HomeMy WebLinkAbout132 BROOKLINE LN - Building Permits•t I CONSTRUCTION AND PLANNING POL . & SPA
APPROVALS Permit# Date Inspector 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
B. Electrical OF ER 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. ❑ 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
20. Rough Factory Fireplace APPROVALS . Permit # •
21. Ducts,in Structure. -. . 70. Underground Hydro
22. Ducts, Ventilating 71. Product•Piping 7,Gas 0 Oil
23. Gas Pipe'=Rough & Test
72. Undergrround Flush
24. Roof Framing r • •• 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing `Y 7 'qc 661-6it 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &Monocoat 75. Dry Chem cal
27. Frame and Flashing 76. Dry Standpipe -
28. Lathing& Siding77. 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 7 Notes:
34. Final Heating& Air Conditioning •
35.iFinal Gas Pipe-Test •
36. Flood or Canopy
37. .Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final -
40. Gas Service-Final •
41. Solar Domestic-Final -
•
42. Backflow Preventer •
43. Backflow Irrigation
44. Landscape Irrigation System , •
45. Sound Attenuation -
•
46. Handicap Regulations -
47. FINAL STRUCTURE&BUILDING (o T,.9y 6c_ -
48. FINAL PLANNING - ;
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECTADDRESS: 132 BROOKLINE LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 069623
'k, OWNER'S NAME: SMITH CHERYL L
muss: 132 BROOKLINE LN PERMIT NO; B 069623 PLAN CHECK NO: N GOVT: N SUP P : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; T/O RESTH & REROOF W/COPM 6 HOT MOP SQ FT : 2, 508
ADDRESS: UNIT:
CLAIM VALUE: 2, 508 . 00 CALC—VALUE: 2, 508 . 00 GROUP OCC ; R-1 /
PERMITTEE: STOUT ROOFING INC ( 310 ) 923-6775
ADDRESS: P 0 BOX 4309 COMMENTS : REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE RETE, REQUIRED
DOWNEY CA 90241 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code,and my license is in full torte and effect. SETBACKS
cITYLIcA.:�Y 377 sTATELIC.: 402536 cuss: C 39 EXP: 10/95
Date:_)L�' OLT
1 Signature: e) MAIN BUILDING ACCESSORY BUILDING
WORKERS'COM ENSATION DECLARATION: thereby affirm that have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
Compensation li kiatge2oL2,pepilled copy thereof(Section 3/300.Lab. 5/19/9 5 LEFT: FT IN RGHT: FT IN LEFT; FT I N RGHT; FT IN
POLICY NO.: 7 01 L b tl tl EXP.DATE:
COMPANY: AIG PARKING REQ:_ PROV; PARCEL; 41916349 ZNE: REF NO:
IC❑ Certified copy i hereby furnished. `Certified copy is fit d with the city Building Division. PLANNING NOTES>
>
Date, i *******************************************************************************
Applicant DEVELOPMENT SERVICES R E U I R E M E N T S
EXEMPTION ROM ORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). Q
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
sublet[to the Workers'Compensation Laws of California. ZONING APPROVED BYDATE: '
Date: Signature: BUILDING APPROVED BY :
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. j h� 6/
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE; It)1 11(
which this permit is issued(Section 3097.Civ.CI. *** if**
LENDER: **************************** * 4************************************************
ADDRESS: LEGALIZATION:N E E SUMMARY 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 SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT 54 . 00 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
