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HomeMy WebLinkAbout078-380-048Charles Malone 15123 V.: E . Avenue ,Oroville I Permit- # 2625=82B,E(enclose Patio -cover t aaonve"rt of rec' reom)SFF,nQ) ,- r 1 s'_-03612'8 03-3296 MALONE, MILDRED 5123 V-5 RD, OROVILLE ' " INAu D CONT: COMM ACTION AGEN WALL HEATER -REP X- �'-a-��.a'+•++ r�:ti:�b.�ir�(yY..Fi'w,;1�r r ,K,,.:,,,_._ ,. .. -+.•�t���t�«+.`+ ?_:• •�;r?'�y,:-:.�a�YJt. �:..�'�6W:i!:,�,i r.a`t'trif`rr.eNeer_;,�..;;r�-A'�•�,�,_,l�;�;nau"j:"i::4�.=t+"3f�;�`yr3„ t r 112-028; s 3-3296 036 ~ivy TALON" MILDRED 5123 V-5 RD, OROVILLE CONT: COMM ACTION AGENCY ,. WALL HEATER REP EX "" } •. u . f - { 1 e COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 PERMIT NO. (Rev. 12/96) APPLICATION AND PERMIT 3" 3�15� V ASSESSOR PARCEL NUMBER nn \J ZONING BUILDING PERMIT OWNER DRED MAT533-.3077 TELEPHONE Sp. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS 5191 —5 Rif- OROMP, CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS CONSTRUCTION LENDER LENDER'S MAILING ADDRESS Fireplace Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 ARCHITECT OR ENGINEERS MAILING ADDRESS Permit Fee $ Plan Checking Fee $ BUILDING ADDRESS � �� T LE Q Energy Plan Checking Fee $ $ PERMIT FEE $ LOT NO. SUBDIVISION'S NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each gas water heater or vent 1 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home S I G I W 920.00 PERMIT FEE $ ELECTRICAL PERMIT Fling Fee 20.00 Main Service eo.A OR LESS 200A OR LESS 23.00 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.P License Class �� r Lic. No. % ? 2e, ) 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 astheir 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( & ACC. BUDS. SO 3.5¢FT_ HON•aESln "uLT,' OUTLET @7,50 OWERAPPARATUS 8 SINGLE OLJrLET C1 R. Ex. Occup. OUTLET OR FD(TURES BAL @'.550 Ex. Occup. oFl s CRRES 6.) E 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S 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. I 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' compensatio`n insurance carrier and policy number are: Carrier JAI/,_ Cr talc-_"/ ' /A1Se_ct e%_r1Cg �_F .i -'t/ MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FEE $ Policy Number RQ V_C) (The above sections Meed'not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 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 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 Z�i �_ � ate /-n — 2 �— Signature of Applicant - ❑ Owner- ❑-C'ntr3 actor ❑ 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 $ 35.00 HAZ. D. IF IMP FLOOD ......... CDF PARCEL PD MD ISr,JE Ais permit isherebyissued under the applicable provisions Of the Butt County C de and/or Resolutions to do work indicated bove f r wh ch fees have been paid. / X /� ,� G) By �Ni Date �0- PERMIT EXPIRES ON V Date ReceiptNo. .%'� �J/l WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT • COUNTY OF BUTTE - DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION ' 7 County Center Drive • Oroville, California 95965 • Telephone (530) 538-7541 3a9,. (Rev. 12/96) APPLICATION AND PERMIT 3' ASSESSOR PARCEL NUMBER 036-112-028 ZONING BUILDING PERMIT OWNER MILDRED MONE TELEPHONE 533- 077 SO. Fr, OCC. BUILDING VALUATION .OWNER'S MAILING ADDRESS 5123 V-5 IRD, OIRCVTTJR 99966 CONTRACTOR'S NAME TELEPHONE CONTRACTORS MAILING ADDRESS ?955 r)FT. ORO AVE, GROVIT-TE 95965) CONSTRUCTION LENDER JFireplace