59110 CROSS DRIVE ROCK ANCHOR 3/4" X 30" ROD MIC2 59096 5/8" X 30" CORAL ANCHOR 59292 59292 LATERAL STABILIZER PLATE MGRB 59145 GALVANIZED ROOF BRACKET MIDH 59100 DOUBLE HEAD ONLY MIS2 59105 SWIVEL ADAPTER HEAD 6756 BUCKLES Cove MEmr=rrrrs, TN 38133 901-385-1 199 Fiix 901-386-6614 PAGE 10 Tie Down Engineering Page 2 September. 28, 1994 If you have any questions or if we may be of further help, please call us. Sincerely, TRI-STATE TESTING SERVICES, INC. UJ,Wt William E. Jac son Manager TRI -STA fl` E TESTING SERVICES, II PAGE 11 BCS 59175 Y. CRIMPING SEAL FOR 1-1/4" STRAP MBU 59140 GALVANIZED STRAP BUCKLE MBUS 59139 SPECIAL GALVANIZED STRAP BUCKLE BISB 59135 SLOTTED BOLT AND NUT MS33 59149 1-1/4" X 33' GALVANIZED STRAP MS35 59150 1-1/4" X 35' GALVANIZED STRAP MS37 59155 1-1/4" X 37' GALVANIZED STRAP MS42 59160 1-1/4" X 42' GALVANIZED STRAP MS60 59165 1-1/4" X 60' GALVANIZED STRAP MS600 T -59170.. 1-1/4",'X 600 GALVANIZED STRAP MHT6 59185 1-1/4" X 6' FRAME TIE W/HOOK MHT7 59190 1-1/4" X 7' FRAME TIE W/HOOK MHT8 59195 1-1/4" X 8' FRAME TIE W/HOOK MHT10 59210 1-1/4" X 10' FRAME TIE W/HOOK MHT12 59211 1-1/4" X 12' FRAME TIE W/HOOK MHT15 59050 1-1/4" X 15' FRAME TIE W/HOOK ' MBU6 59137 1-1/4" X 6' FRAME TIE W/BUCKLE MBU7 59141 1-1/4" X 7' FRAME TIE W/BUCKLE MBU8 59142 1-1/4" X 8' FRAME TIE W/BUCKLE MBU10 59138 1-1/4" X 10' FRAME TIE W/BUCKLE MBU12 59144 1-1/4" X 12' FRAME TIE W/BUCKLE MBU15 59143 1-1/4" X 15' FRAME TIE W/BUCKLE If you have any questions or if we may be of further help, please call us. Sincerely, TRI-STATE TESTING SERVICES, INC. UJ,Wt William E. Jac son Manager TRI -STA fl` E TESTING SERVICES, II PAGE 11 STATE OF CALIFORNIA - BUSINESS. TRANSPORTATIONA ND HOUSLNG AGENCY PETE WILSON. Governor DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT `°''o`" DIVISION OF CODES AND STANDARDS 1800 THIRD STREET, Suite 260 P.O. Box 1407 SACRAMENTO, CA 95812-1407 (916) 445-9471 FAX (916) 327-4712 TDD 800-735-2929 Wo P PIT rSeptember 29, 1994 OCT 05 1994 i William E. Jackson, Manager i J•�(j.� J11 Tri-State Testing Services, Inc. 6756 Buckles Cove Memphis, TN 38133 k Dear Mr. Jackson: This is to confirm that the California Department of Housing and Community Development has approved your firma application to become an approved testing and listing agency for load bearing supports and structural components used with manufactured homes, mobilehomes and commercial coaches. This approval is for the listing and labelling of structural components used in the manufactured housing industry in accordance with the standard established by your firm. Please note the Department may require design calculations- and test data be submitted to substantiate a design when the listed system or component does not appear to conform to your approved standard. We may also request this information for the purpose of routine monitoring or complaint investigation. Revisions to your approved standard as well as listed designs may be necessary in the future as a result of amendments to current statutes and/or regulations. Thank you for choosing to become an approved listing and testing agency. If in the future you have any questions or need to discuss a particular issue, you may contact either myself at (916) 445-9471 or Mike Rosenberg at (916) 255-2501. Sincerely, Chris L. Anderson Mobilehome Parks Program Manager cc: Mike Rosenberg PAGE 12 r:r�'1+r.n _ s .r .., �'�,�..•rr1:..Ir'^nr-n.:.,sv..vF^..^,^-�.� 'rr`wi..rl'+'Y�,'i: '/."a d't*Y...•"Y'1r.-•f�.SR'ti'rr�"� .-sT.. "Y. h r ; COUNTYOF BUTTE - DEPARTMENT OF DEV E�LOPMNTSERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILL� R IFORNIA95965 - TELEPHONE (916) 538-7541 PERMIT APPLICATION DATA SHEET OWNER- . No. Dap "6Z .3. 06 b Proposed Building Use _,(���-�- fir. �` Building Inspector Date _/b At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: I DATE RECEIVED BY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. All items have been sub4ted................................... . Plot plans, 3/4 sets, signed by preparer of plans . .......................... Complete plans, 3/4 sets, signed by preparer of plans . ..................... . Engineered plans and calcl,�3/4 sets, with wet signature on plans . ............. Hazardous Material Form. .. ...................... ................... . Energy Design Compliance and supporting documentation . .................. Statement of Intent for Non-kleated and A/C Buildings . ...................... Engineered truss details and layout in duplicate (required prior to plan check). .... Mobilehome data and manufacturer's insttallation instructions, 2 sets. ........... Feesof $ .......................................... . Impact fees as shown on attached schedule. ............................. . California Department of Forestry plan approval/fees. ....................... . Flood elevation letter (100 year flood) by California Engineer . ................. . Sanitation and plot plan approval Health Department . .............0% City of Chico plumbing permit . ......................................... Plot plan and business license approval from City of Biggs/Gridley. ' Planning approval for (A) Use: (B) Parking: ........ Contact Land Development about (A) Improvements (B) Drainage. ........... Driveway permit (construction approval required prior to occupancy). .. .. .`... ` Preanspect6 requeis Pre -inspection for required. .. to Building inspector (Date) Contractor's license information. (No., Name Style, Classification) . .............. Certificate of Workmans Compensation Insurance . .......................... Owner -Builder Verification (Given to owner , Mail to owner _). .......... . Recorded copy of Agricultural Acknowledgement Statement . .................. Letter of signature authorization . ........................................ Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use..................... ..................... Mobilehome utility clearance.``" ..................................... . Documentation of legal access. ................... Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . .............. . Existing violations/expired permits . ..................................... . Pla check I't ....... �................... When ypwissue the permit process as follows: Mail to, wne . it to c Tactor. Telephone ) Land hold for pickup at ffic Deliver with inspector. Other Parcel urea ion Acreage Applicant Date r' Copy of Haz-Mat form sent Health Dept. Fire Dept. Air-P"ollution Date Copy of plans sent Health Dept. Fire Dept. Other Date By The following data must be submitted prior to permit issuance 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). 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 Copy - Department of Public Works OTF. Oro Ufle 3 ; j1@01404 coot Codc-4 and MO Natio This set of plans and spaccif-Icati.ons IMST be kept on thc,15ob at. all tixas-,i-13 to p-,ii-mme-siaix froin 'die 1)6putment of P0114 dorim. Cmmi& of Butte. I . ju, Sep�a� CZ2-� SME COUNTY BU1LDJN'GbE7AWNi, APPR- 0",v ALL STRUCTURES AND EQUIPMENT INCLUDING OVERHANGS SHALL BE CLEAR OF ALL EASEMENTS. A SET WiGle- OF FT. FROM THE SIDE AND Fr. FAOMTRE REAF-1 P.ROPERTY LINES AND FT. FRONT THE: ROAD CENTERLINE SHALL BE CLEAR OF'STRUCTURES AND EQUIPMENT EXCEPT :7C." A 2 FT. EAVE OVER14ANG. Pvg0vED nti BUM tacoul jAealthn BUTTE COUNTY DEPARTMENT OF PUBLIC WORKS 7 County Center Drive, Oroville, CA PHONE: 538-7541 MOBILEHOME INSTALLATION SHEET 1. Owner's Name: PC- Cleo � Aqelo (A 2. Installer's Name: / �11 ✓ i 3. Is the site currently under permit?� Yes No (If yes, furnish permit number ' q'l' OR Is the site an existing site? . Yes F] No (If yes, furnish two plot plans.) 4. Will the mobilehome be located at least 5 -ft. away from septic k and leach fields and clear of all setbacks and easements? Yes No F-1 (If no, clarify E 5. What is the mobilehome electrical rating? --------------- All0 Amps 6. What is the mobilehome site service rating? ------------- 2(� Amps 7. What is the mobilehome site circuit breaker rating? ----- /O Q Amps 8. Is there any other electric load to be served by the F mobilehome site service? -------------------------------- Yes No (If yes, identify the load and size: (Load) (Amps) -I !, 9. What is the mobilehome site gas pipe size? -------------- / (in.) 10. What is the type of gas service? ------------------- Natural LPG 11. What is the gas pipe length from meter or tank to the mobilehome?--------------------------------------------- - �t 12. What is the mobilehome gas,demand?---------------------- �7CJ�Q�d (BTU) *(This information not required if pipe length less than 6 ft. on natural gas or less than 50 ft. on LPG.) NETT PAGE MUST BE'COMPLETED TO PROCESS PERMIT APPLICATION. MOBILEHOME SUPPORT DATA If -other- than single wide, Mobilehome M•fr.Lla61t1� furnish Setup Model No. Width �0) (ft.) Box LengthJ5Y (ft.) Tagalong or Expando Size Year P6 ft. x ft. 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). FOOTINGS (check one) 1. Wood -pressure treated or foundation grade. 2. Other (specify) SUPPORTS (check one) 1. Concrete block.Z2. Other (specify) Pier Footing Sizes and Locations SINGLE -WIDE MULTI -WIDE Line 1 �ress�s Main Beams Line 2 — — — — — Main Beams �� I.111C Y Tag or Triple Line 1 Piers: Line 1*OpeninRs: Size -Min- ------------ yc Size -Min- ------------------- Spacing-Max - -----------------Spacing-Max. --------- ,_ Each Side of Openings From Ends -Max. ------- '_ " With Width Over --------- '� Line 2 Piers: Line 3 Piers: (Under Bearing Wall Only) Size -Min- ------------ „x Size -Min ------------------- ox Spacing -Max. --------- ,_ „ Spacing -Max .