HomeMy WebLinkAboutE2022-0569 - Permit ApplicationWorksheet for Electrical/Mechanical/ Plumbing Application �FW�
Prirtt,Form o� R,
City of Newport Beach
Building Division
t. Project Address )Nat mailing address) Building Permit No. ` -u ;�_I.-C) 0 g
20t71 Vp4 V16VJATE• NEnvjFoP-r T3LAC�Ia CA , `[z�,60 Floor F—Suite F_
I 2. Owner's Name Las[ Jj, (ZR, {{ ___-_-_-- First I fA(Z�-1 t�1rQMQ_h.l%
Owner's Street Address _ - --_-- ----- "
City State r- Zip
Telephone C _n-1 rZD0 , Owner's E-mail Address a�)hfQrmk 0,4L-ftsV%q_t
r 3. Applicant's Name Last firs A A44 First F.&R-Z,lt l
Applicant's Street Address
3366uUlsrR sT -_ -" _City ceaSM MESA State C4J Zip F7tz6Z6
Telephone � Applicant's E-mail Address
r 4. Contractor's Name Last n First State Lic#
Contractor's Street Address
City State s— Zip—'
Telephone Contractor's E-mail-Address _ - ' Business Licit �—
Mechanical
Furnace Quantity
up to 100,000 btu'
over 100,000 btu)
wall/Floor heaters
Heat Pumps/Package Units
up to 100,000 btu'
up to 1,000,000 btuF---
up to 1, 750,000 btu
> 1, 750,000 btu)
Boilers/Compressors
up to 3 HPl
3 HP-15 HPf77___;
15 HP-30 HPr_,
30 HP-50 HPt
>50 HPF—:
Air Handling Units
up to 10,000 CFMF---
> 10,000 CFM�
VAV Box
Repair/Alter/Add HVAC
Number of ZonesF_—
Ventilation
Bathroom Fanr--
Exhaust Fan:r--
Attic Exhaust
Residential Hood
Commercial Hood:s—
Metal Fireplacer—
Gas Linel—
Fire Dampersl—
Electrical
New Construction Quantity
1 & 2 Family
Multi Family S.F:s
77
Receptacle, Switch Lighting Outlets
Total Outlets "L
Lighting Fixtures
Total Fixturesll
Total Low Voltagef
Separate Circuit:
Motors/Transformers
0-1 HP or KVA1771,
1-10 HP or KVA
10-50 HP or KVA:r_—! .
50-100 HPor KVAI�
Over 100 HP or KVAf77
Signs r
One branch circuit/d
Addl branch circuit:[-
Service
0-600V not over 200A:r--
0-600V& over 200A:r--
over 600V:r—
Temp PP/Piggy Back:r—
Sub Panel:s
Other:r
Bathroom Quantity
Water closet (toilet)-7
Bidet
Urinal �I
Bath Tub
Shower stalk[ -
Lavatory (basin)fl,
Hydro -massage tubt
Kitchen
Kitchen sink 1 !
Garbage Disposal'
Bar sink
Vegetable sink)),
Plumbing
Quantity
Backflow device upto
_ Backflow device over 2"I
Regulators)_
Lawn Sprinkler System:C_
Roof drains
Hose bibbl
Drinking fountain__
Grease trapr—
Grease interceptor
P-traps
Sewer
New sewer
Dishwashers Sewer after/repair
Laundry/washing trap. Sewer abandonmentr—
Ice maker
Floor sink
Miscellaneous i �q CCC�JJJ
Floor drain>r—
Water piping. If-t/iJ� ,�(c
Water softener fl�j/ nnZZ �o56
Water heater— e-, �/ % (�
Lavatory (basin) ea)?2, 02- --s
Gas sys up to 4 outlets) /�G
Gas sys # of outlets over 4