HomeMy WebLinkAboutX2018-1305 - Permit ApplicationWorksheet for Electrical/Mechariicaii Plumbing Application aEW�R>
Print Form City of Newport Beach
Building Division i r
I. Project Address (Not mailin address) r^
J g Building Permit No. Zd22-(75�� �Z�ZZ-o7gb
ri A, NlMAI t Floor I — Suite
r 2. owner's Name Last 146Uq First C c1 ro /
Owner's Street Address ,
City �� State F_ Zip
Telephone �j i � �`�7 tly/�)Owner's E-mail Address
r 3. Applicant's Name Last 1�2 C Cif - First �/�-
Applicant's Street Address
City State Zip
Telephone %V uj - Applicant's E-mail Address
4. Contractor's Name Last 2. First r State Lic #
Contractor's Street Address
City l�EtA C, �.� t� State It t%j Zip
Telephone �1( �?S� Contractor's E-mail Address Business Lic # �—
Mechanical
Furnace Quantity
up to 100,000 btu
over 100,000 btu::
wall/floor heatersi
Heat Pumps/Package Units
up to 100,000 btu:_
up to 1,000,000 btu:r�
up to 1, 750,000 btuF
> 1, 750,000 btu:
Boilers/Compressors
up to 3 HPT
3 HP-15 HPI-
15 HP-30 HPr
30 HP-50 HP f
>50 HPF
Air Handling Units
up to 10,000 CFM:F—
> 10,000 CFMf
VAV Box:F—
Repair/Alter/Add HVAC
Number of ZonesT
Ventilation
Bathroom Fan:_
Exhaust Fan:: —
Attic ExhaustF—
Residential Hood::v
Commercial Hood:F
Metal Fireplace:F—
Gas Line:F
Fire Dampers:~
Electrical
New Construction Quantity
1 & 2 Family S.F:F_
Multi Family S.F::i
Receptacle, Switch Lighting Outlets
Total Outlets:: —
Lighting Fixtures
Total Fixtures:F
Total Low Voltage:F—
Separate Circuit:r
Motors/Transformers
0-1 HP or KVAT
1-10 HP or KVA:F
10-50 HP or KVA::
50-100 HP or KVA:F�
Over 100 HP or KVA:F—
Signs
One branch circuit:F—
Add'I branch circuit:`
Service
0-600V not over 200A:F_
0-600V & over 200A::—
over 600V:r_
Temp PP/Piggy Back:F—
Sub Panel::—
Other:: —
Plumbing
Bathroom Quantity Quantity
Water closet (toilet):
Bidet
Urinal:
Bath Tubf
Shower stall:
Lavatory (basin):
Hydro -massage tub:
Kitchen
Kitchen sink :I
Garbage Disposal!
Bar sink:
Vegetable sink:F
Dishwasher:
Laundry/washing trapf—
Ice maker:
Floor sink:
Miscellaneous
Floor drain:
Water piping:
Water softener:r_
Water heater:
Lavatory (basin):F—
Gas sys up to 4 outlets:Fr
Gas sys # of outlets over 4 f —
Backflow device up to 2":1
Backflow device over 2"::—
Regulators::—
Lawn Sprinkler System:: —
Roof drains:�—
Hose bibb:r—
Drinking fountain:r—
Grease trap:_
Grease interceptor:
P-trap f
Sewer
New sewer::
Sewer alter/repair:
Sewer abandonment::
A, )Ct-d (��, M � q - �,�,),j7
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I i Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading f`Drainage , Elec ; Mech i Hum U Yd LutI Cu Yd Fill j
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F- Landslide F_N/A Floor
b 2l�
Description of Work
..a pt X 111✓0
9
('.�v��f�
New/Add SF
Remodel SF i
Garage/New/Add
Suite No
7— r__
Use 1 Const Type
# Stories; # Units (if Res)
Valuation $ f
Material/Labor; T ((pp
OWNER'S NAME Last "�✓""i�n First j
Owner's Address 1 Owner's E-mail Address
rye
City �`t� -- State - Zip �26 (O Telephone; G� Z 3
APPLICANT'S NAME Last: rl?(/'�(,(� First
Applicant's Address Applicants E-mail Address
City
State j Zip Telephone;
ARCHITECT/DESIGNER'S NAME Last First f Lic. No.
Architect/Designer's Address _ Architect/Designer's E-mail Address
City --— Zi Telephone
State p
ENGINEER'S NAME Last ^� First a Lic No.'
Engineer's Address Engineer's E-mail Address
City -� State s-� Zip Telephone':.
CONTRACTOR'S NAME/COMPANY Lic. No. i 773226 classy
Contractor's Address Contractor's E-mail Address
/00 o Qu �� �7�-r.� '� 2 6 a -- - ✓GD L1 dm�S Op mod- e,&'
City 'N ?; Lc a �� State Zip �uod 6 Telephone' 9i{'l'-2I Z -32.%
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO F'LAIV umtuN FEE