HomeMy WebLinkAbout1836 NANTUCKET PL - Building Permits •
PROJECT ADBRESS: UNIT: - '
7WNER'SNAME: 14(36 NANTUCKET PL 82 CITY OF• COSTA .MESA - BUILDING PERMIT
KAUF.MANN E BROAD
•
aoDifEsS: 1817 SV. RIVERVI£W DR PERMIT NO: G 044969 'PLAN CHECK_NO: N GOVT: N SUPP : N
• SUITE 300
•
• ANAHEIM, CA 92808 CONSTRUCTION TYPE: V-44 PERMIT TYPE: £LE MEC PLU STR PURPOSE : NEW
ARCHJENGINEER: E REO.NO.:
MIK WDODLF_Y Cl� q JOH DESCRIPTION SFD SQ FT: 2,537
• ADDRESS: 180 N. RIVERVIEW DR I ' 300 ' • - '
. afTTEE: ANAHEIM CA 92808 CLAIM VALUE: 144,063.00 CALC-VALUE: 144,063.24 GROUP OCC: R-3 /M-1
PERKAUFMANN E BROAD (714)921-0500
ADDRESS.:
180 N. RIVERVIEW DR 300 COMMENTS: PC#234-89A PD $129.51 (NEW PC#1400-89A)
• ANAHEIM CA 92808 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
ZONING REQUIREMENTS
7000)of Divisio 3 of the Business and Professions Cod se is in full force and effect. SETBACKS •
•
CITY LIC.: , , ; . STATE uc.:3344 SS: B-1 ( inn
Date: / a Signature: ---------
MAIN BUILDING -------- •-------- ACCESSORY BUILDING ---
WORKER COMP 'SATION DECLARATION: I hereby affirm that I h a certificate of consent to self-insure or acerlificateofWorkers' FRNT: 18 FT IN REAR: 11 FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,ora certified copy thereof(Section 3800,Lab.C). LEFT: 12 FT IN R GHT: 5 FT IN LEFT: : FT IN R�GC�HT: FT IN .
POucY NO.: 4189-1090 - EXP.DATE: 03/07/90 'j' I SID
COMPANY:TRANS . INS,, PARKING REQUIRED: 2 PARKING PROVIDED: 2 PARCEL : 04243310 ZONE: PDRM b •
o Certified coy is her y tumished, X.1 Certified opyi5filed 'ththe city ngDiw' n. PLANNING NOTES) SINGLE FAMILY RESIDENCE WITH ATTACHED GARAGE. HALE AOp
> SPACE PROVIDED PER ;UNIT. FOR GUEST.:PARKINGO ,pFOKSYC,CIAL,KIQUIRFM )S
Date: .' App0iant:'� ' 6/27 :n***********k****t********`*4.nfl "*****$******�`*#******* *******************
EXEMPTION 'OM WO' ERS'COMPENSATION DECLARATION:, ' section need not be completed d the permit is for one hundred(5100)or less). ^ , D • E V E ••L 0 P. We N T : S' "E "R ..V .1- C E''S ,.,, ;R .E Q U I R E M E N T• S-1
I certify tha in the performance of the work for which this Dermi is issued.I shall not employ any person in any manner so as to become r - 's / r i �j'
subject to the Workers'Compensation Laws of California. S ' . 'ZONING APPROVED. BY _ "r% -. ,'-:_,Celt .. -DATE: 111/1 J._ y O /
Date: Signature: tet. `• - ..