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 of not more than five hundred dollars($500). ISSUE FEE
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 sate(Section 7044,Business and Professional Code: The Contractors'State License Law
TOTALS————> 54 . 50 0 , 0 0 0 , 00 5 4 , 5 0 54 . 50 , 0 0
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/hersell or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 54 . 50 OVER/SHORT; 00
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). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 , 00 , 5O
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon .st lE it**iE it*ie*it BE if 9f ie 1t 1k 1t*Be it iei¢i¢it it iE it*ie it iei¢if if ieieie*1t 1t BE*i¢it if if********************************
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. IND I VIDUAL F E E BR EAKDOWN
❑ I am exempt under Section' B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 2, 508 . 00
Ido hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
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.(agree to comply with all 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: It ?4 /,'(9 1 Signature: r �� 01 00170691-"00170695 TI 1T e,r c`
L Driver's License or Social Security x: DATE: 10/23/94 TIME: 133:31
1641-46 White—Ruilding',Green—Code Entorcemenh Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
Applicant to_fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Akidr` /.3Z ,7 _ L, to/y �j t.307'.27 S ( 000 00 6654 (0/30/87 57pI6 TL
Applicant's Meil� •ddress •l. I '. / 14/ C-1 TYPE OF CONSTRUCTION 0 NEW LADD IJ ALTERATION U REPAIR
tM&Iinf
.' t.- iT ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ( 4 — I/�•f� �3
Owner's Name V 'hone/ A.P.A'p # ea&_ .. Zone
�` i kr— 1 P �.SJ 270 DE,CRIPTION OF WORK/USE OF BLDG. �..`•) r ✓�
Address/1-C i I!•6/��R c./ / S Main Building: Accessory Building:
4 Arch/Eng. License No ' TYPE OF PE IT IJ GRADING U FOUNDATION STRUCTURAL E Front 0
Address ❑ TENANT 0 ELECTRICAL ❑ PLUMBING MECHANICAL BB Rear N
Contractor's Na • ✓i _. ' :, _ i• ❑ OTHER p I
<1
Address(mailin /
A:5,
r PROJECT DESCRIPTION eras OCCUPANCY K� C Right G
;0�1�2q /4(�J /LUR 'S CONSTRUCTION TVPEJ VALUATIONS /70‘„,.-
ACRES
S Left
City License No. 3 J 77t / ZONE- GRADING CU.VDS. ACRES E
R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: u l ViN •t"seek 2 . M
with section full of Division 3 of the Business and Professions po e, and IVB T
my license is In lull fyrce and effect. l(J 1 A_pJ
License la Li tens '�CJ/1 S
Date fe•I 7 Signature e't -• PLUMBING FEES)
YORK RS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-I sure or a certificate
frif Workers' Compensation Insurance, or a certifi • c••y thereof (5= Ion Backflow Preventer Service Sink
3800, Lab, c p�/ Automatic Washer Transformer 0 15-50 KW
Ns,. Policy Nq�VajQ l� Compo •.fes t— Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
8 Certified copy is hereby furnished. -
Certi ie o y . f' d with the city Bu' Divisio• Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
•
i\'• Date Applicant ,-
EXE• ION ROM WORKERS'CO PENSATION c C •RATION Clarifiets Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
• 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 Drinking Fountains Solar Tank • Fan ,Motors❑0-1 HP 011/,-8
