HomeMy WebLinkAboutX2021-3261 - Permit Applicationprint FormI Worksheet for Combo Building & Solar Permit Application
r Comm'I FX Residential City of Newport Beach - Building Division 5
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FX`Building Fx Grading Drainage FX Elec (x Mech
FX Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing adtd_ress) r Flood
r Fire r Liq � Landslide �N/A Floor Suite No
�53 Y l g'1 A �vG V ��
Description of Work
Use I— Const Type
j'j�D�' o✓1a-� Sco� Raw-IRY4
Wo.l\ ll fH
# Stories # Units (if Res)F—
`uS � �1 I�IYi'�I5 0.vtU• wct�� MOCa,trv�%I
• ~I 3K
Valuation $
New/Add SF�� Remodel SF�Garage/New/Add �—
Material/Labor
OWNER'S NAME Last �pylZq (e-c_
First I � O
Owners Address
Owner's E-mail Address
diI) El M04CVWt A-LAE
I
City tjtwp�-t State CA-
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Zip �kZ. eo Telephone(e(e( to4470gv
APPLICANT'S NAME Last
'"""`1eZ
First
Applicants Address
Applicant's E-mail Address
ql� L l 1404 v.6" M
City State �eyJ� i ta��_ A- % . I ` A
Zip gZ4�3 Telephone (PV � (Rq( _Fj0��
ARCHITECT/DESIGNFFE--��R''(SA:NAAME Last F
First F.- Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City � State �—
Zip F_ Telephone
ENGINEER'S NAME Last
First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
city State
�J �
Zi Tele hone
P �� P
CONTRACTOR'S NAME/COMPANY
Lic. No. ClassF
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. l ?bz ) — 5�' [
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 2?%�1-Z�7
USEZONE DEVELOPMENT NO
PLAN CHECK FEES$
Worksheet for Electrical/Mechanical/ Plumbing Application zEW� R,.
Print Form o° m
City of Newport Beach
Building Division ;^ .i^_.MZl l _OC,
2S
1. Project Address (Not mailing address) Building Permit No. '2Z gQl + ZO'Z l
—f J 3 \1 tS"C_ 'i'VGvlrN Floor F_— Suite F
2. Owner's Name Last �70n2q,�G'` First Oe.
,ner's Street Address 1
ll % Modte ✓toT � T ucity Newpof rr State FekZip FL� (ecr
Telephone 1641 ,#qq-7oql Owner's E-mail Address Jp?R_ IN o%X?CU 514E. coW-I
F_ 3.Applicant's Name Last Gon1 QIG2 First ��-
A licant's Street Address
City State F_ Zip
Telephone F_ Applicant's E-mail Address
r 4. Contractor's Name Last _ First State Lic #
Contractor's Street Address
City State F-zip, F—
Telephone F Contractors E-mail Address Business Licit F_
Mechanical
Furnace Quantity
up to 100,000 btu:r
over 100,000 btu:r
wall/floor heaters F_
Heat Pumps/Package Units
up to 100,000 btu:F
—
up to 1,000,000 btu: —
up to 1, 750,000 btu:F
> 1, 750,000 btu:F_
Boilers/Compressors
up to 3 HP:F__
3 HP-15 HP:
15 HP-30 HPr
30 HP-50 HP:r
>50 HP:F_
Air Handling Units
up to 10,000 CFM:r
> 10,000 CFM:r
VAV Box:r—
Repair/Alter/Add HVAC
Number of Zones:r--
Ventilation
Bathroom Fan:r
Exhaust Fan-F_
Attic Exhaust F_
Residential Hood:r—
Commercial Hood:r
Metal Fireplace:r
Gas Line:r
Fire Dampers:r
Electrical Plumbing
New Construction Quantity Bathroom Quantity Quantity
1 & 2 Family S.F:r—
Multi Family S.F:r—
Receptacle, Switch Lighting Outlets
Total Outlets
Lighting Fixtures
Total Fixtures
Total Low Voltage:
Separate Circuit:
Motors/Transformers
0-1 HP or KVA:
1-10 HP or KVA f_
10-50 HP or KVA f_
50-100 HP or KVA:r—
Over 100 HP or KVA:
Signs
One branch circuit:r—
Add'I branch circuit[ —
Service
0-600V not over 200A:
0-600V & over 200A:r—
over 600V:r
Temp PP/Piggy Back[ --
Sub Panel F 1 _
Otherk—
�
Water closet (toilet):
Bidet:r—
Urinal:
Bath TubF
Shower stall
Lavatory (basin):
Hydro-massagetubr—
Kitchen
Kitchen sink:
Garbage Disposal:-
-Bar sink-F--
Vegetable sink:r
Dishwasher—
Laundry/washing trap:
Ice maker:
Floor sink::
Miscellaneous
Floor drain:
Water piping:r
Water softener:
Water heater:
Lavatory (basin):
Gas sys up to 4 outlets:r—
Gas sys 4 of outlets over 4:
Backflow device up to 2":
Backflow device over 2":r-
Regulators
Lawn Sprinkler System
Roof drains:r—
Hose bibb:r—
Drinking fountain
Grease trap
Grease interceptor::
P-trap:r—
Sewer
New sewer:
Sewer alter/repaiT:r—
Sewer abandonment:r