LENDER'S MAIUNG ADDRESS Total Valuation $ ARCHITECT OR ENGINEER LICENSE NO. Filing Fee $ 20.00 Permit Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Plan Checking Fee $ BUILDINGADDRESS 5191 _ Energy Plan Checking Fee $ $ PERMIT FEE S LOT NO. SUBDIVISIONS NAME PARCEL MAP PLUMBING PERMIT Fling Fee 20.00 USEOFSTRUCTURE SF ❑ Duplex ❑ Mobilehome ❑ Other SPECIFY Each Trap 7.00 Solar or heat pump water heater 23.00 Water piping 15.00 Each as water heater or vent 1 15.00 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other ❑ Describe Work: Gas piping sy2tem 1 - 5 outlets 15.00 Building sewer 15.00 Mobile Home I S I G I W 920.00 PERMIT FEE $ 35.00 ELECTRICAL PERMIT I Fling Feel 20.00 Main Service OOOV GR LESS 2o0A OR LE 1 23.00 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 ' full f rce and effect. License Class - Lic. No. y 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. ❑ 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 Main Service 200A TO 1000A 46.00 NEW CONST. DWELLING OCCUP. OR ADDNS. ( y ACC. BLDS. SO 3.5QFT: NEW CONST. MULTI -O - NON RESID. CUITS 97.50 POWER APPARATUS 8 SINGLE OUTLE7 CIR. Ex. Occup. OUTLET OR FORURES SAL @',50 Ex. Occup. GFl�E�°TSA RLNs DRQ 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE $ 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' c mpensation insuran a carrier and policy number are: Carrier S Policy Number (The above sections nee not b6 co pleted 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 / to — Q —�j' Si ure of Applicant - ❑ r tractor ❑Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in hei ht. MECHANICAL PERMIT Fling Fee 20.00 Heating Cooling Hood 6.50 Ventilation PERMIT FET= $ Mobile Home Installation Fee $ Energy Inspection Fee $ occ CONST. TYPE TOTAL FEE $ 35.00 HAZ D. FEES IMP FLOOD CDFPARCEL PD HDIS E is permit i hereby issued under the of a Bu unty Code and/or indic ted b r ch fees have B PERMIT EXPIRES ON applicable provisions Resolutions to do work been paid. 0 Date l Ji Defe rReceiptNo. c3Sv WHITE-D.D.S.-B. D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE DEPARTMENT OF PUBLIC WORKS 196 Memorial Way, Chico — Phone: 891-2751 7 County Center Drive, Orovi Ile — Phone: 534-4541 Skyway and Elliott Road, Paradise — Phone: 872-2961, Ext. 57 CORRECTION NOTICE e BUILDING OR PROPERTY ADDRESS A routine inspection indicates that the following violations of County Ordinance exist at the above address and should be corrected. Please notify this office when correction of work is completed. If you have any question pertaining to this . matter, or need additional explanation, please contact this office immediately.. 46) 100, rLftmU�` Inspector,• �— Date l ;4 — 0 PERMIT NO. 2625-82B,E. PERMIT EXPIRES 1// SAO OWNER CHARLIE MALONE _ CONTR. owner ASSESSOR PARCEL 36-112$ LOCATION- 5123 VE Avenue, Oroville Temp. Power Pole t Called PG&E Temp. Elec. Service �'. Called PG&E Temp. Gas Service CalledPG&E 1 V ,p JOB FINALED (Date). ! !, _.l Signature / t. � t a d = OK = Not OK = Not Applicable = Not Ready RESIDENTIAL, (Single and Duplex) Date UNDERFLOOR Plans OK except #'s Date FRAMING (Continued) 1. Zoning requirements -Setbacks -Easements 48. PfereTry=ine Firewall & Openings 2. Ftg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth 494--&r Doors -One 3' -Check Garage -3rd story, 2 exits 3. Fig., Garage; Soils -Steel- / /" Ftg. Depthairs; Width -Headroom -Rise -Run -Landing -Fire Protection 4. Ftg., Porches & Decks; Soils -Steel- / /" Ftg. Depth 5L_4H7wv='I7n Roof Overhang -Attic Vents -Rafter Outriggers 5. Stemwalls, Main; Steel-Blockouts-Wrapped-SlabIng-Nailing-Veneer 6. Stemwalls, Garage; Steel -B lockouts -Wrapped -S lab 53.