1 Workers' Compensation Laws of California.
1 Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
INOTICE: If,after making this declaration,you should become subject to the - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there.is a construction lending agency for the performance _ POIe Light
of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors 'Water Heater Outlets Range
Lender's Name _
Lender's Address Kitchen Sink . Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that l.am exempt from the Contractor's License Law for the Lavatories Auto-Wash
• Garbage Disposal Standing Sections
followingunte (Section Businessonru and Professional Cade: Any city or \
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap LaundryTrays
any structure, prior to Its issuance, also requires the applicant for such permit y Generator ❑0-5 KW ❑5.15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt - -, - - -
.herefrom 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 s
p natty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered -- t Reinspection Fee ( $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES •
License Law does not apply to an owner of a property who builds or Improves r
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICEa- •UIREMENTS:
Boiler Hood or Type I ❑
' employees, provided that such improvements are not intended or ofd forr/ Q
sale. if, however, the building or Improvement is sold within one year com- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground �"
prove for the purpose of sale). Building Approved By Date /0 _0-
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By a. • aSO-.. - Date (r- 1 7
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or Improves thereon,and who contracts for such projects with a con-
tractors license pursuant to the Contractor's License Law). I am aware that System Repair/Alteration
BUILDING PERMIT $ SMIP $ _ .517
proof os their Worker's Compensation insurance should be provided to me. ■ 1
�/
0 I am exempt under Section B.& P.C.for this reason f :• Fire Dampers '1 /• PLAN CHECK $ • PERMITPLUMBING $ ISSUANCE $
Date Owner Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above / ■0-100,000 BTU 0100,000: GRADING $
information Is correct. I agree to comply 'th all city and county ordinances ELECTRICAL $
and state laws relating to building co action, and hereby author) rept PLAN CHECK 50% $ MICROFILM $
sentatives of t to este the above-mentioned pro rty f r
inspection puIf ,/
Signature ..if Date MECHANICAL $ -7.019 TOTAL FEE $ �`/�
Drivers' License or SS • / - Issue Fee $ 3 PLAN CHECK 25% $ _ i •00
•
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant: Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS ' Permit# Date Inspector APPROVALS Permit# Date Inspector
-
1...Temporary Electrical SerVice or Pole 52. Pool & Equipment Location
i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
r 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER 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, ❑ 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 -
20. Rough Factory Fireplace i2-?-Y7 1.20 APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat / ((( 75. Dry Chemical
27. Frame and Flashing /941' 76. Dry Standpipe
28. Lathing & Siding /M� 77. FIXED SYSTEM FINAL .
29. Insulation 78. FIRE PREV. 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: hiCa5 C--ThA ` , 04
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36.',Hood or Canopy
37.'Final Factory Fireplace 1-111-80 �o _
38. Final Plumbing • - ;
39. Water Service-Final i
40. Gas Service-Final ./- ' r
i
41. Solar Domestic-Final 1 /
,.42i. . Backflow Preventer
43i Backflow Irrigation - ,'T/,',
44. Landscape Irrigation System • .
. 45: Sound Attenuation
46 Handicap Regulations -
'47. FINAL STRUCTURE & BUILDING /tAi ifiC-� °' #Tj
48. Special Requirements Completed D " t
I + • ,
49:f Electric Release to Edison • S `•
50. Gas Release to Southern California Gas Co . • , . •
51. CERTIFICATE OF OCCUPANCY '
No. Date
I
Y
UWIVtK SAN VISTA WILDING CO. UAIt 10-4-67
JOB ADDRESS 132 Brookline Lane : BUILDING PERMIT NO. 27642
GENERAL CONTRACTOR Same DESCRIPTION of WORK Residence W/Att. Garage
AP No. LOT 70 TRACT 5160 FIRE ZONE . VALUE $18:114.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-3
SOIL �-/-S /01.,4-' SUBCONTRACTOR PERMITS ISSUED
GAS r Q� LSO 2-3-
-,2-3-
-, Date Number Signal _
WATER tig1 SI617—(o2 /, P umbinq
ROUGH PL MBING ILS/4e-IGx L*L4cJ/Aj /Q_5-e7 0-6, ,,I� %
PROP. SWR. LINE Q HOUSE CON.ca"---- 44-74-5' l'-ie-1.,-7
SPRINKLING SYSTEM
MISCELLANEOUS r
ROUGH HEATING AND AIR CONDITIONING �l2-y G)
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Neatin and Vent.
TRENCHES FORMS LI STEEL REINF. I e,.^. /Ca��?T .rte �/�j /j//��f �"i y/
FLOOR SYSTEM .0.mm / (7 /~�'(`/�� mil' / (O
BOND BEAM n STEEL REINFORCE n
SHEATHING LO tifi
FRAMEHIAND INAS FLASHING C LATHING - IN r�UT Cd '7
PLASTER, BROWN COAT Iyn.O V V.
