HomeMy WebLinkAbout1617 CORSICA PL - Building Permits ADDRESS OF BUILDING: 1617 CORSICA PL WIT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERSNAMEIFeNOWN:MILLER, ROBERT D TR ERM NO: B 077328
ADDRESs:1617 CORSICA PL
i'. COSTA MESA, CA 92626 PERMIT NO: B 077328 PLAN CHECK NO: N GOVT: N SUPP : N
545-8660
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
‘.,.
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT: 3, 400
ARCH.OR ENG.'S ADDRESS: MT:
CLAIM VALUE: 3, 400 . 00 CALC—VALUE: 3, 400 . 00 GROUP OCC : R-3 /
wNmACTo'sNAME:DICK VAN HAMERSVELD ROOFI ( 310 ) 924-5308
CartRACTOR'SMAJUNo19712 MEADOW' S CI COMMENTS: REROOF 2300SF RESIDENCE W/COMP SHINGLES
ADDRESS:CERRITOS CA MHO.: 383051 *******************************************************************************
90703 UMT: Z ONI NG REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penally of perjury that I am licensed under prodsions of Chapter 9 SETBACK S
(commandng with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect
CRY LIC.NO.: qq //LIC.CLAS&C-39 uD 3 3 1 EXP• MAIN BUILDING ACCESSORY BUILDING
Dale: J' 29 9b Contractor: ���.. .// FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
7 ` LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally el perjury that I mm exempt from the Contractors License Law for the
following reason(Section 7031.5 Business and Professions Code:Any city or county whim,rewires a penny to sebum,after,improve. PARKING REQ: PROV: PARCEL: 13919206 Z N E: REF NO:
demolish.or repair any structure.prior to issuanpermits issu .also requires the applicant for such pento file a signedMomentement that he or she PLANNING NOTES> /
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing wish Section 7000)of Division 3 of the
Business end Professions Code(or that he or she is exempt therefrom and the bash for the'alieged exemption.My violation of Section > (
7031.5 by any applicant lora permit subjects the applicant to a civil penalty of nor more than five hundredddlars lS500(). **********************************************************************3E4E3E*OE3E***
❑ I,es owner of the property or my employees with wales es their sole mmpmuation,will do the work.and to awcture is not intended DEVELOPMENT SERVICES REQUIREMENT, S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does nol apply to an Omer of property
who builds or improves thereon.and Moo does such work barnsel or hersel or through his or her own employees.provided that such
improvements not rd provioffered irigshee«e osis nu�bd�d or imperom'e for is sold of sale) yeas of completion.the ZONING APPROVED'BY DATE : i'
❑ I.es owner dlhe"°pert'.sin stelYcentra°bgwBhioensedcatre"eletocenwucthe prded(Secion7044,Busine°eand BUILDING APPROVED BY : DATE : ". "
Professions Code:The Contractors License Law does not appy to an owner of property who builds or improves(hereon and who
contracts for such projects with a cmatlrecor( this mace:
licensed pursuant to the Contractors License Law). S ("2Y q /
❑ lae=emwunaerseptlOn: B.aP.c..for son: ********* * *****D BYiE********************* ***************D**EEiE* ✓ llJ/J**
Date: Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: Y
I do hereby certify(hat l am aware of and understand the requirements of Calaania Health end Safety Code Sections 25505,25533,and
25534,and that I or any future building occupant will/wB not(circle one)need to comply with said cele codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC • FIRE SMIP/RES GRADING
e permit for construction or modaragnhprn the As a Fty enagemenl Dbtda.Resideruielconstrucare ionappications aexempt from these
provisions. PERMIT 87 . 25 . 50
Date: App-rad: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE
❑ Ihave and wlmeimaioacedaicatedconsent tose4;nawekrworkers'compensation,aspwddedfor bySecion3700of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code.for neped°ma adtnewektorw hmapermitb aagee. TOTALS----> 87 . 75 0 . 00 0 . 00 87 . 75 87 . 75 . 00
❑ I have and will maintain workers'compensation insurance.as required by Section 3703 of the Labor Code,for the performance of the