-6/neee-MeeU Drip Screed-Fdn. Vents-Underflr. Access 7. Piers -Fireplace Ftg.-Steel 54Fc61aaipgArea-Glass Protection -Skylights -Plastic 8. D.W.V.: Fall -Fittings -Test -2 way C/O -Sewer Test 55. Shear Walls; Nailing -Bolts 9. Gas Pipe; Size -Anchors 10. Water Pipe; Test -Anchors -Regulator -Service Test 11. Electric; underground 12. Plenums & Ducts; Clearance -Material -Support -Ins. 13. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples C ate Card -BI Date Card -BI Date Card -BI Date Card -BI Date. Card -BI Date Card -BI Date Card -BI Date Date FIN Plans) OK except q's Card -BI Date Card -BI Date Date PLUMBING (Permit) OK except q's 14. Water Ht.; Vent -Access -Combustion Air 15. Water Pipe; Test & Anchors -Nail Protection Ext. Steps -Door & Sidelight Protection -Landings 5 58. c Furnace; ts�Clearance-Comb. Air -Connector - I cfe; Above Floor-Ducts-Mech. Protection 16. D.W.V.; Test-Fttngs & Anchors -Nail Protection 59• -BedEe^9 17. Shower Pan; Test, First Floor -Tub Access 60. s & Tub Access 18. Test Tub & Shower, 2nd Floor -Tub Access Trim Trim & Subpanel; Breaker Sizes -Labels 19. Gas Pipe; Size & Anchors 62• 63.rances-Hearth 64. I; Int. & Ext. Card -BI Date Card -BI Date 65• ix . pp lance; nd.-Air Gap -Cooking Clearance Card -BI Date Date Card -BI Date ELECT ICAL Permit OK except q's 66. s at Kit. Counter 67. oor; wing- an ing-Closer 68. A - n , f I r_ 9„ n .. 4. % Fixture &Transformer Clearance -Ins. Protection 69. Wtr. Htr.; V eeraTlC> - oro b. Air-Connector-P.R.V.- I ge; Above Floor-Mech. Protection 21. Elec. Receptacles Spacing -Lights & Switches at Doors e Boxes & No. of Con rs-St 70, 71. h. Equip. Listed for Location age; (G.F.I.)-Romex Protec. omex Installed Close to Ede of Studs & C.J. 7,4/Squip. Ground made upFasteners Bond Gas & Water 72. 73. tic F] Yes ion -Post Caps 26ce Circuits in Kitchen & Conductor Size _ _ I e / / ga. Cu or Al-A.C. Wire Size / / ga. Cu or Al 74. Fdn. Vent oor-Drainage &Wood -Earth Clearance under Floor ❑ Yes 27. Range Cir ga. Cu or AI -Oven Circ. / / ga. Cu or Al, ed Neutral ❑Yes ❑No 75. Following ins Y s E]No; Walks ❑Yes E) No; Yes No 28. - iser Conductors & Ground -Main Disconnect 76 29. Equip. 81 ra-MtT, Panels-Motors-Mech. Equip. 77, Irnces-Brkr. & Cond. Size -115V Outlet 30. C4o&b@&•Gieeet•Light-Shower Light 78, oo Iiance-Firepl.-Clearance to Opngs. 79. , lectrical, Plumbing C I yDate L!" Card -BI Date 80. ec. rim; .I. Receptacle -Underground 81 Card B -I Date Card -BI Date 82 Date MECHANICAL (Permit) OK except N's 88--Co-rrections from Previous Inspections 84. nor Zecf_�agged; Gas -Electric 31. A.C. Ducts; Insulation & Support 85. C/O to Grade -HD Approval _ 32. Vent Fan; Exhaust above Insulation nergy Compliance Certificate -Other Certificates _ 33. Condensate Drain & Overflow; Size & Grade 34. Furnace -Vent; Access -Comb. Air -Return Air Vent -115V outlet 35. Attic Access & Platform if Furnace in Attic BI Date Card -BI Date Card -BI _ _Date Card -BI Date Card -BI Card -BI Date Card -BI Date Date Card -BI Date Comments at Final: Card -BI Date Card -BI Date Date FRA G(Plans) OK except q's Si ; Proper Material & Anchors _ Na , Studs -Nailing, Spacing & Bracing -Plates -Sound earing Walls over Girders & Floor Nailing 39--Brefl-Step-ima Walls (rat proof) -___40. F-icc furred Ceilings -Stairs -Chases -Tub Bader & B - ize & Bearing _ 42. Han rs-Post Caps -Anchors -Connectors Ing. Joist-Rft_r. Ties-Purlin-Roof Brac.