--------------- From Ends -Max.------- '- From Ends -Max --------------- Line - ------Line 3 Roof Loads: , Size -Min. ------------„ „ x "x "x "x "x "x 'k "x Location (From Front) Line 4 Piers: Size -Min .------------ Spacing -Max.--------- From Ends -Max .------- e 5 Piers:. (Under Bearing Walls Only Size -Min ------------------- Spacing -Max.--------------- From Ends -Max .------------- Line 5 Roof Loads: Size -Min.------------ 11x "x 'L.c I 'k 'k 1. x 1. .x 'k Location (From Front) RESIDENTIAL {/ 036-023-006 PERMIT#94-1743 BIGELOW, STEVEN P 'POPORO BANGOR HWY, OROVILLE ✓. MOBILEHOME UTILITIES JOB FINALED (Date) Signature / V=OK O = Not OK -=Not Applicable ' =Not Ready_ MOBILE HOMES . Date/Initials •MOBI OME UTILITIES Plana OK except #'a zoo irements-Setbacks-Easements So cial MH Support Sketch . Sewer; L tion -Test -Fall -C/O Concrete At-WaTe—r; Location -Teat -Easement Needed ,(Sketch) 8. Gas cation-Teat-Wrep: / /" L'Yt. / Nat. or/ P'L" ft./ /"LPG 8 Disconnect Date/Initials MOBILE NOME INSTALLATION Plana OK except #'s 1.. nning Requirements -Setbacks Easements 2 Footings; Size -Spacing -Marriage Line Gyj%' MH Teat -Demand -V Contf'gct EI tricity; MH Test-Crossove-Breakere-Clearances 5. Drain; MH Test -Fall- nnector . Water; MH Teat -Regulator -Connector -Pat rand Sewer Connected -C/O to Grade -HD Approval wl�es and Electricity Tagged Its; Insp.-Sketch 10:'Cert. of Occupancy j MISCELLANEOUS Date/Initial DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'a 1. Zoning Requirements-Setbacks-Easementa 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails 4. Wood Awn.; Posts-Beams-Rftre.-Connectors Shthg: Rfg: Bracing 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 8. Carports; Windows -Doors 7. Electric 8. Frmo: Sils-Anchors-Studs-Rftre-Trusses 9. Siding; Nailing -Veneer -Stucco -Mesh 10. Roof; Shthg-Roofing 11. Ext.; Steps -Doors -Landings Date/Initials POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Soils; Compactlon-Structure Stability 3. Pool Structure; Steel -Connections -Thickness bead Men -Lining 4. Elec.; Receptacles and Lighting, Distances-GFI 5. Elec.; Pool Lighting; 15 volts-GFI S. Elec.;Enclosures; Conduit Entries-Terminals-Usted 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.; Grounding; Equip. w/5' Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Pane lboards- Ins. to Main In Conduit 9. Health Department Approval 10. Plumb.; Cir. Test -Water Supply Test V=OK O = Not OK - = Not Applicable = Not Ready RESIDENTkAL (Single & Duplex) Date/Initials UNDERFLOOR (Plans) OK except #'s 1. Zoning -Setbacks -Easements -Flood -Slope 2. Ftg., Main; Soils-Elec. Grnd.-/ P' Ftg. Depth 3. Ftg., Garage; Soils-Steel-Elec. Grnd.-/ /" Ftg. Depth 4. Ftg., Porches & Decks; Soils -Steel-/ /Ftg. Depth 5. Stemwalls, Main; Steel-Blockouts-Wrapped 6. Stemwalls, Garage; Steel-Blockouts-Wrapped 6a. Hold Downs and Special Anchors 7. Slab; Steel -Wrapped 8. Piers -Fireplace Ftg.-Steel 9. D.W.V.; Fall -Fitting -Test -2 Way C/O -Sewer Test 10. UF. Gas Pipe; Size -Anchors - yard gas piping: size -test 11. Water Pipe; Test -Anchor -Regulator -Service Test 12. Electric; Underground 13. Pienums & Ducts; Clearance -Material -Support -Ins. 14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples 15. Access & Ventilation 16. Insulation Date/Initials PLUMBING (Permit) OK except #'s 16. Water Htr.; Vent -Access -Combustion Air -Baffle 17. Water Pipe; Test & Anchor -Nail Protection 18. D.W.V.; Test -Fittings & Anchor -Nati Protection 19. Shower Pan; Test, First Floor -Tub Access 20. Test Tub & Shower, Second Floor -Tub Access 21. Gas Pipe; Size & Anchors Date/initials ELECTRICAL (Permit) OK except #'s 22. Fixture & Transformer Clearance -Ins. Protection 23. Elec. Receptacles Spacing -Lights & Switches at Doors 24. Size Boxes & No. of Conductors -Stapled 25. Romex Installed Close to Edge of Studs & C.J. 26. Equip. Ground made up w/Meth. Fastners-Bond Gas & Water 27. 2 Appliance Circuts in Kitchen & Conductor Size/GFI 28. Subfeed Wire Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al 29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al. Insulated Neutral ❑ Yes ❑ No 30. Service -Riser Conductors & Ground -Main Disconnect 31. Equip. Clearances Panels -Motors -Meth. Equip. 