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HomeMy WebLinkAbout154 BROADWAY - Building Permits • aiy~= CITY OF COSTA MESA F.ora:`, EBUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT ' s°r VM99-00194 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 154 BROADWAY Status: ISSUED Suite No Applied: 04/21/1999 • -• Issued: 04/21/1999 Vicinity: SIDE REAR OF STRUCTURE NEAR PARKING LOT. Parcel Number 42523322 ISSUED BY: Applicant: CRAMER, MATT -- " Yom= �Y_ '=<` � Address: 33208 PASEO CERVEZAX --" � 2- --"1 t-.-1�;-C-->>� ' - 71: iPhone: 949-493-5954 .' SAN JUAN CAPISTRANO,CA\, , Zip 926751 -'\ 1 ,� Owner POLUCHA, TRACY-A % -c- -, - ��� / c� Address: 154 BROADWAY - "- -� J Phone: >��/ � COSTA MESA,CA.:; Zip: 92627 i Contractor: MARK I-IASSINGER H &C ' A�.v\f/' Address: 33208 PASEO CERVEZA 'r'\,. Phonon' 949-493-5954 _ SAN JUAN CAPISTRANO,CA Zip: 92675 .1..• � / -- . S. \J�,License:-550408_I Arch l Eng: �<< �y� ,� � 7/ Address: ' - Phone: /� --- Zip:• 2 License: \A' , `,,; `SCOPE OF PERMIT( H' J. , REPLACING CONDENSING UNIT AND UPGRADING DUCT SYSTEM::1 REPAIRING/ALT COOLING- SYSTEM AND 1 REFRIGERATION SYSTEM<=100 K BTU/H // ' igci -0032r9' Al N. LS/C- FEE SUMMARY f it -. Quantity -- •-- 1 1 - .. Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repaira:AltRefrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 -- Ventiliation System " . I $0.00 0 Repair/Alt Cooling/Heat $12.25 1 . Evaporative Cooler - $0.00 0 Inst/Rep.Recess Wall Htr $0.00- 0 i'p \,Commercial Incinerator $0.00 0 Refrig Sys<700 k BTU $13.25 1 • :-,,f-C1'•:• '2'Domestic Incinerator . =,`. $0.00 0 Refrig Sys>100 k BTU $0.00 0 _ ' Compressors/Absorption Systems Gas Piping $0.00" 0 _ . .r2 '- , Up to 3.hp'/,100 k BTU .4 - _ $0• 00 '0 Facto Fireplace - 1.. <" Factory p � $0.00 0'.� �� 3To�15 hp%500 kBTU-'c $0.00 0 Hood wlMech Exhaust $0.00 , 0 2 '- '� 215 To 30 hp/1,000 k BTU %,- $0.00 0 VAV Box $0.00- 0 -. ,\ "630;To 50 hp/1;750,kBTU' j '2/2 $0.00 0 Vent Fan/Single Duct $0.00 0 . , �� Over 50 h'p/Over 1;750 BTU<7 '/. ' ' - $0.00 0 Appliance $0.00 0a- -c ..,- Boilers ---2-cr.---- / Fire Dampers $0.00- 0- . _ - _ -Up to3 hp ` $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp. - = $0.00 0 Inst or Relocate Appl Vent $0.00 0 " f": . , 15 to 30 hp.;,\\ $0.00 0 Air Handlers< 10000cfm $0.00 0 /, • 30 to 50 hp.‘ / $0.00 0 Air Handlers> 10000cfm $0.00 0 '- i r\c-\: ;Over_50 hp - •' -2- $0.00 0 Floor Furnace $0.00 0 Other Mechanical Floor or Suspend Heater $0.00 0 -- - 7 4-A- --ylnvestigalion:Fee $0.00 -- -____-Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $47.50 COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS c ) i 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. Er 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. T My workers'compensation Insurance carrier and policy number are: Cartier. Policy Number: (This section need not be completed If the permit is valued 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with i s rovisio s. o p .Applicant Signature. Date: C n?"(_ J WARNING:FAILURE TO SECURE WORMERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRUANAL PENALTIES MID CML FINES UP TO ONE HUNDRED THOUSAND DOl1ARE($104000),IN ADIXTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MID ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.a Class e Contractor's SignatureDate: (� -x2-! - 5'S 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,CMI Code). Lenders 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:My city or county which requires a permit to construct,altar,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 lore 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 properly,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 contractors) 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,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 dMsion. 