-Truss-Shthng.-Ring. 44.-•FirepfaC2'f es or Type A Flue -Fireplace Throat 45. Size & Romex Protection -Draft Stop -Ins. Baffles _____.46. .54w*� i�s+ars or Exiting Doors -Sill Hgt. & Dimensions 47. Gnrejr-F"V"Protection Framing (NOTE:Anentrymust be made each time youvisit jobsite) V = OK 0 = Not OK = Not Applicable MOBILEHOMES * = Not Ready MISCELLANEOUS '0-_ s Date MOBILEHOME UTILITIES (Plans) OK except it's 1. Zoning Requirements -Setbacks -Easements Date DECKS, COVERS, CARPORTS, ETC. (Plans) OK except k's 1. Zoning Requirements -Setbacks -Easements 2. Soils; Special MH Support -Sketch 2. Footings; Size -Depth -Spacing -Connectors 3. Sewer; Location -Test -Fall -C/O -Concrete 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts-Beams-Rftrs.-Connec.-Shthg.-Rfg.-Bracing 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Gas; Location -Test -Wrap:/ /"L"ft./ /"Nat. or/ /"L"ft./ /"LPG 6. Carports; Windows -Doors 7. Utility Clearance 7. Elec. Card -BI Date Card -BI Date Card -BI Date Card -BI Date Card -BI Date Date Card -BI Date MOBILEHOME INSTALLATION (Plans) OK except q's 1. Zoning Requirements -Setbacks -Easements Card -BI Date Date Card -BI Date _ POOLS (Plans) OK except #'s 1. Setbacks -Easements 2. Footings; Size -Spacing -Marriage Line 2. Soils; Compaction -Structure Stability 3. Gas; MH Test -Demand -Valve -Connector 3. Pool Structure; Steel -Connections -Thickness -Dead Men -Lining 4. Electricity; MH Test -Crossovers -Breakers -Clearances 4. Elec.; Receptacles and Lighting; Distances-GFI 5. Drain; MH Test -Fall -Flex Connector 5. Elec.; Pool Lighting; 15 volts-GFI 6. Water; MH Test -Regulator -Connector _ 7. Water and Sewer Connected -C/0 to Grade -HD Approval 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equipment -Heater 8. Gas and Electricity Tagged 9. Exits; Insp.-Sketch 8. Elec.; Grounding; Equip. w/5' -Circulating Equip. -Pool Lghtg. Boxes -Enclosures -Panel boards -Ins. to Main in Conduit 10. Cert. of Occupancy 9. Health Department Approval 10. Plumb; Cir. Test -Water Supply Test Card B -I Date Card -BI Date Card -BI Date Card -BI Date Card B -I Date Card -BI Date Card -BI Date Card -BI Date >� COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT N 7 County Center Drive - Orovilie, California 95965 - Telephone 916/534-4541 APPLICATION AND PERMIT ' ASSES' R PAR -CEL NUMBERo � ZONING AE BUILDING PERM( W TELEPHONE SQ. FT. OCC. BUILDING VALUATION OW ShJkILING A DRESS CONT A TOR'S NAME c TELEPHONE CONTRACTOR'S MAILING ADDRESS Fireplace Fs CONSTRUCTION LEND UNKNOWN Total Valuation ,jrpas Filing Fee $ 10.00 LENDER'S MAILING ADDRESS Permit Fee $ Q,. ARCHITECT OR ENGINE!7jV LICENSE NO. Plan Checking Fee $ _V C) Penalty $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Permit fee $� l 0O BUILD Ess lG PLUMBING PERMIT FiIingFee 10.00 5/23 Each Trap 2.00 Repair drainage or vent piping 5.00 Water piping LOT NO. SUBDIVISION NAME PARCEL MAP Each qas water heater or vent 5,00 Gas piping system 1 -5 outlets USE OF STRUCTURE SF Duplex❑ Mobilehome❑ Other SPECIFY Building sewer Lawn sprinkler system 5.00 TYPE OF WORK New F] Addition❑ ergode!❑ Utilities Installation❑ Other Describe work: A �0 10A Al 6CE M P,emit Fee $ Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600V OR 100 AMP ORSLESS 5.