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation-orovisions.oi the Labor • BUILDING APPROVED BY 7 : ' '6'S' L_. r- " 1 '" DATE: Q7 e•I a-`8 \
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. " �,., �,
CONSTRUCTION LENDING AGENCY: I hereby affirm that theses a'•constmction lending agency for the performance of the work for .rtAPP L IC AT ION ISSUED''BY: 7• •'• DATE: j..___
which this permit is issued(Section 3097,Civ.C):- • - - ********************** **** ***********************�ik F** *
LENDER: .c ******************Al*************** ***** ************************************
ADDRESS: - LEGALIZATION:N F E :E . S U M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,Improde,demolish,or, • PERMIT 797.00 39. 5 0 69.86 32.75 10.08
repair any structure,prior to its issuance,also requires the app0cant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - 25% - 50$ 252 SMI P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than Me hundred dollars(5500). • I S SUE FEE 3.00 15.00 15..00 •
I, as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL : PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: .The Contractors'State License Law TOTALS----) 949.19 33.00 ,- 0.00 982.19 982.19 .00
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 completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 98 2.19 OVER/SHORT: .00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 797.00 42.50 84.86 47;75 10.08
•
❑ and Professions Code: The Contractors*State License Law does not apply to an owner of property who builds or improves thereon •
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ************************************************************************""***
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.A P.C. I N D I V. I D U A L -F E E BREAKDOWN
for this reason: - , TYPE QTY DESCRIPTION rf UNIT COST TOTAL COST
Date: Owner: SFR 1996 DWE-TYPE V-WOOD FRAME -GOOD 67.70 ' 135,129.20
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 76 RES-BALCONY EXTERIOR STAIRWAY 13. 54 1,029.04
25534 and that I or any future building occupant wilvwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District Residential construction applications are exempt from SFR • 465 RES-GARAGES TYPE V 17.00 • 7,905.00
these provisions. ELE 1996 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT .03 69.86
MEC 1 INSTALL FORC/AIR FURN <= 100 K BTU/H 9.00 9.00 I
Date: Applicant MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H • 9. 00 9.00 ,
I hereby certify that I have read this application and s. ' r'above information is correct.I agree to comply with at city and county NEC 5 GAS PIPING SYS 5+ OUTLETS PER OUTLET .75 3.75
ordinances and stat'laws relating to budding constru 4.n and hereby• horize representatives of this city to enter upon above-mentioned ' MEC 1 FACTORY FIREPLACE 6. 50 • 6.50
property for insp: tion aura ses. MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4.50 ' 4.50
Date: _ .�� Signature: .• w,� .s r." PLU 2 BATHTUB 2. 00 4.00
PLU 1 DISHWASHER • 2. 00 2.00
Driver's Li. nse or S.cial Security
1641-46 White-Building;Green-Cade Enforcement;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor - - 2 - • • :7 :-Li -
• - • GONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# - Date - Inspector APPROVALS Permit# Date Inspector
ii.•'#. Temporary Electrical Service or Pole.t 52. Pool &Equipment Location
c a -
2.. Soil Pipe-Undrgrnd. . _ ti2:elbli tks) 53. Steel Reinforcement • '
-aka'Electrical Conduit Utility-Undrgrnd: • 54. Forms •
4.•Electrical,Coiiduit-Undrgrnd. _ 55.•Electrical Bonding
5/Steel'Reinforcement 56. Rough Plumbing & Pressure Test
•
t 6.;Electrical'UFER Grnd. °` p.sci .i/C. 57. APPROVALTO COVER-GUNITE 1
f.
7.:Footings -- • , F P,....2/0•41. c4i f. 58. Electrical Conduit-Undrgrnd. ,r
• 8..Foundation ' : g2 C(Ret 59. •Gas Pipe, 0 Undrgrnd., Test , :
9. ;,Water Pipe-Undrgrnd. ' �pj{-b'OC ��`-, 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System I 61. APPROVAL TO DECK
11. Property Sewer Line,& Hdyse Connection 62. Backwash & Receptor-Final
12. Sewer Cap t t63. Heater & Vent-Final •
t t .
13. Roof Drains''_ 64. Plumbing System - Final ,
14. Rough Plumbing •y 'i/gd Litt 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final ,
16. Rough Electric-Wiring 3i1'93 67. Fencing & Access Approval •
' 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air•Conditioning *Vero FIRE DEPT. REQUIREMENT
r r , r ly4d l.Ed � - c
•
20;;Rough Factory Fireplace , Lir' p.ficp 1, APPROVALk,�r Permit# • . , r r .-r -
217;Ducts, in Structure•• I •• •' x :7.'1).1'770. lJrider F•o nd Hydro
22. Duets, Ventilating '. i .- '-i. ` - ; C •-. G_ I.-' .;,, -71. Product Piping 0 Gas boil
• 23 •Gas Pipe=Rough & Test - 1 I L •r ' "•72. Underground Flush •- ,, t '`
24: Roof Framin n 1 '�• `'
9 I ~ ,. r i. :.73-Undergrnd.StorageTank.OGas 0Oil
25. Roof Sheathing t, ._ N.',72-ta ;:‘,41.14i. 74!•Overhead Hydro.. ..
26. T-Bar Ceiling (Structural) & Moriocoat r, _ It_ x t; 75. Dry Chemical r, s, r - •r 1_ • • �-^
27^Frame and Flashing, - ^ 7.'?