32. Clothes Closet Light -Shower Light -Spa Light 33. Smoke Detector Date/Initials MECHANICAL (Permit) OK except #'s 34. A.C. Ducts Insulation & Support 35. Vent Fan; Exhaust above insulation 36. Condensate Drain & Overflow; Size & Grade 37. Furnance-Vent; Access -Comb. Air -Return Air Vent -115 outlet 38. Attic Access & Platform if Furnance in Attic Date/Initials FRAMING (Plans) OK except #'s 39. Sils, Proper Material & Anchors 40. Wells Studs -Nailing, Spacing & Bracing -Plates -Sound 41. Bearing Walls over Girders & Floor Nailing 42. Draft Stop in Wells (rat proof) 43. Fire Stops; Furred Ceilings -Stairs -Chases -Tub 44. Headers & Beam -Size & Bearing Date/Initials FRAMING (Continued) 45. Hangers -Post Caps -Anchors -Connectors 46. Cing. Joist-Rftr. ties -Pu riin-roof Brac-Truss-Shthng.-Rfng. 47. Fireplace Ties or Type A Flue -Fireplace Throat clearance 48. Attic Access; Size & Romex Protectlon-Draft Stop -Ins. Baffles 49. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions 50. Garage Fire Protection Framing 51. Property Line Firewall & Openings 52. Ext. Doors -One 3' -Check Garage -3rd Story, 2 Exits 53. Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection 54. plywood on Roof Overhang -Attic Vents -Rafter Outriggers 55. Siding -Nailing Veneer 56. Stucco Mesh -Drip Screed -Fd. Vents-Underflr. Access 57. Glazing Area -Glass Protection -Skylights -Plastic 58. Shear Walls; Nailing -Bolts 59. Insulation -Walls -Ceilings 60. Infiltration -Walls -Windows Date/Initials FINAL (Plans) OK except #'s 61. Ext. Steps -Door & Sidelight Protection -Landings 62. Smoke Detector 63. Furnace; Vents -Clearance -Comb. Air -Connector - In Garage; Above Floor -Ducts -Mach. Protection 64. Bedroom Exiting 65. G.F.I. & Bath Fixtures & Tub Access -Spa 66. Elec. Trim & Subpanel; Breaker Sizes & Labels 67. Stairs & Rails 68. Fireplace or Stove; Clearances -Hearth 69. Elec. Outlets at Wood Panel; Int. & Ext. 70. Kit.Fixt. & Appliance; Grnd: Air Gap -Cooking Clearance 71. Elec. Outlets & Receptacles at Kit. Counter 72. Garage Fire Door, Swing -Landing -Closer 73. A.C. Duct in Garage -Damper 74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V. In Garage; Above Floor -Mach. Protection 75. Plb., Elec. & Mech. Equip. Listed for Location 76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protection 77. Insulation -Foam -Looked In Attic ❑ Yes 78. Guard Rails & Deck Construction -Post Caps 79. Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth Clearance Looked under Floor ❑ Yes 80. Following instld.; Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No; Planters ❑ Yes ❑ No 81. Stucco; Brown -Finish 82. A.C. Unit; Disconnect, Electrical, Plumbing 83. Vents Above Roof; Plbg: Appliance -Fireplace: Clearance to Openings 84. Water Well; Disconnect, Electrical, Plumbing 85. Exterior Elec. Trim; G.F.I. Receptacle -Underground 86. Ventilation Throughout House 87. Glass Protection 88. Corrections from Previous Inspections 89. Gas Test -Meters Tagged; Gas -Electric 90. Water & Sewer Connected -C/O to Grade -HD Approval 91. Energy Compliance Certificate -Other Certificates Comments at Final: C_ OUNTY OF BUTTE - DEPARTMENT 'OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT �---� ASSESSOR PARCEL NUMBER 036-023-006 ZONING AR BUILDING PERMIT OWNER STEVEN P. BIGELOW TELEPHONE 534-1414 SQ, FT, OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS PO BOX 2751 OROVILLE 95965 CONTRACTOR'S NAME OWNER TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS Filing Fee $ 20,00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ 23,00 ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 4b 3010 ORO BANGOR HUY PERMIT FEE $ 23.00 If OROVILLE, 95966 PLUMBING PERMIT Filing Fee 20.00 Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15,00 LOT NO. SUBDIVISION'S NAME P RCEL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SFO Duplex O Mobilehomp Other SPECIFY Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home RSI R ir 1 @20.00 60.00 TYPE OF WORK New O Addition O Remodel O Utilities A Installation O Other El Describe Work: 2 BEDROOM PERMIT FEE $ 80.00 Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service8OOV OR LESS I 200A OR LESS ) 23.00 23.00 Main Service I 200A TO IOOOA ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. I & ACC. BLDS. ) SO 3.50 ST.. CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one) O I am a licensed under provisions of Chapter 9, Division 3 of the Business and Professions Code and my license is in full force and effect. No.ClassificationI, asthe owner, 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) O O I, as the owner, am exclusively contracting with licensed contractors. (Sec 7044) Cl I am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET -NON-RESID. I BRANCH CIRCUITS ) @7.50 ( POWERAPPARATUS ) & SINGLE