14430 (3)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - tJSF RAI I Phlf\IT PFNI 01\11 V
BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
v `PERMIT NUMBER
3.0
BDDH"s
ADDHE55
'
l AJ
DWNEIi'S
NAmE •
PRUNE
CITY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
PLAN CHECK FEE P.C. NO.
�.,r
G. No. Q
-
NF
eARC14iTFC
DR
ENGINEER
uc. No.
OUTLETS -SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
APPLIANCES - RESIDENTIAL 4.00
PANELS 10,Q0
PANELS (OVER 200 AMP) 20.00
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS
11P
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
ISSUANCE GATE
TEMP. METER OR POLE INS. 20.00
noolisSS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONI kAC'fORS DECLARATION
I hereby nffruithl [hut I ant Iiccnpnu o
,ld under ,visiolf Chart cr 9
I rommrneing wSection ]000) 01' Divisi-n 3 .1 tire limn,, and
PiUlaslora Co yqaIW/�I y li'lo". iI in Illi f- a• 1
.\ Liavlse Cllus_J_V - Lie Number.`_ 1/��
OWNER-BUILUEIt OECLAKATION
I hereby dtinn Out I am exempt born IF, Conttaaor'a Liana'
Luw For [Ill l dlowing muun.(Sec. 7031.5, Bllsinam and l'nde
Code: Anycity or county which requires a peril w construct, alter
Improve, drnnifi,li, or cpu r nny aricHre. Prior 1- i1, lasaunee, alto
rec Ooll tit' aPPliCanl IDr Inch ,,,Foit lu file a ai,n,d .temenl H,,t
he is licensed Pnralal t to the P1.1;,1U1b ui tire Con D:rcWrl Liana
Luw (Clupar 9lconish uncnciny wSecfrl,n 7000101 Division 3 of the
Bristol" HH1 PmlFmiolu Code) or thin he la exempt tit c..Herr and
0m basis for the dIcgvJ vu• rlitiun. Any iuininn to Sermon 7031.5
tit, ullet d'ddoicns the appiirunnuucn'11 pen°1ty
bylt Tiippme
-f nm more Hun l.1 IouWra'J JI,.. tS500op
❑ I, a owner ill ill ,Hn, I"ill 0Hy'. o.lny. Ind till Hili wagca;ta
Hlrir ed co nglvnwbIol a (S the 'alk' ml the str Prate I wI
cute: i -, ontr cJ lar ill se L'. ,does Hot jpsa and Prowilerrm
'fb. ContrannrS License Luw Juca not apply 1-mt owner ut
PI -11111Y
PruperlY who biliala ur implore, Ihrrroll, and who dU,, audt xrok
himself -r Ho -ugh his own L•n,IUY,,,, provided till Inch impmlC-
nivnls arc let intended nr oNe,ed io, sine. if, however, the burin,
OF improvement iI ,.Id within 'll' year ill' c-elpleli-n, till o
builder will have it, huNrn of proving Dol he dial Fill hOld ur till-
prole fat purpura of ,:da')'
11I, as -wile, of the prope,H. un e\dudvdy r.nFl,l H, Hili
IieenxJ eontrunor, to wit,urict the project (See, 7044, Itnslo"s`
--it I'rofassiuro Code: I'lie Contrun0r, Licrluc u. dna nor :Ipply
In an -wre, OI prapony who builds -r improves then..... and who
Cunlmt,lI for such pruiena with a HHH,a Hno li, I d pun 11111 Ili
Ole Conuaur', Ulcer, Luw.
❑ tuns uvngn malar See ,ILAItC. Iirt Bli'
rr:lwn
BLDG.
❑
ELECT.
❑
PLG.
MECH.
❑
BUILDING Il
INFORMATION
MISC. - REFER TO ORD
PERMIT ISSUANCEVALUATION
10.00
5/FT.
ELEC. CONTH. LIC. NO,
ELEC.
TOTAL
PERMIT TO
�' d�
`^.O
CITY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER IEA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, CO D. 5.00 1!2 -
F IXTURES - PER TRAP5.00 --7:-:--
50 FT. FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM - 1 INC. 4 OUTLETS 6.00
GAS - EA. SYSTEM - OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB CHIP,
❑ ❑ ❑ ❑ ❑
INDUSTRIALWASTE INtTER. 30.00 O
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
_
SEWER -SANITARY -STORM EA(f ,('p[/10.00 U
TRACT NO.
