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Home My WebLink About1645 BIMINI PL - Building Permits • i 4`,501 'F CITY OF COSTA MESA BUILDING DIVISION F• 4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER o PERMIT P05-00174 Sb � - (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 1645 BIMINI PL Status: ISSUED Suite No Applied: 03/08/2005 Issued: 03/08/2005 Vicinity: e.. / Parcel Nunmber: 13922315 ISSUED BY: // - Applicant: NOCK, CANDY Address: 11612 KNOTT ST SUITE 217 Phone: (714)895-1246 - GARDEN GROVE,CA Zip: 92841 Owner: WEBER, KEITH LANG w Address 1645 BIMINI PL Phone: Z 0 COSTA MESA,CA Zip: , 92626 413 Contractor: NOCK PLUMBING ' Address: 11612 KNOTT ST SUITE 217 Phone: (714)895-1246 • GARDEN GROVE,CA Zip: 92841 License: 707775 SCOPE OF PERMIT WATER HEATER CHANGE-OUT IN EXISTING SFD. 1 WATER HEATER 1, NO OTHER WORK AUTHORIZED WITH THIS PERMIT. - FEE SUMMARY, AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer _ $0.00 0 Sump Pump , $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00" 0 • Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer . - , $0.00 0 Bathtub $0.00 0 Pressure Regulator ".:$0.00 0 Urinal $0.00 0 ' Clarifier System $0.00 0 Process Piping(per 1.0 ft) $0:00.-,.- 0 Vacuum Brkr Bkflow(1-4) ,$0.00 0 Connect(Ice,Soda,etc) $0.00 0 Redeptors $0.00 0 „, : _ Vacuum• Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 ' Wash Basin $0.00 0 I t Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 - Sewer Connect $0:00 0 - 'Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 . . - Water Closet'(7oilet) $0.00 0 Drain,Roof $0.00 0 Shower • $0.00 - 0, - - . Water Heater/vent $12.30 1 Drinking Fountain ' $0.00 • 0 Sink,bar - $0.00 ' 0 Water Piping.(Instor Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0. ' Water Re-pipe, ' $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor _ $0.00- /0'" .' 'Water Service $0.00 0 ' Gas(1-4 outlets) $0.00 0 Sink,kitchen ' ' '$0.00 - .0 Water/Softener $0.00 0 Gas(Over 4 outlets) $0.00 - 0 Sink,service/mop., , $0.00 =.0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 _- .VIOLATION $0.00 Gas Service $0.00 0 ' - Spa(public) - . $0.00--;,',0: PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 - - - _ REINSPECTION $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related f 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 I or a period of 180 days. NSPECTIONS: In order for the work authorized under this permit to be considered legal, such 'work must comply with all applicable codes, and all equired inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. OR INSPECTIONS CALL: (714)754-5626 46-46(8/00) DECLARATIONS n -f 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. wR(OW c/o brio mnpr �alnon Ins ranee rde�rvaynd poli number are: /1 I,e,-, \ K=..11/44 er y(`' IA rY 111 N r� '\1' 1 t 6r I 'Uy Policy,NufO et- (J (r\K n 'Ail (TMS sect oon need not be comp sled iRRhe rmit is value at 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 the workers' compensation laws of Califomia,and agree that if I should become subject to the workers'compensation provisions f Section 3700 of the Labor Code,I shall forthwith comply with thes�rOviyoos� C P_ n�_S /� I i< Applicant SI nature: //// p Daley `tl V tom[ 1-1LJ� J\ C��l, 1�- WAR INE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 licenst r.P,r I ns of Chapter 9(commencing with Section 7000)of Division 3 of the Busine and� Professions Code,and my license Is In full force and affect.Lic,S I I Class# l v. T Contractors Signe u e: /�� Dat-, .1 Q -":21M Contractors -,. ;.rte=• 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). Lender's Name: Lender's 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 toe 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,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Lew 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.). ❑ I am exempt under sec. . . Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(38)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? 0 Yes 0 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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 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 rk, 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 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? f ❑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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a.Qermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? I0 Yes 0 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? 0 Yes 0 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? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I 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 information 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. 15-S -Mat Of Legal Owner(s) t Oi ApddKfrr'Avchorized'Appsicant 1%P . CODE t INSPECTIONTYPE PAIS IIMAILa CODEP INSPECTIONTYPE PAIS INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical ((�� 1266 Pool Spa Final • 208 Final Plumbing g-t3 -09 Ian/ 200 Final Re-Roof 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 . 4UUC D/e6/81 bp00 TL Applicant to fill in all spaces within heavy border lines and.sign all appropriate declarations. I CITY OF COSTA MESA PERMIT N - TRACT NO. LOT NO: •BLDG.NO. - ' - - ,CONSTRUCTION PERMIT 7a3 ' Project Address//6:,<<S i9/m/Al/ Cc,71• TYPE OF CONSTRUCTION • ..- r' • .. • ' ' Owner C Afz6�Ny� //rq - phone SS7 [�//� D NEW ❑ ADR ❑ALTERATION _ - - - ' ,543 � doStg /�J --LCS/' - ❑ REPAIR ❑ Address/6 f CONVERSION ODEMOLISH r" ZONING REGULATIONS Arch/Eng. - License No. 0 OTHE •R • _ Address' - DESCRIPTION OF WORK A.P. ` - ZONE PLNG. REF.yp - Coritractor �/?,�+�F/�' _A.-/ rgJE•GBhdn 33--9'77 TYPE OF PERMIT , • BUILDING - ��OBP Ili vLINE' SETBACK LST. • % Address „s!{� -�'fyO/YY �A,GG'f� �.PO(/E 0 GRADING .❑ FOUNDATION 0 STRUCTURAL SIDE YARD , IILICENSED CONTRACTOR DECLARATION - ❑ TENANT ❑ ELECTRICAL �PILUM BING ❑MECHANICAL LS SIFT- DE YARD - ' 1 hereby affirm that I am licensed under provisions of Charter 9 (com- RIGHT • mencing with section 7000) of ,Division 3 of the-Business and ❑ OTHERS- . Professions Code, nd my license is In full force an feet - REAR YARD(TO P/L) ��' PROJECT.DESCRIPTION - .- - _ _ ' License ss Lice sp a Noa/� 7 - PKC.SPACE REQ. PROVIDED Date Signature e,�'_,_',�t'-i". :SQ-FT _ WORKERS'COMPENSATION DECLARATION - - 'OCCUPANCY=CONSTRUCTION TYPE STREET WIDTH PARK FEE $ ' • 'I hereby affirm that I have a certificate of consent to self-insure or-a VALUATION ZONE - • ZONING APPROVED BY I DATE " ^ertificate of Workers' Compensation Insurance; or a certified copy SPECIAL CONDITIONS: �n�N� reof(Section a8D0 Lab.C.). GRADING CU. YDS. ACRES 4 (p f rw C cy No .r1/61 491:// Compan, A2C--7-4.55 ZieeS- - - - - .. - CEL�tD E-Z`Y A - - • - Certified copy is hereby furnished.' - -. - -' CA{Y [i Certified copy is filed with the city Building Division. Iv .1 y , I. • EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - DATE1 ' (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 -PLUMBING',:: PLAN CHECK . •'ELECTRICAL PLAN CHECK subject to the Workers' Compensation Laws of California. - . . _ _ -- UW tLLINIe -1../.1R/AGE - Date Signature • BATHTUBS SHOWERS 50 FT ' 50 FT - - NOTICE: If after making this declaration, you should become subject TOILETS URINALS - GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must - TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS , • (APPLIANCE • 10-50 KW-50+KW revoked.