work for which the permit is issued.My woken'compensation insurance carrier and policy number are:
Cartier: REVENUE DIVISION TOTALS--> COLLECTED : 87 . 75 OVER/SHORT: . 00
Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed I dispense is for one hundred dollen(SIM°r less) 87. 25 . 50
❑ I certify that in the performance of the work tor which this permit is issu I shall not employ any person in any manner eo as to
become subjed to the workers'compensation laws d California. mat a I subject to the workers' *******************************************************************************
compensation provisions d Section 3703°""°LaborCode,I°ha n°° py�� IND I V IDUAL F E E B R E AK D OWN
Date ii—.n c/—96 Applicant: �... �1
Warning:Failure to secure worker'compensation revenge/s unlawful,and shall subject en employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines up to one hundred thousand dollars(3f OI000A In addition to the cost of compensator;damages as provided for In
Section 3706ofMeLaborCode,lnnunandattomey'sfaes. SFR 3400 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 400 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a compaction lending agency for the END OF FEES
performance of the work for which this perms is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and stale that the above information is coned.I agree to comply with all city and county ordinances
and state laws rebuke to building constudion and hereby authorise representatives of this thy to enter upon the above'mentioned property
for inspection purpnsesDlCK VAN HAMERSVELD
01
j
ijei:7 � 4.„7/ Date: —�5-- 9ti ol,TT: ;ri2' T, t. i_ c
Signature of Owner/Agent/Appl avM.omactor
15151 d6 WP) White-Building&Safety;Green-Ale:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
•
1
CONSTRUCTION AND PLANNING POOL& 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
6. Electrical UF 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, 0 Urdrgrnd.
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 'i 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 0 Gas 0 Oil
•
23. Gas Pipe-Rough&Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing YJa-¶6 6ce ..w 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 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: •
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood 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 ' 7b Gcc �7-' i
48. FINAL PLANNING l !
49. Electric Release to Edison •
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No, Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA M A CONSTRUCTION PERMIT P MIT NO./ TRACT NO. LOT NO. UNIT NO. A P # I Zone ,
Project Address / /'? 1 .n�5 IC R Di(l (/F 3 sa' Z S
��(� S Main Building: Accessory Building:
ApTYPE OF CONSTRUCTION L] NEW LI ADD U ALTERATION LS iiEPAIR E Z
Owner's
Name Mailing AddressC '/,9a 0 CONVERSION 0 DEMOLISH 0 OTHER T Front 0
Owner's Name `� m I��I Ip� / Phone��937 tT/
Address
/6l / (nee JCA !?i( ! OST/9 /netsA DESCRIPTION OF WORK/USE OF BLDG. B Rear N
C Right N
Arch/Eng. License No. TYPE OF PERMIT LI GRADING��'1U'1 FOUNDATION� LI STRUCTURAL G
Address L 0 TENANT 0 ELECTRICAL L�t�PCOMBING 0 MECHANICAL $ Left
Contractor's Name fly�fD�L//j1�JtiGl Phone rP"C��.�'3/,3Q 0 OTHER PIMg. Ref.# Parking Req./Provided E
0 ,ESC$1-Zj'G /(Iu, L�, 7I71IN}T5js 91611 PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes: 0
Address(mailing) / l.l.C'S
„y / CONSTRUCTION TYPE VALUATION$ T
City License No. ``�� �r �� �/ '/T7GZ/ M
ZONE GRADING CU.YDS. AC REe
LICENSED CONTRACTOR DECLARATION S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: y� /� �� `,�T/�
with section 7000) of Division 3 of the Business and Professions Code, and ,/Caf "J inc,e /2 �
my license is in fLip fo ce ad effect. V / [per e�- ELECTRICAL FEES
License Gass t - sP C-- 0 License NO.3) O ?-1-/2_ �e�/ ('U��u� /r
1'^ oate it I C I 0- Signet. _.WL. le_ PLUMBING I FEES Automatic Washer Transformer ❑ 15-50 KW
1 WORKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW
(sJJI.