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 et 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 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)? ❑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 compiled 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 akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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? 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 Duality 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. • i� (SlSnhture Of Legal Owner(s) Date And/Or Authorized Applicant 7 Date $oot t I/SPECTIOd TYPE PATE KOALA COOEI INSPECTION TYPE 118101,111616 Fixed System Final Fire Prevention 206 Final Mechanical 5-1T-94 8W 1266 Pod Spa Final 208 Final Plumbing • 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 2446-46 01-:11.!4.- '� >_ CITY OF COSTA MESA `y' �,� BUILDING DIVISION t 1 " - ' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E99-00328 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 154 BROADWAY Status: ISSUED Suite No Applied: 04/21/1999 Vicinity: ELEC PANEL ON NORTH SIDE OF STRUCTURE. Issued: 04/21/1999 Parcel Nunmber: 42523322 ISSUED BY: Applicant: CRAMER, MATT Address: 33208 PASEO CERVEZA Phone: 949-493-5954 SAN JUAN CAPISTRANO,CA Zip: 92675 Owner POLUCHA,TRACY A Address, 154 BROADWAY Phone: COSTA MESA,CA Zip: 92627 Contractor: MARK HASSINGER H & C Address: 33208 PASEO CERVEZA Phone: 949-493-5954 SAN JUAN CAPISTRANO,CA - Zip: 92675 License: 550408 SCOPE OF PERMIT ELEC FOR MECH PERMIT#M99-00194 FOR REPLACEMENT OF CONDENSING UNIT 8 UPGRADES. FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft' $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $16.25 1 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 • up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches _ $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment - $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 • 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 • 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 - Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $38.25 Intermed Pole $0.00 0 • COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS 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. r-- 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'compensation Insurance carrier and policy number are: Carder: - • • - Policy Number: (This section need not be completed if the permit is valued 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 California,and agree that should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with th s r visions. Applicant Signature: Date: C rX I —s-WARNI9 THOUSAND FNLUA ET(SECURE WORKERS COMPENSATIONTST COMPENSATION. IS ON.DAMAGES AND SHALL SUBJECT t AN SECTION 37 TO CRIMINAL L OR COD E.I AND CML FINES TUPO N ONE HUNDRED. THOUSAND DOLIARE($100.000),IN ADDmON TO THE COST OF CDMPENSATION,ONMGES AS PROVIDED FOR IN SECTION 31080E THE LIBOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc. Class it Contractors Signatur Date: t4...—69-1 —S 5' 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,CMI Code). Lenders 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 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 contractors) 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 Drivers 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,lalsework,or demolition or dismantling thereof,will be more than Mir y-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). 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 end 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 ¢oes or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 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 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 apennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IBJ Yes 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? 