- - - - -- _ ,, _ CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS ' MOTORS " 0-1 HP 1-10 HP ' - _ I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS- - ' SUMPS (INC.SOLAR) 10-50 HP_50•+ HP - - formance of the work for which this permit is Issued (Section 3097 - 11 Civ. CJ. - - - FLOOR SINKS FLOOR DRAINS • 'FIXTURES - 'OUTLETS' SWITCHES -� �p Lender's Name `lJR-•O Lender's Address DRINKING FOUNTAINS - 'GAS TUBE SIGNS' ' OWNER BUILDER—DECLARATION INTERCEPTORS CLARIFIERS - - I hereby affirm that I am exempt from the Contractor's License Law for POLE LIGHTS ' ' , the following reason (Section 7031.5 Business and"Professions Code: SWIMMING POOL P TRAP ' - - LUNS I HUt-d IUN. - Any city or county which requires' a permit to construct, alter, POLES METERED SUB improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION - PANELS - MAIN - SUB _ quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License'Law GAS SERVICE OUTLETS 'SERVICE- ' ' ' -- AMP !Chapter 9 (commencing with Section 7000) of Division 3 of the - - '^+'.mess and Professions Code) or that he is exempt therefrom'and the' WATER HEATERS(.0 BTU OUTPUT' - - qq CO - - - - s for the alleged exemption. Any violation of Section 7031.5 by /Jl • applicant for a permit subjects the'applicant to a civil penalty ' SEWER CONNECTIONS - - ' :. 'not more than five hundred dollars ($500). . _ _ ❑ I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS - - - - - - ' sole compensation, will do the work, and the structure is not intended _ ' or offered for sale. (Section 7044; Business and Professions Code: The SOLAR PIPING SYS. 'I - 1 ISSUE'FEE - • - - Contractor's License Law does not apply to an_owner,of.a property _ _ . who builds or improves thereon, and who does such work himself or ISSUE FEE 'I 3 00 APPLICATION APPROVED BY - - DATE - through his own-employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK ' _ is sold within one year of completion, the owner will-have the burden SUMMARY OF FEES of proving he did not build or improve for the purpose of sale). .BUILDING - - --- ' HEATING SYSTEM_ _0-100,000 BT_U PERMIT $ • • SMIP • $ - 0 I, as 'owner• of- the`property, 'am exclusively contracting with ADUCTING AND - • - - - • licensed contractors to construct the project (Section 7044, Business 100,00B+BTU PLAN CHECK $ PERMIT. I 'and Professions Code: The Contractor's License Law does not apply to' - $ C �� - + ISSUANCE $ - an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU _ PLUMBING. �7 tracts'from'such projects with a contractor(s) licesned pursuant to SYSTEM - ' ' - - - - GRADING $ ' 1 ' the Contractor's License Law). _ - 100,000+BTU _ . 'PLAN CHECK $ ' - ❑I am exempt untler _Section B.& P.C.for this BOILERS BTU , 'ELECTRICAL $ $ r, i _ - "- "" - MICROFILM $ SYSTEM REPAIR,ALTERATION 'PLAN CHECK $ - AA - - - - 'TOTAL FEE$ S-QV ''MECHANICAL'$ [hereby certify that.l have.reae.thls application and state that the above. EXHAUST_SVSTEM_ MULTIPLE__ ! f LESS AD--_-- Information is correct. I agree to comply with all city and county PLAN CHECK' $ ' - VANCE PC-$_ " ' ordinances and state laws,relating to construction,and hereby authorize - representatives of this city to enter upon the above mentioned property-,for 1Y speCtion pu uses. - _ _ p Signature bC- R / '� 'G Date /07�/pY FINAL FEE $ s� Drivers'License or SS 'ISSUE FEE' - - -• - -• ��s'-"- CMF 0865-46 . 