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
of Workers' Compensation Ins3urance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter Duo to 100 amps
3800, Lab. C.N e/ // r
Policy No. Cite/
`rC! Company 67-1J/ I A4b Backflow Irrigation Sewer Cap Dishwasher i-' Meter Dover 100 amps
iCertified copy is hereby furnished. Dryers ❑Gas ❑EI¢ttric Sub Panel
Date TI IS 1`O WORKApplERS'
- DECLARATION
Fan Motors❑O-1 HP ❑1%-8
an
EXEMPTION ROM KERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed If the permit Is for ono hundred ($100)or Dishwasher F.A.U. Inc.Solar 09-15 HP ❑16-15+
less). Solar Piping
I certify that in the performance of the work for which this permit is issued, I ::i
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fixtures
Microwave
Workers' Compensation Laws of California. -
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If,after making this declaration, you should become subject to the - — e Outlets Ran
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9
comply with such provisions or this permit shall be deemed revoked. - -_- - - --
CONSTRUCTION LENDING AGENCY Switches
Gas Service Outlets Z Water Closet Z y, Sign
I hereby affirmk that there Is a construction rmit lending (Section
for the performance C.)
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Heater r2 Ott Garbage Disposal Standing Sections
Lender's Name f Generator 00-5 KW El 5-15 KW Trash Com ctor
BUILDER
Lender's Address Kitchen Sink Water ServiceCompactor
OWNER UILDECLARATION -
f n affirm that Se I amon exempt1.5from theand Contractor's l e Lawfor orhe Lavatories Auto-Wash
followinguntreason esiarl permit
Business construct,
Professional Code: Any city ar
county which requires tapeseta c ,al or alter,improve,demolish or repairmitP-Trap Laundry Trays
any structure,gre, p rtar m nt the/, also requires the tcto applicant for such permit
to file a signedrastatement t that pe is licensedcommpursuant to the provisions of Roof Drains
the Contractor's a License Law Professions
r(Chapterf9s ons n9 with Section 7 x)of - _ _ _ -
Division 3 of the and alleged
axe Code) or that he/she is exempt -- -therefrom and and the basis for the alleged exemption. Any violation of Section Reinspection Fee $15 Issue Fee $ 3
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
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 ---, Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or Improves f
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type 1 ❑ Application Issued By ? Date 11 I T kre
employees, provided that such Improvements are not intended or offered foryP
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground SUMMARY OF FEES
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
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 ❑0.100,000 BTU ❑100,000 BTU u-O ISSUANCE $
builds or improves thereon,and who contracts for such oroiects with a con- PLUMBING $ 7
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation Insurance should be provided to me. GRADING $
17 I am exempt under Section 8.& P.C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers ELECTRICAL $
PLAN CHECK 50% $ MICROFILM $
Heating Owner System&Ducting Registers
I hereby certifysthat I have read this application hand state that the above
00-100,000 BTU 0100,0008 MECHANICAL $ TOTAL FEE $ "7• 0 b
Information is correct. I agree to Comply with all and
and county irepre-
sentatives
PLAN CHECK 25% $
and state laws relatingis tot building construction,vehereby authorize for
sentatives ou this city t/o� enter upon the above-mentioned property1for
inspection
purposes..
_tie._ 1 1.ce-' . `IA-
! Reinspection Fee $15 Issue Fee $ 3 01 00019789-00019789 TOT 7.00
DATE: 11/17/88 TIFIE: 11:52
0865-46,rev. 5/88 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
2. Soil Pipe-Undrgrnd. . �< 53. Steel Reinforcement
r 3.�Electrical Conduit1Utility-Undrgrnd. 54. Forms '
4,ElecuicaliConduittUndrgrnd. • 55. Electrical Bonding
b(Steel Reinforcement , 56. Rough Plumbing & Pressure Test
I
6 Electrical UFER Grnd,- 57. APPROVAL TO COVER-GUNITE
7)Footings 58. Electrical Conduit-Undrgrnd.
8.Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
94-Water Pipe-Undrgrnd'• ' 60. Backwash Lines,P-Trap, O Undrgrnd.
10Structui'al Floor System * ' 61. APPROVAL TO DECK
11 CProperty Sewe,' 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 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing' 73. Undergrnd.Storage Tank O Gas 0 Oil
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 /j //-b(- (-Ep
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing I j3J/�q �Eo
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
48. Special Requirements Completed
or
49. Electric Release to Edison /
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER COAtESA, IPG. DATE 5^14-59
JOB ADDRESS 1617 Corsica Place BUILDING PERMIT NO. 93U3
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 14,552.00
AP. No. LOT 64 TRACT2822 FIRE ZONE DESCRIPTION OF WORKReS. w/att.Garage
INSPECTIONS ,ya.fe _ DATE I GROUP TYPE ZONE A 1 '
Underground Soil t24=pU.G. WatedV}fS ."-LS 4y SUBCONTRACTOR PERMITS ISSUED
Underground Gas _ DATE NUMBER
Overhead Water and Gas
Rough Heating At 7-/auW.� ,icer/Ze ez/C-t9. O4-y--Si / 5-,57-73 "
Rough Plumbing //, -0- ' 4..e ../ •-,14--....c --47 .5"-/6/-.577-7 � a,
Miscellaneous _ _.