STRUCTURAL, FINAL /I�� FF��
HEATING, VENT., REFRIG. AND A.C., FINAL /ytf5 2,-J-(r fr�4/id.. y_ j' 1,74,7-47 279
PLUMBING, FINAL AND GAS TEST n !/ -- _ �L/U a /
rd
ELECTRIC, FINAL i P4 r c
BUILDING, FINAL Ii• // @— - t
27642 •
OCT -11.61cm 00 116" *1.-, ,. 90 „1,
COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 1206 COSTA MESA, CALIFORNIA 92626 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING l 3 ` to.. '�C.. -� /'�_ For Office Use Only
y/(��(
d�-t(.Q K[CEIFTNO. 2 V42
ADDRESS /
COSTA MESA, CALIFORNIA
RECUI 1" DANK5 IIflD 1EEU D
OWNER (2t,t i,/ / '( 7 /0-9-4
BUILDING
MAIL ADDRESS
ADDRESS d- ,( + ' iA^
T[
FIRE O
//�� t. ��'y ZONE TYPE OROUt�C
CITY {fJ�(-t 4/�i NO.O✓/'`�1')f /// //l`�/ /J y/�/7
LI. ' ''.R(h N L #r!;
APPROVED ///a DATE 7 -G6 (p/
ARCHITECT
ENGINEER E ////// ZONING -C �-'�'e�
ADDRESS etc ! /_v 2 geer{.eFl.(lQ Z0� NO.O! OE[O!N -•
n ft I FLAN/ 2r--SUILDING /i i
CONTRACTOR `0�.L�( -LI" j L(/, `�
LEGAL
ADDRESS (-a/ ,
(.(.[i� D[SCRIRION Za (• ' ..• /l//^^
D
CITY Q Ce..--PLA--t i—J A.P.NO. 4%'LDS a / J 0 – O
NOTE: NO EAVE OVER ANG SHALL BE LESS THAN
STATE TEL. SO'TO SIDE a REAR e.L
LIC.NO. NO.
_ n{) X F� EAVES
( 7(� I _NOW ON LOT ALLOWED f U.S.C.REQUIREMENT/
OF LOT
SIE
YARDS APPROVED YARDS APPROVED
USE OF - MAIN BUILDING ACCESSORY BUILDING
EXISTING GLEN/.
C FROM C/L STREET/
6tTS*OK SINIPPRee FRONT 0 FT.
CENTER OF STREET REAR YARD --
-----r— I R.OMR 0 FT. R.
SIDE YARD LEFT RIGHT
DESCRIPTION OF WORK L..smog 'OPT. FT.
NEW ALTERATION ADDITION REAR 0R. FT.
DISTANCE BET. BET.MAIN&
REPAIR _MOVING DEMOLISH MAIN BLDGB. ACCESS.BLOCS.
BUILDING. n NO.OF / VAR.# DATE
SIZE �xi .L i ROOMS / STORIES C.V.
Il� p.# APPROVED
EXTERIORWALL I ROOF Fp (
COVERING COVERING BY GU• am (Y' . � DATE 9---2/
/'oJ
VUS[OF BUILDING D WOR�TO BEP�RFORMD
p
UR /J l
fr
�Q/374a.Rd g e, 1
I HERESY ACKNOWLEDGE THAT.I HAVE RIAD THIS A►PUGTION THE AMOUNT SHO UNDER VALUATION IS FOR THE 2
ANO STATE THAT ASOV[.15 CORRECT AND AGREE TO COM. PURPOSE OF STASLISHINO A PERMIT PEE ONLY.
PLY WITH ALL CI o INI1NCEi AND RATS LAW/REGULATING VALUATION
BUILDING CON UCTO 6 Q N
De PERMIT FEE 5
e
PE°RNI.tiTT-u OFURE .1-C _,4 AM y�
- \ 1i/�/I/
PLAN CHECK S 4301..
AUTHORIZED A i 96
TOTAL PEE $