OUTLET CIR. Ex. Occup. ( OUTLET OR FIXTURES ) Ex. Occu FIXED APPLNS. OR p'(OUTLETS (RESID.) EA.License i Temporary Service Mobile Home Facilities 20, 00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE 1 declare under penalty of perjury (check one): O This permit is for $100.00 (valuation) or less. O 1 have placed on file with the County of Butte Dept. of Development Services, Building Division a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -insure. /oLI shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. Notice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE $ 63-00 Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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 Be to save, indemnify and keep harmless the County of Butte against all liabiliti , dgments, costs, a d expenses which may in any way accrue a ainst said Co un in onsequence of t ranting of this permit. X - 'ti--- Date !e! Signature of Applicant - O Owner O ContractorAgent Iof An OSHA permit is required for excavations o r 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 $ 166.00 HAZ- D. FEES IMP _ FLOOD a� COF PARCEL PD HD I UE This permit is hereby issued under the applicable the Butte County Code and/or Resolutions indicated above for which fees —have been By PERMIT EXPIRES ON (Dere! provisions to do work paid. Dae bp N •7 Receipt No. 163274 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT :w,. ;:'ti"'`r»w.�"•-.�y�.n-i..,�t�}•+.I'.w�.,...�sw"'•`t�R..� v...•rk"'-i[s''�+�+,.vn+ ,_r�t4k;-<�,�F�.,..1""1"�i''��i'd`/"7'r'r�.s..�,,,y,:rt..",-s..,.h.,*Kh*1'^A..iir-..i--�s...�-»t�.,.q.r+�v.r.•Y"!'-n7...�i•. w-��...,5 COUNTY OFBUTTE -DEPARTMENT ORDEVELOPM ENT SERVICES -BUILDING DIVISION 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 -TELEPHONE (916) 538-7541 / OWNER Proposed Buil .-,%_, PERMIT t. Jinq Use _ APPLICATION DATASHEET A. P. Building Inspector Date V � ap-3 6 rm t-�p� lication; I was advised the following data must be submitted prior to permit processing and/or issuance: At time of pe { �1 DATE RECEIVED BY All items have been submitted. .................. �z ................. �d 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 talcs, 3/4 sets, witti 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 . ...................... Engineered truss details and layout in duplicate (required prior to plan check). .... 9. Mobilehome data and manufacturer's installation instructions, 2 °sets. ........... 1 Fees of $:. ................................... . 11�lmp2ct fees as shown on attached schedule . ............................ . 1 California Department of Forestry plan approval/fees. .................... . Flood elevation letter (100 year floo ) by California Engineer . ................ . Sanitation and plot plan approval S`�-- 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). . . Preanspection requ� 20. Pre -inspection for required. .. to Building Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification) . ............. . certificate of Workmans Compensation Insurance. .. 0, A 23' Owner -Builder Verification (Given to owner ,Mail to owner �. ..........at- 26. Recorded copy of Agricultural Acknowledgement Statement . .................. Letter of signature authorization........................Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use. ........................................ . Mobilehome utility clearance . ............. t ............................. 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. Mail to contractor. Telephone 3 and hold for pickup at /)Gt 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). a 1. Index permit for above items No. 2. Additional items required: V• I Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was gdvised of above required data _ phone _ mail ounter by _ Date Plans checked by ' C�� Date — ns approved by _ Dat Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works ti B 1 G ELOW V RS SBC 1 RTES L. P.O. BOX 2751 OROVILLE CA 95965 916-534-1414 6-21-94 I, Steven P. Bigelow, grant permission to Donna Weaver to act as agent and signer of all permits needed* for the project located at 36- 23-006.