Prop. Swr. Lint—Boat. on. St. Swr. 77244(ti /1�('./..-.---#- -t& -7/2.4/S r Iry I
Sprinkling System IQ✓nl'
Heating, Final ���JJJ/_w 7 J UMW
Plumbing Fixtures //, O OM
SVil
Final Gas Test ffff�lll '
Construction Pole
Underground Power /
Rough Thing /Yfj _ 7ig .Gk'e-r,, tw.,_<..Z",_,eve., 7-'-57 5 Y
Trenches Forms Steel -tivka 5 -2Y 4 y
Floor System _
Steel Reinforce Chimney Re-Rod
Bond Beam _ -
Sheathing
Frame and Flashing ,.t I • _ ' /0 darnLathing, In Out c/ e
Plaster, brown coat Aid _ $'4-O -91 - ' . .
Plumbing Fixtures, Final
Electric Fixtures, Final 42e) - 9-3-4 - -
Building, Final
OCCUPANCY yci/ 7 3"
7I
-_ - -
Form 210-3M-4-59 t 9303
. 9303 :EE RLCEiVED
COSTA MESA BUILDING-SAFETY DEPARTMENTitn"v MAY 113 1959
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
FOR APPLICANT TO FILL IN COMPLETELY rcti
APPLICATION nFOR' PERMIT
TYPE OR PRINT BUILDING
ADDRESS 1617 Corsica Pl.
/•
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
OWNER Comesa Inc. _ I RECEIPT NO. IMIT33NO.
MAIL (] E. 97yt CI{. RE//GG��EEI�VE/pr/BY DATE RECEIVED DATE ISSUED
ADDRESS J 1. bh St 1(.V/ I -/3-1-5-Y1L /7 , r
CITY Costa Mesa EL. L182159 ADD
ADDRESS ''
ARCHITECT
ECarlsontde
ORENGINEER rook NO.
COSTA MESA. CALIFORNIA
FIRE a
ADDRESS c . - •' a ZONE J /�
Dike & Colegrove,Inc. STATE 167293 APPROVEDPR ( DATE /J
CONTRACTOR LIC.NO. \\
ADDRESS L19 E. )7th St•" Copta Mega ZONING
ZONE NO.OF USE OF NEW
+ DESCL
RIPTION NT. 64. BLOCK 17 / I PLANS 7.I.BUILOING /1
APPROSED ///� I((III//LL {{!! (�
BY /,L/....4 /i�j/�yDATE C."`-/�J Y
SIZE NO.OF BLOCS. YARDS nil
/
OF LOT 60 x 104 NOW ON LOT None REQUIRED ALLOWED
' USE OF None (CENTER LINE ST.) �j�
EXISTING BLDG. FRONT 7 tFf. •
IN.
SETBACK LINE FROM
CENTER OF STREET 54' REAR YARD 27 I R.SIDE crFT. IN.
SIDE YARD I LEFT 51 t RIGHT 5 L.SIDE CFT. IN.
DESCRIPTION OF WORK
REAR 97 FT. IN.
.. NEW I % II ALTERATION I II ADDITION
' REPAIR I II MOVING I II DEMOLISH I
SIZEBIDING NO.OF
1450 ROOMS 6 STORIES 1
EXTERIOR WALL ROOF
' COVERING atnoco COVERING Rock
USE_OF B LDING A WORK TO BE PERFORMED
S'�ingle family dwelling with
attached double garage
•Plan 140AR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
I BUILDING CONSTRUCTION.
VALUATION
SIGNATURE OF �'/,��r�`�,., PERMIT FEE $ 3400
• PERMITTEE •�+�
PLAN CHECK $ 17 00
Dike yr $
AUTHORIZED AGENT Dike & Colegrove, Inc. 14,552 TOTAL FEES 51.00