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Home My WebLink About1741 Tustin Ave - Building Permits (54)( O MFS 1 � o J ' Qy�y A� (714)754-5273 • Fax(714)754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1741 TUSTIN AV Suite: 14 Vicinity: Parcel Number: 93328004 Applicant: JOHN SMITH Address: Owner: ORLEANS COMPLEX Address 1741 TUSTIN AVE Arch : Address: Phone: BUILDING PERMIT Zoning: Phone: Zip: Phone: (949)631-2168 Zip: 92627 Phone: 909-657-5600 License: 443878 Eng Address PERMIT NUMBER /B99-01570 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/29/1999 Issued: 09/29/1999 ISSUED BY: RA L_ Phone: Zip: COSTA MESA, CA Contractor: JOHN SMITH ROOFING Address: 3410 LA SIERRA F149 SCOPE OF PERMIT RIVERSIDE, CA Zip: 92503 Arch : Address: Phone: BUILDING PERMIT Zoning: Phone: Zip: Phone: (949)631-2168 Zip: 92627 Phone: 909-657-5600 License: 443878 Eng Address PERMIT NUMBER /B99-01570 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/29/1999 Issued: 09/29/1999 ISSUED BY: RA L_ Phone: Zip: License: License: SCOPE OF PERMIT REROOF - T/O, USING EXISTING SHTG, 2 LAYER OF 15# FELT & NEW 30 YEAR COMPOSITION SHINGLE ROOF. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,200.00 Permit: $153.25 Claim Valuation: $7,200.00 SMIP Res: $0.72 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $153.97 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0.0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 the work for which this permit is issued. My workers' compenn Ton su�ra7nce c�aArder and policy number are: Carder: . L'rY4-/'�c.. V(.U•J Policy Number: (� (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) ❑ I certify that in the performance off the work for bi 'ch this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca'(ornia, d agr tha f I hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provi 0 �S. Applicant Signature: Date: WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100, , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter(commend with Section 7000) of Division 3 of the Businevse3entl Professions Code, and my license is in full force and effect. Lia a _ Class N CC�r Contractors Signature: Date:�� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ' ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .- __._ ........... .._."----- mama.._. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...--- 3 or Does will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ves LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes [I No .- .. .......---- _.-._....---------.. ______... ...mama_ _. .....---._.. .............. 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the infornation given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ig tur Le Date 4d/(5r Authorized Applicant Date CODE #, INSPECTION TYPE DATE INTRIALS CODE INSPECTION TYPE DATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof y--�! 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 24 6446 Applicant to fill in all spaces except those within heavy border Imes and sign all appropriate declarations. / PERMIT "LHPI I HAG I NU.CITY OF COSTA.MECONSTR( 1 Project Address /0. --US%//rZJ?, 33 DI Ot Ia,' //VCy — TYPE OF CONSTRUCTION NEW ADD Applicant's Mailing Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name _/ZnA_), _PhqnZV1_9k.1 DESCRIPTION OF WORK/USE OF BLDG. — Address ALTERATION LJ REPAIR Arch/Eng. Address Contractor's Nam License No. TYPE OF PERMIT GRADING ❑ TENANT ❑ ELECTRICAL ❑ OTHER r 1:FOUNDATION STRUCTURAL L'� PLUMBING ❑ MECHANICAL m Phone�?a Y -)D Address (mailing) 3 �. �111_)6000 PROJECT DESCRIPTION SO. FT. CONSTRUCTION TYPE OCCUPANCY_ VALUATIONS o City License Na ��e7 ZONE GRADING CU.YDS. ACRES— PERMIT LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full2 tl rceffect. q q License a x -s LI en a D dOr/ / G, Date Ii Signatured S/� WORKER5' COMPENSATION DECLARATION -tereby affirm that 1 have a certificate of Consent to self -insure or a certificate Workers' Compensation Insurance, or a cernfietl recopy thereof (Section _d001 oY No. C.)0'r d 40 �/-r i%Cn Company ` ❑ Ce(tilied copy is hereby furnished. ertf'e op 1 Iled with the city B I i 9 DI isio Date 'T �(�— Applicant )_ 1 ylz-"'u-� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit i5 for one hundred ($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 the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of 'vision 3 of the Business and Professions Code) or that he/she is exempt :refrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil 6enalty of not more than five hundred dollars ($500). LJ 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. lractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or imoroves thereon. and who contracts for such oroiects with a con- tractors) mlicense pursuant to e Contractor's License Law). I am aware that proof oftheir Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre. sentatives of this city to enter upon the above-mentioned property for Inspectionpu 5. Date _1/ �� Signature Drivers' License or SS 9P A.P. 0 SMain Building: Accessory Building: E T Front B Rear A C Right K Left Ping. Ref. # Parking Req./Provided Planning Notes: _ V •nnn Zone I N G R E 0 M T S. Remarks: /�ST%iLLCQ W ATC �t k( .a7 L'C_ s SUMMARY OF FEES BUILDING PERMIT ELECTRICAL FEES PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Bar Sink Showers Backflow Preventer Service Sink PERMIT Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps Bathtubs Sewer Connection $ Dryers ❑Gas . ❑Electric Sub Panel Clarifiers Solar Collectors $ Fan Motors ❑0.1 HP ❑ 115 - 8 Dishwasher Solar Piping ELECTRICAL F.A.U. Inc. Solar ❑9-15 HP ❑116-15+ Drinking Fountains Solar Tank GRADING Fixtures Microwave Floor Drains Swimming Pool w/Spa 50% Device Boxes Pole Light Floor Sinks Urinal $ Outlets Range Gas Service Outlets Water Closet $ Switches Sign Interceptors Water Heater a D Garbage Disposal Standing Sections Kitchen Sink Water Service Generator 00-5 KW 115-15 KW Trash Compactor Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 Boiler Duct- Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO d6 Heating System & Ducting ❑0-100,000 BTU El 100,000 Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,0008TU 0100,000BT System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 Reinspection Fee $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By ApolicSition issued By $ 3 01 DOD31531—DDD31531 T meg DATE: 04i26IC9 TIME: 15:35 b1 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ X00 ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ ao PLAN CHECK 25% $ 01 DOD31531—DDD31531 T meg DATE: 04i26IC9 TIME: 15:35 b1 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PO( SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System - Final t 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval `17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1,8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1.9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 37g 39. Water Service-Final M rr. 40. Gas Service-Final t-? 41. Solar Domestic-Final 42. Backflow Preventer r 43. Backflow Irrigation 44. Landscape Irrigation !!