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. ( DWELLING OR ADDNS. ACC. BLDGS. 2�sgft ,� CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No: Classification 1, as the owner, or my employees with wages as their sole compen- Xsation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors. (Sec. 7044) ❑ I am exempt under Sec. , Business and Professions Code for this reason NEW CON5TR I.OUTL T 2.50 ea CAPPARATUS rNiEw•CONSTR ( POWERCy� NON. P,ESID. (SINGLE OUTLET CIR. Ex. Occup OUTLETS OR FIXTURES 5 L� IXED APPLNS. OR Ex. OCCup.(OUTLETS (RESID.) EA. 2.00 Temporary service 10.00 Mobile Home Facilities 15.00 Misc. Wiring 7.50 Permit Fee $ , Contractor MECHANICAL PERMIT Filing Fee 10.00 C WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): ❑ The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice to Applicant: If after making this statement, should you become subject to the W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Heating Cooling Hood 3.00 Ventilation Permit Fee $ Contractor i certify that I have read this application and state that the above information is correct. I agree to comply to all County Ordinances and State Laws relating to building construction, and hereby authorize representatives of the County of Butte to enter upon the above-mentioned property for inspection purposes. I also agree to save,' indemnify and keep harmless the County of Butte against all. liabilities, judgments, costs, and expenses which may in any way accrue agajnst said ounty in cons quence of the granting of this permit. %� Fes, Date 2 Signature of Applicant — Owner Contractor ❑ Agent ❑ An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 storiesin height. Mobile Home Installation Fee $ TOTAL PERMIT FEE $ r Occu?. GROUP —P* TYPE of ONST. /V PARCP E D HD SSU This permit is hereby issued under sions of the Butte County Code and/or work indicated above for which DI CTOR PUBLIC BY PERMIT EXPIRES Date the applicable provi- resolutions to do fees have been .paid. WORKS D e r Receipt No. WHIT!-D.P.W., YELLOW -ASSESSOR. PINK -INSPECTOR, GOLDEN ROD-APDLICANT RRC TTIRNT TAT. ENERGY CONSERVATION STANDARDS CONSTRUCTION COMPLIANCE CERTIFICATE THIS IS TO CERTIFY THAT ENERGY CONSERVATION REQUIREMENTS HAVE BEEN INSTALLED IN CONFORMANCE WITH CURRENT _ENERGY CONSERVATION REGULATIONS AT a-/,2.- UE (location) BU ILD ING PERMIT NO. A.P. NO. f THE FOLLOWING HAVE BEEN INSTALLED AS PER APPROVED.PLANS: (Check each item or write N/A if not applicable) INSULATION: Slab Edge Fdn. Walls AV Floors Walls Ceiling/Roof Ducts /?/V - Circulating Pipes APPROVED HEATER C� APPROVED WTR.HTR. GLAZING: Single Glazed v Special (Insulated) CERT. & LABELED WDS. & SLIDING DRS. WEATHERSTRIPPED DRS. BACK DAMPERED FANS INTERMITTENT IGNITION DEy ES CERT. APPLIANCES X04 I DECLARE THAT ALL REQUIRED ITEMS AS NOTED ABOVE HAVE BEEN INSTALLED IN ACCORDANCE WITH THE ENERGY CONSERVATION REQUIREMENTS AND AGREE TO THE COMPLETENESS OF THIS CERTIF ICA�E AS �SUITTED. Insulation Applicator Name �� y 7x)44-r/,JQ (TIP w 9 j Signature of Insulation Applicator General Contractor/Owner Signature of D General Contractor/Owner se print) to Contractors dh2e No. 41111 (p`iease pri ) Date k 7Z� State Contractors License No. THIS CERTIFICATE MUST BE .ON FILE WITH THE BU ILD ING DEPARTMENT PRIOR TO REQUESTING FINAL INSPECTION AND SHALL BE POSTED IN A CONSPICUOUS LOCATION WITHIN THE DWELLING.