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 Safely 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 penally 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.1 agree to comply with all state taws 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 ure Of Legal Owner(s) d r9/ G`5 Date And/Or Authorized Applicant Date CODE t INSPECTION TYPE PATE BMW CODEC INSPECTION TYPE PATE g1IM5LS • 1616 Fixed System Final Fire Prevention 206 Final Mechanical {��.{/,�LF�{/,/� 1268 Pool Spa Final _ 208 Final Plumbing ' I _ • i 200 Final Re-Roof 210 Final Electrical L 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 2446.46 .. onto/'.(:�i��'t- - -Iii 1 '. r —_COdTA MESA, CALIFORNIA V Q�- / B DING 1 FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN �j Receipt No. GPermmiit No. Building J(�i%�� /f /xf7 L l S O I �or/) 191 Address '..v-r~.��Y� Costa Mesa, 001711& Received Date Recd. Issu 3/ Nearest n/f J r {fin :gel/H/43.1- G(j Cross St ���c �Lj / Building Address Owner 2 / Costa Mesa, California Mail / p Address / 7A • Nearest Tel.`J.8,33y� Cross St. City C No. Zonw I No.of I Type ,/ I Gr C Architect or Lic. Plans V7. Engineer No. Approved by Date Address CORRECTIONS ` / y Lie. Contractor _,,, _p__ �,c,,_ _'o,�t - 19//--a‘11,,,` t !` , Address /(/ // L5— ' 1 c✓✓c a IIkl Legal Lot q Description I No. 1 I Block e I Tract 3 / 7 rG U ` (Attach Metes and Bounds) I n Ni 3 1 1955 dg ^' Size of Lot 0.-0O X/f b No.of Now. on BlLots.')Z4 - nUse of A' ITV Existing Bldg. „ Fam lies I Rooms cL( 1 Qf_CQ�TA M�FSA �, Setback Line from ! /A, Rear Yard q ! _fr fY"- Z Center of Street /0Q i Side Yard ONJ q DESCRIPTION OF WORK i a4 -o New IN Alteration I I Addition I , Repair I I Moving I I Demolish 1 Building No.of dore / Size -51,fX 31 Rooms Stories Exterior Wall I Roof Covering $ µmy Covering AL - APPROVALS Use of New _ Foundation Location Inspector Date Building tv,,. _ . ,,,4,,,,_ .' Forms,Materials, ♦ r _ Under-Pinning Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath.Int. and state that the above is correct and agree to comply Lath. Ext with all City Ordinances and State Laws regulating building construction. Signature of �, _ D ?� ' ,,�/ Plaster,Int. Permittee /1s�jL/� .t(IR�.l1(.C.Y Plaster,Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ �qh / 7� o'IflCheck $ /O ' — Bond Beam $ %/(� 0d Q' XK Feeai .$ Y'�---- FINAL FORM 204 O-H 2M 9-94 _ , . ce _ , _ e c • e -J c _ E d. o L. - - o. • -� . - • t. it . t ,` — " _..r:. 4 . - 1 1 Z �. , s .i,r' Street.-Lt c, ,•� f. - rc. '..n PLOT PLAN J • Show location and distances from r ••• - . , property line and between buildings. _ -,.,.,,;. I • t . - . _ .- - _. - - -_ - ..s ; OWNER BONEBRAKE, DR. HAROLD / DATE 2-9-55 JOB ADDRESS 154-158 Broadway ✓ BUILDING PERMIT NO. 899 GENERAL CONTRACTOR Frank Bissell VALUE $16,000.00 Let 1BLOCK B TRACT 377 Professional building, dental v�' office GROUP F2 TYPE V ZONE R4 FIRE DISTRICT 890 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR . DATE NUMBER -1- Footing f //jj Footing Trench /(i _ k- 23/3-3 Foundation Forms and Grade to Ga age { b Rough Framing I'<"'`v�-a-.-t( cLs y' -.'i,S'`Y� Plumbing,Rough to SlabS0 ' / a-e.t.a5.- -3--.-3-: 3=3' � Plumbing,Rough Complete �ri r3-/,5-;Sr XL,� n.. ,d ;Le,.,,,Q1 a_ag-Ss /$c3 .Temporary Pole / ,Wiring, Rough 3.0 Zit,,nrert „ A/ec-e • 3-25-SS /f$o Heating,Rough tGv/� y////.a/7//'/ Heating,Final CI• v- / -S'S /4.// Sewer Septic Tank or CCesspool Lathing/AJ z! £uj `-- 1—'4' 4 3-,, -/ � Plastering / C'.e-'75 7 y'-�J/ Plumbing,Final,Fixtures Complete)tt S A0-.0 . / Plumbing,Final Gas Test i.7 --?je f � -If CA (Car , `---., S/2J`-J t- >i 4--/4 - Wiring,Final ?ct,.5 S-3- t' `- Occupancy �e L4 ....5-2 Jj Form 210 0-11 1M 12-53