► Thank You, G Patrick . Bigelow Section 264.1 of the Butte County Code wknowledgetnent be recorded prior to issua= of abuilding . =nit. The property described herein is adjacent to land or included '94-03151-41. Rec Fee 6. OL within an area zoned for agricultural purposes, and residems I COP 1-.0( of this property may be subject to inconveniences or Recorded I Check 7. O C discomfort arising from the use . of agricultural chemicals, O f f i c i a l Records I including, but not limited to herbicides, pesticides, and County of I fertilizers; and from the pursuit of agricultural operations Butte I including, but not limited to Cultivation, plowing' spmyingCandace J. Grubbs I ' Recorder i pig' and harvesting which occasionally 8� 2: 2 5 p m 25 -Jul -94 I P U B L X X 1 dust,smoix, noise, and odor. Butte County has established agricultural zones which have as a priority use for. productive agricultural purposes and residents within said zones and on adjacent property should be prepared to accept such incom�enience o: discomfort from normal, necessary farm operations. All that real property situate in the County of Butte, State of�Califorma, 'descn'bcd as follows:. PARCEL I' PARCEL 2, AS SHOWN ON THAT CERTAIN PARCEL MAP,- RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE,c STATE OF CALIFORNIA, ON DECEMBER 29, 1986, IN BOOK 105 OF MAPS, AT PAGE(S) 48. PARCEL II• AN EASEMENT FOR WATER LINE 20 FEET IN WIDTH, AS SHOWN ON THAT CERTAIN PARCEL MAP, RECORDED IN THE OFFICE OF THE RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON DECEMBER 29, 1986, IN BOOK 105 OF MAPS, AT PAGE(S) 48. ` EXCEPTING THEREFROM ALL THAT PORTION LYING WITHIN THE BOUNDS OF PARCEL I, DESCRIBED HEREIN. '. Date: '\7 State of California County of On \\jb personally appeared PRO O y personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within Instrument and acknowledged to me that he/shelthey executed the same In his/her/their authorized capacity(les), and that by his/her/their signature(s) on the Instrument, the person(s) or the entit person(s) acted, executed the lnstru_ m . the WITNESS my hand add ofiiciaL ' ` ASOFF4W MAL A 0.L UM / \ RW NOTARY PUBLIGCALIFOR PrbapeiOM In 14,1 Signature Seal: A.P. # .S60 -.1)-5- G E.H. USE ONLY Plot Plan Amched Floor Plan Annched Seat to B.D. TO: .' Building Department FROM: Environmental Health SUBJECT: Sanitation Clearance 'it ? 1 Owner Location C)/f.6 ,/ AP# Plan Approved for: Sewage Dis sal . Water Supply: Public "Z Private Well Clearance for bedroo mobile home. Other �1 final for: Final clearance O.K. for: Environmental Health 8/92 904 rs COUNTY OF BUTTE Department of Development Services Building Division Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541 Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) Y _5 2. I (have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name 4351�1 Tec[ 1�aekv,� Address 1250 Rob Sdo City %mVille, Phone E S ----q1911 Contractor's License No. 1. 48e,3 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address IN, -%4 City Phone Contractor's License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property Owner / Social Security N ber J`= 3 / .o Date NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are permitted to issue the permit. S D ,r i B 1 G E OW V RS AUC 111T'ES P. -O. BOX 2751 OROVILLE CA 95965 '916.-.53:4-1414. 6-21-94 I, Steven P. Bigelow, grant permission to Donna Weaver to act as agent and signer of all permits, needed: for the,. project located at. 36- 23-006. Thank You, O Patrick Bigelow BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District oRD [.-�� Building Department No. A.P. Number D3-•��j Jurisdiction 0 City] County Property Owner (lel Property Location/Address %/(% D% -,-) /-, e- Subdivison Residential Development Commercial/Industrial Buildin 0 No. of Living AHI Units 0 New Lot No. Sq. Footage Addition (Group R) Sq. Footage Addition (Including Exterior Roofed Areas) 6A) 1q� Date (Floor Plans reviewed by School District Personnel) District Identification No. 81F81 u� School District cert es that _. A .. (Applicant): zz (Street Address) (City) (State) has complied with the requirements of Resolution No. C%3- 9 �3 representing &_9(� square feet. School District Representative Paid by Check Number &, Bank Number Paid by Cash (Phone Number) 966 (Zip Code) ` by payment of $ //�191. yo . Date If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeformmkt (4/92) q BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM (One Form Per Building) School District�� L--�� Building Department No. A.P. Number Jurisdiction City] County Property Owner elvea, Property Location/kddressOf Subdivison Lot No. Residential Development 0 Sq. Footage No. of Living VHI Addition (Group R) Units v.SE4.1) Commercial/Industrial 0 Sq. Footage New Addition (Including Exterior Roofed Areas) i 6 ) Buildirv6 department presentative Date (Floor Plans reviewed by School District Personnel) District Identification No. 2?U-Y School District certifies that /� �. A (Applicant) (Street Address) CU v (Phone Number) - - (Ilia ity) (Zip has complied with the requirements of Resolution No. 9.3— by payment of $ VYY. representing : ` square feet. School