�ystem 45. Sound Attenuation,, 46. Handicap Regulations- egulation47. 47.FINAL STRUCTURT& BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date WADING SAFETY li" RTMENT V. O. Boa No. 317 1�I �T � —639 C Costa Mesa, California DatPZ CITY OF COSTA MESA CERTIFICATE OF OCCUPANCY Building Permit Use of Buildino- -/.1L -/" ( /-/!f, 'fB/Yc /eft The building located at 17 Al / C!��,//.- ,/� ��;�}-{ Legal Description I !/�_ nrz X .W,O n[ry. ;Atm /�% —2 �i�� oz. i r%. z (See reverse side for Metes and1ounds) T has been inspected and found to comply with tYS/Provisions of all City of Costa Mesa Ordin- ances applicable thereto for aGroup Occupancy. ISSUED TO:� J// :2 �2?: City Bu Off- 'al (Owner of Building) B7 '7" i CC: [IOriginal--ownerCl 1st copy—Gas Co. ❑ 2nd copy— on Co. ❑ 3 d- opy—File Form 206 SB P 1M IEO OWNER BRAEBURN CONSTRUC N CORPORATION 144,146,14C,�DA1 3-20-62 JOB ADDRESS 17111 Tustin Ave.. Bldr?.14.Units ' U.145.1h6.147 BUILDING PERMIT NO. 16582 GENERAL CONTRACTOR Geo. D. Buccola VALUE $ 39,514-00 PERMITS ISSUED DATE AP No. 11 -281-02 2 7 Imo.' & 28 TRACT FIRE ZONE DESCRIPTION OF WORK 4 Unit Apt. INSPECTIONS I Signature I DATE GROUP H& J TYPE V ZONE R-2 Soil Gas 43,NaSUBCONTRACTOR PERMITS ISSUED DATE NUMBER Water , Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line p'House Con. G'St: Swr. E]( _�r� V - Al lel (: i Yrti i7•f A'' /L t/ b �/ I I Sprinkling System Construction Pole Underground ❑ Power ❑ °rti Rou h Wirin 9. i n- _7_ �/ he ' renches ❑ Forms ❑ Steel Reinf. ❑ o- i y Floor System v Bond Beam ❑ Steel Reinforce ❑ Sheathingy- Frame and Flashi Lathing — In Out 6 y Plaster, brown coat Re rig. ❑ Air Cond. ❑ Fina Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final _ )- Building, Final OCCUPANCY FORM ON - 5M — 7.613:6502 16582 'COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX -317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT A BUILDING 1%41 T11et1Ae Bldg• $14 ft 1 ADDRESS UA// Ta 9'I COSTA MESA. CALIFORNIA 9RECEIVED FRE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT g,L) D BUILDING f- /S/6-ly9 For Office Use Only Brae GOASt• RECEIPT NO. I PERMIT NO. OWNER Yliill B MAIL y RECBJ�ED BY DA RECrEIVr�, I IDPTE�IB,5UEOjy6 I ADDRESS FO BOX l Ne Tt B88ch //[� --,1 C�%� TEL. 1 Illn� G CITY NO. 0 DDRES ADDRESS ARCHITECTpp B L. Romber NO. 1642 COSTA MESA. CALIFORNIA OR ENGINEER r 08 3355 Via Lidot Newport Beach FIRE ADDRESS ZONE TYPE t1l GROUP CONTRACTOR APPROVED yf/ a BY DATE ADDRESS 3700 Newport B19d NING N ZONE_ 'L� I NO. OF �L_ n I USE OF NEW,/ CITY Q rt Bea{Pih I(,/ 1 PLANE BUILDING STATElq(,V� EL. ��g JW �WJ LYV LEGAL LIG. NO. NO. DESCRIPTION SIZE OF LOT'3'301 z 660 NO. OF SLOGS. IND ON LOT O' p y A P NO. //7— Zp I ��L' L 1 2' USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINA FROM -/ (CENTER LINE ST.) -7-0FT. -,- CENTER OF STREET REAR YARD_?N FRONT IN. SIDE YARD I LEFT RIGHT/ R. SIDE [ Z FT. 'S'_ 6e .z , IN. DESCRIPTION OF WORK L. SIDEc3/d FT. NEW I I ALTERATION I I ADDITION I REAR Z/ IT. IN. REPAIR I II MOVING I I DEMOLISH I -C APPROVED /O DATE �'"�ix C i� BUILDINGG //i o NO. OF / SIZE /-�4%-� -/o ROO MS STORIES EXTERIOR WALLROOF COVERING OVERING USE OF BUILDING AND WORK TO BE PERFORMED J7- / 1HEREBY ACKNOW OE T T 1 H V READ THIS A PLICATION THE AMOUNT SHOWN 8NDE. VALUATION IS FOR THE AND STATE THAT T E BO I6 C CT AN AG E TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLV WITH ALL CI 0�1 B SUILDING CON ION STATE WS GULATING / VALUATION SIGNATURE 60 PERMIT FEE $ (�' _ 0 PERMITTE^ 3 9, jay -P $ _PLAN CHECK $ � / • � a, AUTHORIZED AGENT TOTAL FEE X