r'5. 'CK• &I 76. Dry Standpipe 1- `-' ••• r-• I 1 1 r '
28. Lathing & Siding * '" '.l (7,4.449&IOW, 77.1•••FIXED SYSTEM FINAIrl.. r c. • . ...-. . .
: 29. Insulation ' 32-..?..1-op 11�•r,'1,- 78 ,FIRE PREV. FINAL 4,,,,. ='; - tJ ` " `e_` '
x,30. Drywall Nailing `- : ,,. , „ %Lt/ALO '., "k.,.;,, `AEALTFIDEPT,.REQUIREMENT-r Fr`-;
r31. Plaster Brown Coat•; • 1 ' ,f3
/ ' o G!(� T 9. FINAL INSPECTION* •
1 - r 1 - l i n f•
32_Electrical Power Meier-Final "', :(.,,c441.5 /' F• ' ."_FOOD CERTIFICATE ISSUED,.. r•/, .+r r
33:.-Final Electric , _- • - (Wit � o'1 ' _ - :r
n r r
:-34':Final HeatinT& Aird Conditidning. ;-11 , prep! ' , D•FQ ,,..
:35.1,Final Gas Pipe-Test:;t r. ` ( Q • • • R_`�' ' QU " iNTS t 1
36. Hood or Canopy' -i' 1 r r• I kT '' 61/420\ r yV� / .
-37..Final Factory Fireplace: i .-� 6E2?:r at S.t, - r-_
s14= . .. _
C38. Final Plumbing n F / ' • c a
;39. Water Service-Finalci , r /.2034: y .- :, _ -• •
40. Gas Service-Final ,r r. t : • 1. •,'.r T 1 k r --.
= n C F-: 7 `-
r . r': _ . •- !r - I I h. t . 4 r: . Y. .
;:41. Solar Domestic-Final r ; q. -t I pt , =''
142. Backflow Preventer. • ' r 1 I h: ' •• '
Il ,-n . �.-. - - • t I. r, l • .. I - . .
43. Backflow Irrigation" ,-+;, ' + c i r tt - •
44. Landscape Irrigation System `_'''t 71' r• t' x
45. Sound Attenuation, ._.; " •�: r r t. _
=• t. *
46.'Handicap Regulations tr t, , '`
47. FINAL STRUCTURE & BUILDING f-, S-i5'= `61u, .. -t ' ' :,
48..FINAL PLANNING' i , ` •• itsti `a-e
_ g -
' a • - M ° „ '49: Electric'Relese to Edison � � V. '', ♦
C.
. -, ,
50. Gas Release to Southern California Gas Co •• 1 �I •i IC +: - • -- •
51. CERTIFICATE OFOCCUPANCY 4. *
No, Date
PROJECT'ADDRESS: UNIT:
OWNER'S NAME:
,. . ADDRESS: ' • .. . • -
PERMIT 'NO: G 044969 . PLAN CHECK NO: N • PAGE: 2
*t***s************************************************************************* •
ARCH/ENGINEER: REG.NO.: - '
ADDRESS: UNIT: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PERMITTEE: PLU 1 ' LAUNDRY TUB OR WASHER 2.00 • 2.00
ADDRESS: PLU 1 SHOWER 2. 00 2.00
• PLU 1 SINK, KITCHEN 2.00 • 2.00
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section PLU 4 WASH BASIN • 2.00 8.00
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. PLU 3 WATER CLOSET ( TOILET) 2.00 6.00
CITY LW.: STATE UC.: cuss: PLU 1 WATER HEATER AND/OR VENT 2.00 2.00
Date: Signature: PLU 1 WATER SERVICE 2.00 2.00 . '
WORKERS'COMPENSATION DECLARATION: Ihereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' PLU 5 GAS PIPING SYS 5+ OUTL—PER OUTLET . 50 2.50
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). PLU 1 GAS SERVICE 2. 00 •. 2.00
POLICY NO.: ' EXP.DATE: ' _ PLU 1 CONNECTION TO BUILDING SEWER EA` ' 5.00 5.00
COMPANY: END OF FEES
•
❑ Certified copy is hereby fumished. 0 Certified copy is Bled with the city Building Division. ,
Date: Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is 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 `1,' .