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 43. Pool & Equipment Location -- -- ' - • - , 2. Soil Pipe-Undrgrn • • 44. Steel Reinforcement - - ' 3. Electrical Conduit Utility-Undrgrn - 45. Forms • 4. Electrical Conduit-Undrgrn _ 46. Electrical Bonding ' •- • 5. Steel Reinforce. - 47. Rough Plumbing & Pressure-Test -- - • . - -. . 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE- • 7. Footings 49. Electrical Conduit-Undrgrn • • 8. Foundation • " " . .. - - 50. Gas Pipe, ❑Undrgrn,Test - - 9.. Water Pipe-Undrgrn. 51.- Backwash Lines. P-Trip, ❑Undrgrn • - • 10. Structural Floor System - ... .. 52. APPROVAL TO DECK - 11. Property Sewer Line & House Connection , • 53. Backwash &.Receptor-Final 12. Street Sewer-Connection _ - 54. Heater & Vent-Final 13. Rough Plumbing `-' �':; - 55. Plumbing System - Final ' 14. Rough Electric=Conduit( _ - - - - 56. Electrical-Final . 15. Rough Electric=Wiring '' " " -`i 'if-.:,,j' - - 57. Solar System-Final • . , "' - 16. Rough Heating& Air Conditioning - b8. Fencing &Access Approval -17. Ducts, in Structure.- 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating - - _ 19. Gas Pipe-Rough &Test .. . , • 60. POOL/SPA SYSTEMS FINAL • - • - 20. Roof Framing _ _ - . .- • 21. Roof Sheathing - • 22. Frame and Flashing - NOTES: . 23. Insulation ' • 24. Lathing & Siding- .: _ - - 25. Drywall Nailing 26.. Plaster Brown Coat _ . . . . - - • -• 27. Electrical Power Meter-Final •• . . ' - . - - • 28. Final Electric - . - . _ .. . . " ._ „ .- . - - , 29. Final Heating & Air.Conditioning • -. • .. - . . .30. ..Final Gas Pipe-Test - _ ' 31. Final Plumbing " - •, •• - . 32. Water Service-Final _ . - ' ' . ' 33. Gas Service-Final - . - -r - • ' 34. Solar Domestic'Final • - . - - •' 35. - Landscape Sprinkling System. • - .- . • ' • 36. Sound Attenuation _ ' ,. • 37. Handicap Regulations - 38. FINAL STRUCTURE & BUILDING . - 39. Special Requirements Completed - - . • - 40. Electric Release .to Edison : • . ' 41. Gas Release to Southern California Gas Co. - - . . 42. CERTIFICATE OF OCCUPANCY • -.No Date - - COSTA MESA BUILDING-SAFETY DEPARTMENT ;:,rl,-In,- tII,r,;,(jC DLFI, P.O.BOX 317 COSTA MESA.CALIFORNIA I C:07.1 1.7.231\ C:T • EOR APPLICANT TO flit IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BIL ADUDRDIESSNG 16145 Bimini Place FOR MESA. CALIFORNIA OFF/CE USE ONLY 1 .OWNER Glenverde Homes,Inc. RECEIPT NO. PERMIT O. MAIL RECEI/V.ED.BYA_ DATE EC ED DATE ISSUED ADDRESS Box 65 !�✓/ //m7-5-, NO" O Q loco CITY Balboa Island,Cal. TNPr3-4220 BUD ADDRESS v ARCHITECT • LIC. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS ZIRE (1 __ p ZONE TYPE GROUP ',It- CONTRACTOR Macco Corp. STATE 98808 APPROVED CONTRACTOR LIC.NO. BY DATE ADDRESS Box'65,Balboa Island,Calif.,'71µ� 1 ZONINGlUSE OF ✓,,�f� �l"� DESCRIPTION LEGAL -I NO. 156 BLOCK (TRACT 87 ZD �// PLAN: j/ I BUND N� p-/ ✓l. c ,L/ A.P.NO. APPROVE 4 (((///ffl \Iw�-�� BV � .� DATE ) 3-CS-7 SIZENO.OF BLDG:. S OF LOT 7000 I Now ON LOT 0 REQUIREDALLOWED USE OF - ST.) ) EXISTING BLDG. ., FT. IN. SETBACK LINE FROM55 50 i • CENTER OF STREET REAR YARD R.SIDE ' 3 FT. IN. SIDE YARD (LEFT 5 (RIGHT 5 L.SIDE �J)1 FT. IN. DESCRIPTION OF WORK REAR V - FT. t IN. NEW . I x II ALTERATION I II ADDITION REPAIR I I MOVING II DEMOLISH I BUILDING NO.OF ' SIZE 1525/1,40 ROOMS 8 STORIES 1 COEXTERIVERINORG S WALLt CCO ICOVERING rock USE OF BUILDING AND WORK TO BE PERFORMED residence , Orrin(/ ra ed I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION _ SIGNATURE . .. it EDE HOMES,INC. q PERMIT FEE $ e�,'rj �� PERM ITT. ' 15/ 6 7/.— C(......._ ' $ AUTHOR( lJ / PLAN CHECK S /7j SD l\ \ TOTAL FEE $ 0 .3 6