District Representative Paid by Check Number & Remarks: Bank Number Paid by Cash Date If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to additional school fees to fully mitigate its impact on the school district's schools. White (applicant), Yellow (building department), Pink (school district) feeformmkl (4/92) COUNTY OF BUTTE Department of Development Services Building Division Oroville: 7 County Center Dr., Oroville CA 95965 Chico: 1469 Humboldt Rd., Chico CA 95928 OWNER -BUILDER VERIFICATION Attention Property Owner: Ph: 916-538-7541 Ph: 916-891-2751 An "owner -builder" building permit has been applied for in your name and bearing your signature. � 23 Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally 511a to rovide the major labor and materials for construction of the proposed property improvement .(yes or no) 2. 1.106ve riot) signed an application for a building permit for the proposed work. 3. I have contracted with the following Name Address Phone 1533 —Q► R -7 (firm) to provide the proposed construction: City D rOVil le Contractor's License No. (P2 1 0 6 3 4. I plan to provide portions of this work, but I have hired the. following person to coordinate, supervise, and provide the major work. Name I n Address City Phone Contractor's License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Signed: Property Owner Date Social Se61*1/- .r S3 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. 1 Mss This verification must be completed and returned to our office before we are permitted to issue the permit. APW 036 — 0 D3 --aoo�, Sk vepl '& e k 2Y3 '3 arvice ize 10-6 AP # � 6 Z � 00 -c OWNER PERMIT .MH UTIL.CLEARANCE DA J INSPECTOR 'RIC Other Load ,00 GAS Support Compaction Pipe Struc. Test Re Type Size Length YES NO YES NO lifFli LVy,��0 µF-: .Acocrdance wits F cc,,n <•-�, cc sfjE�, 931*0 ci for ttacooiai��� gilt, MO t This est of plaxis and spa3iflcaitons 1-TUST be kept on the fob wt all t' !� - sn � ":.; i?� u:.i.lwrfu: to 211$': ch, nngos o - �u`'-x'a:rr: On �;Ei�a�iw''thlthout itr�,gn pia-mies'_i)aa il,o:� the DePLTt?-AQP Of 'oFB, O'.nitu of lVuvs. f, G f � 2-V0ED SUNS ta n149alth ;wy_w nature S�9 _ ALL. STRUCTURES AND EQUIPMENT INCLUDING OVERHANGS SHALL BE CLEAR OF ALL EASEMENTS. A SET BACK i"3F _, FT. FROM, THE SIDE AND Ast 41-6 FT. FROM TRE REAS! PROPERTY LINES AND SZ:) FT. FROM THE ROAD CENTERLINE SHALL BE CLEAR OF 'STRUCTURES AND 'EQUIPMENT EXCEPT FOR A 2 FT. SAVE OVERHANG. All materi?"Is 6? V, 0 lqoTl?. encs ` .Acormd J,P of .11�;y Pf": kia Qhe Urt), 00dM Codes ehull tal- rle`U-ua 4 Jae This set of plans and -,np, IMP.T be kept on c: -t to J. t �:Zla shout, ofJLG"LNJ=V Of Butte. IZI?t Y©�- �Alo�ooJ xrl ") / 0� ALL STRUCTURES AND EOUIPMENT INCLUDtNG- OVERHANGS SHALL SH CLEAR OF ALL EASEMENTS. A SET BACK OF: Fi-. FA(-)0THEE SIDE AND 04- ., S' Fr. FMCWTIRE PROPEFUYILINECS ANo FT. FIROM THE ROAD C: "N` SHALL SE a, EAR OF'STRUCTURE S AND EOUIPMeNT EXCEPT FOR A 2 FT. EAVE OVERHANG. WOOED wft"MnNeetth COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7 41 PERMIT NO. APPLICATIONANGi PERMIT�� ASSESSOR PARCEL NUMBER 036-023-006 ZONING AR BUILDING PERMIT OWNER STEVEN P. BIGELOW TELEPHONE 534-1414 SQ. FT. OCC. BUILDING VALUATION OWNER'S MAILING ADDRESS PO BOX 2751 OROVILLE, 95965 CONTRACTOR'S NAME OGTdER TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation Is Fee $ 20.00 LENDER'S MAILING ADDRESSFiling Pe it Fee $ ARCHITECT OR ENGINEER LIC E NO. Pla Checking Fee $ 23.00 ergy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDING ADDRESS 3050 ORO BANGOR Y I VPERMIT HW FEE $ 43.00 PLUMBING PERMIT Filing Fee 20.00 OROVILLE In Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 LOT NO. SUBDIVISION'S NAME PA EL MAP Each gas water heater or vent 15.00 USE OF STRUCTURE SF ❑ Duplex O"Mobilehome Q Other /PECIFY20.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S G W I TYPE OF WORK New O Addition ❑ Remodel'Cl Utilities ❑ Installation Other ElContractor Describe Work: 9 ggpgonm PERMIT FEE $ ELECTRICAL PERMIT Filing Fee 20.00 � Main Service ( 200A SOOV 200A OR LESS OR LESS I 23.00 Main Service ( 200A To t000A ) 46.00 NEW CONST. DWELLING OCCUP. OR ADONS. ( & ACC. BLOS. I SD. 3.54 Fr. CONTRACTORS ICE E LA I declare under penalty of perjury (check on ) ❑ 1 am a licensed under provisions of apt r 9, Di Ision 3 of the Business and Professions Code and my license is in f I orce a d effect. License No. Classi in f , I, as the owner, or my employees with w s as their sole compensation, will do the work, and the structure is not inten ed r ffered for sale. (Sec 7044) ❑ 1, as the owner, am exclusively contracting wl licensed contractors. (Sec 7044) ❑ 1 am exempt under Sec. Business and Professions Code forthis reason NEW CONST. MULTI -OUTLET .NON.RESID. ( BRANCH CIRCUITS I @7.50 ( POWER APPARATUS ) & SINGLE OUTLET CIR. Ex. OCCU OUTLET OR FIXTURES P• ( ) 20 @ 1.00 RAL. 50 Ex. Occu FIXED APPLNS. OR p' ( OUTLETS (RESID.) EA. ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 WORKER'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ This permit is for $100.00 (valuation) or less. O 1 have placed on file with the County of Butte Dept. of Development Services, Building Division 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 Worker's Compensation laws of California. No ice to Applicant: If after making this statement, should you become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit will be revoked. PERMIT FEE S Contractor MECHANICAL PERMIT Filing Fee 20.00 Heating Cooling Hood 6.50 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 Butte County Ordinances and California 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. 1 also agree to save, indemnify and keep harmless the County of Butte against all liabil' ' judgments, co s, and expenses which may in any way accrue against said Co ty n consequence the ranting of is permit. X ` '�y DateI'lIj Signature of App�flcaih 70 Owner ❑ Contractor Agent An OSHA permit is required for excavations ov r 5"0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee $ 100.00 Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ iL4 no HA2- D. FEES IMP Fl CDF PARCEL PD HD ISSUE 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. By Date PERMIT EXPIRES ON (Dote/ Receipt No. 163274 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT �rjEls-M:ID 7 At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE CODNTY OF BUTPE - DEPARTMOT OF DEVELrORMT SERVICE'S - BUIMING DIVISION E 7 COUNTY CENTER DRIVE, OROVILLE CA 95965 - TELEPHONE.(916) 538-7541 OWNER �� A.P. # PROPOSED BUILDING USE y / DATE IZ7 REC. # DATE REC ' SCHOOL DISTRICT FEES 2. (paid at District Office)..... ...... SHERIFF FEES ` (paid at Building Department) Residential..... x =$ /63,27d unit amt. ' Commercial (sgft). x =$ ' sq.ft. amt. 3. URBAN AREA FEES (paid at Building Department) Residential (per unit) x =$ # units amt. Commercial (per sq.ft) x _$ sq.ft. amt. 4. RECREATION DISTRICT FEES (paid at District Office)................. ........ 5. DRAINAGE DISTRICT FEES (Contact Land Development Division).............. 6. SRA FIRE INSPECTION AND PLAN CHECK = $89.00...... (paid at Building Department) 7. OTHER �rjEls-M:ID 7 At time of permit application, I was advised the above fees are required to be paid prior to issuance of the permit. APPLICANT DATE {`sTX•OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541 OWNER Proposed Building Use PERMITAPPLICATION DATASHEET 165Z-066) No. a 36—��_— eq& Building Inspector 7 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 . ...................... Engineered truss details and layout in duplicate (required prior to plan check). .... �---- Mobilehome data and manufacturer's installation instructions, 2 sets. .. .... . '1 Fees of $ . ........................................... Impact fees as shown on attached schedule.5LH.00(_c... Her.)OC.. 61.11 1 • • • •� 12. California Dbpartment 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: . ........ laContact Land Development -about (A) Improvements (B) Drainage. ✓19. Driveway permit (construction approval required prior to occupancy)� 0.7,!.%� P Inspection request 20. Pre -inspection for required. �, ing Inspector (Date) 21. Contractor's license information. (No., Name Style, Classification). (,�q..... . Certificate of Workmans Compensation Insurance. ........... Owner -Builder Verification (Given to owner , Mail to owner ......... .ga Recorded copy of Agricultural Acknowledgement Statement . Ev_tI o, :::::::::::: : ::: Letter of signature authorization. . 26. Copy of recorded deed of parcel creation and 60 right of way to a public road. ..... �7. 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 u issue the permit, rocess as follows: M it to owne . Mail to contractor. Telephone and hold for pickup at office. Deliver with inspector. Other Parcel Creation - - `� Date Acreage Applicant 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 1. Index permit for above items No. 2. Additional items required: (Circle new item not checked above). Contractor, designer, owner, was advised of above required data. by Contractor, designer, owner, was advised of above required data by phone _ mail Counter by _ Date phone _ mail Counter by _ Date Plans checked by Date Plans approved by Sets of plans on hold in File cabinet AP folder Copv - Department of Public Works Date