subject to the Workers'Compensation Laws of California. '
• •
Date: Signature: — 4• -
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 he deemed revoked.
CONSTRUCTION LENDING AGENCY: I here*affirm that there is a construction lending agency for the performance of the work for
which this permit is issued(Section 3097,Civ.C). • 7
•
LENDER: '
ADDRESS: - - • . .. . . , .
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business '
and Professions Code)or that he/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 01 not more than five hundred dollars($500). .
I, as owner of the properly 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 Contractors'State 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 completion,the owner will have the burden of proving he/she did not build or improve '
' for the purpose of sale). '
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon '
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware • '
that proof of their Worker's Compensation insurance should be provided to me. .
❑ I am exempt under Section: B.8 P.C. -
tor this reason: '
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ,
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a •
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from
these provisions. '
Date: Applicant: '
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with at city and county • • '
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Date: Signature:
Driver's License or Social Security M: • '
•1641-46 White—Building:Green—Code Enforcement:Canarv—Applicant:Pink—Revenue:Goldenrod—Assessor -
•
r :0NSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
S. 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 UF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, E Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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
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
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19.. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
r erne. : c __
R _
20. ough Faciory Firpla
;jai - �+ APPROVALS Permit #
21. Ductsjtin Structure 70. Underground Hydro
22. Ducts°,Ventilating 71. Product Piping 0 Gas 0 Oil
•
23. Gas Pipe -Rough & Test 72. Underground Flush
24. Roof'Framin ` `""''t 4.- "
` L` "
,• 9 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof•Sheathing 74. Overhead Hydro
26. YBar.Ceilirig ($tEu ural( &.frlphocoat 75. Dry Chemical
27. Framefand'Flashirij- r I rr 76. Dry Standpipe
28. Lathi g & Siding <N./err •
77. FIXED SYSTEM FINAL
29. Insulation. t ^. [ �•t' : ,- t. 78. FIRE PREV. FINAL
30. Drywall Nailing h „' r r w HEALTH DEPT. REQUIREMENT
r
31. Plaster-Brown Coat n 79. FINAL INSPECTION
32. Electfical Powe Meter-Fiyal 4 -- 80. FOOD CERTIFICATE ISSUED
y 1• -r
33. F.inal.Electric -- c,n. Notes:
34. Frinalr•Heating& Air Conditioning 1•,
35. Final,Gas Pipe-Test ': --, rcf 112436 Cjep
36. Hoodior Canopy U .+r
t rr,r,
37. final Factory Fireplace -m,
38. Final'Plumbing = r
r-
39. Water'Service-Final r."
40. Gas Service-Final
41. Solar,Domestic-Final
42. Backflow Preventer
-, l
43. Backflow,Irrigatiori',`",`",`-,'; .C.. , •
44. Landscape•Irrigation System "- C t
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. FINAL PLANNING
49. Electfic Release to Edison
50. Gas Release to Southern•Califomie Gas Co
51.,CERT,FICATE OF.OCCUPANCY.'
Date
I
1WA ENGINEERS
Frik 17390 BrookhursT Sheei,Suite 100
Fountain Valley,California 92708
(714)968-1221 •FAX(714)968-9286
May 18, 1990 J.N. 207-03
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, Ca. 92628
Attn: Mr. Victor Clift
Subject: Fine Grade Certificate
I hereby certify that the fine grading for lots 21, 59 through 61
and 78 through 87 of Tract 13224 were graded as shown on the
approved precise grading plans for said project.
ie % Gam
r) Llewellyn D. Incledon RCE 17593
TS •
Etc% ►ti vl06-T -
(tea
es
p' e'.414 $- %. V �� ,r. r\* c- , - , �< ff t - t , 'L1 , a
` •-/ � . 0 /.•- ,c4- ' , %' s/1��Y '. i-1 i`,. i- • r''IN • ': _! CM: cC _"�j-'' _/- -•,.
