HomeMy WebLinkAboutE2012-0377 - Permit ApplicationrA
F' 2int Form _ 1 Worksheet for Building Combo Permit Application 1,221
xComm I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
2.c12 03�3
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Building F Grading
F-Drainage fg"Elec (";:Mach FPlum cu Yd cutt', Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
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Description of Work
Use f'lA2tlN1q
IZt(�(ei e a ]d
r 'L6A'+ �r -e
z'1 �����y .
# Storiest # Units (if Res)[
---
Valuation $
Material/Labor
New/Add SF Remodel SF
Garage/Now/AddF.
OWNER'S NAME
Last
70wner'-s tail
Owner's Address
Address
City
State �
Zip Telephone
APPLICANT'S NAME
Last �j First
Applicant's Address
Applicant's E-mail Address
city t�5c` y-,
State Fce7..
Zip 31-�. Telephone e torl, 21rt a °
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
------ .__�,� State ��
Zip F I Telephone��
ENGINEER'S NAME
Last
First Lic. No
Engineer's Address
Engineer's E-mail Address
City --.._
State F
ZipF - _ TelephoneF�
CONTRACTOR'S NAME/COMPANY
l �r6MeT�i '
,t ,�,�� Lic. No. �d'tl °CE/y Class/ Gf®
F"G _ —-
Contractor's Address
J
- Contractor's E-mail Address
,r�
City a
State
Zip _-.-' Tele hone .�7-35
ENERGY P/C FEE $
FIRE P/C FEE $
PERMIT NO. kA 2At .t— 9/
GRADING P/C FEE $
PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT 4
-
TOTAL FEES PAID $
E 2-012 03-7 --
I?n'P¢rm - Worksheet for Electrical/Mechanical/ Plumbing Application lZ2 I L"tctsfi Rvvy
City of Newport Beach iN
Building Division
1. Project Address (Not mailing address) f I c9��FO -
Building Permit No. I
_. ....... _.. Floor F Suite
n 2. Owner's Name Last First
Owner's Street Address _.... .. _.. .... .__ ___._. ..._.. _'
City �—,. State r Zip F®s..
Telephone Owner's E-mail Address
13. Applicant's Name Last First
A licant's Street Address
City �� State Zip
Telephone i Applicant's E-mail Address
r, 4. Contractor's Name Last First State Lic # ��'
_...... ..._._ __.___... ._..._.._ 1
Contractor's Street Address
City ��', State F Zip
i (�
Telephone Contractor's E-mail Address ;Business Lic # L �J
Mechanical
Furnace Quantity
Electrical
New Construction Quantity
Plumbing
Bathroom Quantity Quantity
up to 100,000 btu:—',
1 & 2 Family S.F:�
Water closet (toilet) Backflow device up to 2":7
over 100,000 btu:l_,
Multi Family S.F. —(
Bidets Backflow device over 2":n
wall/floor heaters F_
Receptacle, Switch Lighting Outlets
Urinal F1 Regulators
Heat Pumps/Package Units
up to 100,000 btu.F—
Total Outlets:
l
Bath TubF__j Lawn Sprinkler System:F-----7
.
up to 1,000,000 to
Lighting Fixtures
Shower stall Roof drains:
u to 1, 750,000 btu I�
p
Total Fixtures.-
Lavatory (basin)[ Hose bibb:_
> 1, 750,000 btu �1
-
Total Low Voltage:
Hydro -massage tub Drinking fountain:'
Kitchen
Grease trap F_ -
Boilers/Compressors
upto3 HP
Separate Circuit :�_�
Grease intercept
interceptor:
sink �'
177
-
3 HP-15 HP:�
Motors/Transformers
Garbage Den
P-tra �:�
15 HP-30 HP�
0-1 HP or KVA:�
Barsink• Sewer
- ll
30 HP-50 Hl
1-10 HP or KVA:F77
Vegetable sink New sewerli
10-50 HP or KVA:
Dishwashe177 Sewer alter/repair:
>50 HP
-. -
50-100 HP or KVA: ,
�'
-
Laundry/washing trap Sewer abandonment;
Air Handling Units
up to 10,000 CFMF_',,
Over 100 IT or KVA:-�(
Ice maker
> 10,000 CFM,.
� zs dCi,/}
Signs
Floor sink
VAV Box:--
One branch circuit:F`
Miscellaneous
Repair/Alter/Add HVAC
—I
Add'I branch circuiC1777
Floor drain:
Number of Zone
s
Service
Water piping
Ventilation
Bathroom Fan ��
0-600V not over 200A:��.
—i
e
Water softener :
-
Exhaust Fan.—
0-600V& over 200AF
Water heater) I,li—�.—'
Attic Exhaust —
over 606V:�
Temp PP/Piggy Back -i —
Lavatory (basin) i
Residential Hood:
i
Commercial Hood.w
Sub Pa nel:
--
Gas sys up to4ouilets� �
Gas sys # of outlets over 41
Metal Fireplace:—,.
�
Otherw;
-.
Gas LineF_11
Fire Dampers F,