HomeMy WebLinkAboutX2021-2839 - Permit Application (2)Print Form I
1. Project Address (Not mailing address)
Worksheet for Electrical/Mechanical/ Plumbing Application
City of Newport Beach A 20 Z _ 7 s 3 ei
Building Division
Building Permit No. I...
r 2. Owner's Name Last
Owner's Street Address
Telephone I _...._ _. _...
3. Applicant's Name Last
Applicant's Street Address
Telephone
Owner's E-mail Address
Floor
Suite
State I—. Zip
r 4. Contractor's Name Last
Contractor's Street Address
Applicant's E-mail Address
First I
City I
State
Telephone
Contractor's E-mail Address
First
City I
State Lic #
State I—•••.: Zip I
Business Lic #
Mechanical
Furnace Quantity
up to 100,000 btu::•••...
over 100,000 btu:I
wall/floor heaters.
Heat Pumps/Package Units
up to 100,000 btu:I-
up to 1,000,000 btu:s—'
up to 1, 750,000 btu:I —'..
> 1, 750,000 btu:I
Boilers/Compressors
up to 3 HP:I
3 HP-15 HP:r •
15 HP-30 HPI.
30 HP-50 HP:I
>50 HP:
Air Handling Units
up to 10,000 CFM:!'.
> 10,000CFM:I—•
VAV Box:I
Repair/Alter/Add HVAC
Number of Zones:I --'.
Ventilation
Bathroom Fan:I—',
Exhaust Fan:! —
Attic Exhaust:r—
Residential Hood:J
Commercial Hood:I
Metal Fireplace]
Gas Line.
Fire Dampers:!
Electrical
New Construction Quantity
1 & 2 Family S.F:I—'
Multi Family 5.F:J
Receptacle, Switch Li _tin
Lighting Fixt
Total Fixtures:!—•••
Total Low Voltage:I
Separate Circuit:7—.
Motors/Transformers
0-1 HP or KVA]
1-10 HP or KVA:I —'•.
10-50 HP or KVA:I—••••.
50-100 HP or KVA::
Over 100 HP or KVA:I—
Signs
Service
One branch circuit:!
Add'I branchcircuit:r—I,
0-600V not over 200A:
0-600V & over 200A:I—•••.
over 600V:I—••.
Temp PP/Piggy Back:
Sub Panel:!—
Other:! —
Bathroom
Quantity
Water closet (toilet):!
Bidet.•••••..
Urinal :r—••.
Bath Tub:li':
Shower stall:I —''.,
Lavatory (basin):-1
Hydro -massage tub:!
Kitchen
Kitchen sink
Garbage Disposal:!—•••..
Bar sink:! —
Vegetable sink:I
Dishwashers
Laundry/washing trap s—'•••••
Ice maker.!
Floor sink:s—••••••
Miscellaneous
Floor drain:I
Water piping:I
Water softener:s—
Water heaters —
Lavatory (basin):!
Gas sys up to 4 outlets::••••••••...
Gas sys # of outlets over 4:7
Plumbing
Quantity
Backflow device up to 2":r—
Backflow device over 2':1—'.
Regulators:r—•'••,
Lawn Sprinkler System:
Roof drains::••••••....
Hose bibb:I
Drinking fountain:r—.
Grease traps—
Grease interceptor:I —.
P-trap:!
Sewer
New sewer:J
Sewer alter/repairs—•
Sewer abandonment::