1988, 10-12 Permit App: 88003185 Mechanical Fixtures INFORMATION WORKSHEET
PARCEL NUMBER: /q5//3 - 6715 3/e5
STREET ADDRESS: C • 7<5 5 k . !C 2:-.4..) "� vim'
CITY/STATE/ZIP: 444/ r�/5�� � c.( ,4 c79 t9
SUBDIVISION: 5UL t_v /4 ILLS 1 S-1
BLOCK: t LOT: /5 ZONE: AS DISTRICT: E.
LOT AREA: /2Q F/A: WIDTH: DEPTH: R/W:50
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: _Ti4Lit-) PHONE: 97
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT: PHONE: - -
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE: Co N UCdc`xbN ' , ? '7 0 '%XT -
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BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: 19 40/76:i
CONTRACTOR: c.G PHONE: - .535 - oZ Sv2
MAILING ADDRESS: 44/ej 4r• /J-
ARCHITECT/ENGINEER: PHONE: - -
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. :
REQUIRED PARKING: # HANDICAP: SEWER (Y/N) : HYDRANT:
PLUMBING INFORMATION
CONTRACTOR LIC#: J
CONTRACTOR:
MAILING ADDRESS:
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MECHANICAL INFORMATION
CONTRACTOR LIC#:
CONTRACTOR:
MAILING ADDRESS:
ELECTRIC: GAS: OIL: CCAL: WOOD: SOLAR: HEAT PUMP
ENERGY CODE: WSEC: NWEC: UTILITY: SGC:
APPROACH: PRESCRIPTIVE: POINT: COMPONENT: SYSTEMS:
MECHANICAL FEES PLUMBING FEES
ITEM DESCRIPTION TIMBER OF ITEM DESCRIPTION NUMBER OF
PROCESSING FEE Y! ) OR NO PROCESSING FEE YES OR NO
DUCTWORK SYSTEM TOILETS
WOODSTOVE/INSERT SINKS
GAS WATER HEATER SHOWERS
GAS HTG EQUIP(100,000)BTU } BATH TUBS
GAS HTG EQUIP +100,000 KITCHEN SINKS
GAS PIPING — # OF UNITS DISHWASHERS
HEATPUMP 1-100 BTU GARBAGE DISPOSAL
HEATPUMP 101-500 BTU CLOTHES WASHER
HEATPUMP 501-1000 BTU UTILITY SINKS
HEATPUMP 1001-1750 BTU ELECTRIC WATER HEATERS
HEATPUMP +1751 BTU FLOOR DRAINS
REFRIG 1-100 BTU FLOOR SINKS
REFRIG 101-500 BTU BAR SINKS
REFRIG 501-100 BTU ROOF DRAINS
REFRIG 101-1750 BTU LAWN SPRINKLER
REFRIG +1750 BTU SEWAGE EJECTOR
AIR CONDITIONER 0-3 HP WATER SOFTENER
AIR CONDITIONER 3-15 HP URINAL
AIR CONDITIONER 15-30 HP DRINKING FOUNTAIN
AIR CONDITIONER 30-50 HP O
AIR CONDITIONER +50 HP l 00
VENTILATING FANS
EVAPORATIVE COOLERS (' S
HOODS
CLOTHES DRYER , n
RANGE
GAS LOG
UNLISTED GAS APPLIANCE
AIR HANDLER 1-10000 CFM
FORM E:{REY. MAIL. TO GAS INSPECTION DIVISION
CENTRAL HEATING APPLIANCE TEST RECORD
ADDRESS
CUSTOMER'S NAM
/` _DATE�d
/"7 — PERMIT NO. —
INSTALLING AGENCY `,- Y
-�J G7 % BTU_2 ��� MANIFOLD PRESSURE-------
COz____----� 02--------_°/. CO-----
MAXIMUM BURNER RATING
BTU. BELLY DIAMETER, GRATE AREA OF H.P. RATING____________
I' 101
SETTING WHEN TESTED----
LIMIT CONTROLS—TYPE
RESPONSE TIME
SAFETY PILOT CONTROLS—TYPE O 4Aj c‘1)$. e
STACK TEMPERATURE—CONVERSION & RECESSED WALL HEATERS Na
�#
LINER & DRIP TEE
TYPE OF CHIMNEY
DRAFT "WC. SULPHUR AMMONIA TEST
SPILLAGE TEST ST
,®* 0, l't i'v 1j n
TESTED BY 9.f""
APPROVED BY MASTER GAS FITTER-- Dept, o D S