PARCEL NO,
WATER HEATER / fi.00
Oxltar Ualc
WATER SYSTEM 5.00
\
W'okKliks Cmu'IiNSn'noN uECLn an1'1°N
1 hereby affirm DUI 1 line a ,Flit i,me ui ,on,ent w „Ihinalle,
or a erldicmc al yi'ulkeri ('olnpoual ion Ir,ttrancc, or.j rertmod
ropy' tr,NUI IS,,. 3SOQ Lob.C.l.
Policy' N'u.Cnngnlny
❑ Ceridwit eo,y brrrhy'IuHt, ,,d.
ppl C li 1'I fly lil.•J with Dr clp' in,. lion Jiri,ium
APPlican
CIiNTIII('Afli OP SSI`JON ION PROM 11'UkKIi KS'
C11M I'IiNS,\PION INSURnNC1'
Ilhis action need our ba' rontplclN it Ili, pennil is lar one
hundred d-Iler, I S 100)-r 1-)
I lenity' dw in the pcH.rn,a,, 0f the work Iia which Ihls per
is issua•d, I ,lull n-1 eugsl-y any pvnun it an, runner m as lebecome %ciren m Ibr Worker'C0nlpcn,mi-F Luw, -I CABornie.
Um,ICAN
ACC. DATE
ACG FILE NO.
WATER TR EATIfjG QUIP. 5.00
r' -
ZONING
ENG. SITE NO,
,.�•,\i .r(\:•\+
„1
MISC. - (,'��V REFERTOORD.
FIRE SPRINK
v N
❑ ❑
ENERGY TQ4
v N
❑ ❑
PERMIT ISSUANCE 10.WFLE,
ZONE
A.L.U.C.
Y ❑ N❑
1cOM L ur
'
PLG.
TOTALN❑
-
CIT MECH ICAL PERMIT
FEE SUMMARYIlli[
INGNOIICIi
ALTER OR ADD TO MECH. 5.ot
: 1
'IO AI'1'LApple: lis suer making Ihis Cerlii i<am of P,-
cloption, you,florid bec0nu• Iobjcrt In the WorkcriColnpc ,,moil
of the Labor Codeyen n -RI forth.oh comply wiI, such ortvisions or Ihis permit shall be decried revoked.
LENDING AGENCY
hereby affirm that Fill, is a nmstrocllun lending agency fur
pcdonnance of Ihr wu,k tot aitch Hti, wrinit is issued (Sec'
Civ.C.).
NoneLendcri
APPLIANCE 5.0HECKprovisions
AIR HANDLING UNIT (TO 10,000CF.M.) 4.000NSTRUCTION
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.0C
FEEI
EXHAUST HOOD (WITH DUCT) 5.0the
FILM3097.
HEATING UNIT (TO 100,000 B.T.U.) 8.0Lendr,',
Address
HEATING UNIT(OVER 100,000 B.T.U.) 9.5IC
I eerily thin I have reed Ills applicu ....I and vme than the oho',
iofonnmion i, mrrn'I. I agree to comply with it City' and r-unly
urdlnanca and stale laws ,dating m building CmlllrLI ion, and
hereby inion i Preprrly for ves of Ir puryy to
hereby enthorin• rL•prcwnlotins ill' Ihis city to enter upon the
(We) ,gree to wee, indemnity :ltd keep harmles.v the City 0I
cpcni-o ugaiR51 l"'I'doic,, Iudgmcns. and r,pcn,a whirl
mar in Ins' x'aY --o'
- agaim ,alJ t'��L}} at anu'qu' " ul the
sill ul'1Lillel lir \\U,`^ SI MECIL
K _ll(i
ore of Applcunl/C Dmr
VENTILATION FAN (SINGLE)4,00
BOILER -COMP 13 H.P. or 100,B.T.U.) 6.00
000
PLUMBING
�a0
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
CONT. LIC. NO.
MLCH.
TOTAL
TOTAL
OFFICE COPY