>ir.'1: 5V FC='A 116 CALi-u:.°.'_r. �f_n�_-.___ > } •
f 514 FCZM. !<26 R_:._A SF II f
r/
a
• INSULATION CERTIFICATION
' N.
s` ,,,, This is to certify that, in ronfernTonce with the current energy regulations (California Adminis-
{ ) trat,re ` -Jab?, Tire 25, Stele of California') and approied pians, insulation hos been instened in r
the building l'xated at: V'
/I
Costa Yesa OC3n e
1836
82
cd
__ Nantucket Place — __ -- ---_—_- -- -- — __._-- .j1
5-.. ro ;❑ ..•:'.•�., —_ —_ Sr.-. —.— to e_-s. ^ Tr. No.
rt) .
DESCRIPTION OF INSTALLATION I
ROOFS
\I Type of Mi:erial __ '_— Mai'.'acturer _—_—.----_ Thickr:ess_ P. Va!ue`•__
O'hcNS CORNING N.
/�i EY'ERIOR WALLS - . ''e 11 .11" )
e-,.,1,
Type of Matera!-i3Er'GL=.JJ_.',iiTTS— Manufacturer_
FIBERGLASS. Thickcess_3_ R Value ')
-- —
(Or Tote N,.=d Y -
CEILINGS OWENS CORNING 6z" 19 `is, 1
€VBATTS:ee. r= 4G -.SS LLS FIBERGL
. ASSThickness9i" 30 �/
T+pe of Ma'erial_ V,a 7,1I.m.__ _ R Value" ,r
"'' Sq. Ft. Ca.a:ed__---
//
BLOWN: ,�� .i
Type of Material______________ __—_ Mam Trod. Nina)
Thickness_-- No.Bags__ .�4
a Non.l
%' WLSag_—__ Sq. FL Cohered____—._ R Vah:e"_-_
i S
•
FLOORS /�
/� Type of Material_— ______ (or Trede.urer _—____Thickness _R Value"__
• i j (Or Tred. f....) s,
SLAB ON GRADE ✓'_,
Type of Ma'erial — __ Manufacturer__ _._—___Thickness R Value'•_ \ .
�1 or Tr.e. R•. .7
v. Width of Insulation Inches
•
' FOUNDATION WALLS (if required)
•
i
4, \: Tipe of Material_- - —_-- _—_ Man,fse-jrer_ --- ----Thickness. .__ —_R VaI;e••—_ .
Eil
(or Tai. Nome)
iiii
rGeneral. Contr>ctor (5,i1"en KAUF''IAN & EROAD License Somber _ I
777
1:.�9 _. _ Tale__. Date_t Accent 1psy.1ation Crnrn b/ Sumrtra..o ns !atia) 0.pnTata) . Y Ucanse Nw�ber2742'3v:,•,. Y,c- C.• Sit. 'LYi" :f a-• 1GY)41 By- •-C 7-! : �.- --- Title.— /� --- Date_MSY zi.19901y`� Q("c•r kr. SK. IVA3 .1 w "..'1 .•! k'•+ rid• •' :.. Ste••
Ir. . �y. . Y - `r -?.,c _ ...-:.'N by "V. [r ',.'• •n s -r., .v'- >_c' . -.'r ..n.
' • ✓ ...�.I- 0.." .cf .- ,: .-I ). ..•. .• . .. M>_..,•'
j1•-1 . - • -s 1 n•. ' . ivy' +.• x..y. .'oc•••.. -.. t' .' : • �..
.. . Y.•;..'. ... _... .r •.'w tom•. w • 5....1rr 115 _t a;'__'NG NEMS. INC.• 3)55 ?ee'r,i 4.e., Loi ertee. Cfht. 9%34_-i?i3)873yin •roc, ;egf—t BL'_:' NG In:USTRT A5$C0:17;:r, DF CA•jFN.A, !NC, 1STl ee.e', 5'A. Los kites. G,., 9VT'5—(?13;625.5771