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r <br />Ah <br />PUBLIC WORKS REVIEW WORKSHEET <br />PROJECT ADDRESS: 4016 HOYT AVE Permit #: C1806-007 <br />TENANT: OLUWOLE OLUSEYI <br />DESCRIPTION OF WORK: CREATE SFR IN LOWER FLOOR OF BLDG TO CREATE DUPLEX <br />PW Reviewer to select all that apply below: <br />Utility Permits (Note: Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br />SANITARY SEWER: DOMESTIC WATER SERVICE: (Not Including Cost Estimates) <br />❑ New Connection ❑ New Connection, Size <br />❑ Alteration ❑ Meter Only, Size <br />❑ Repair ❑ Backflow Prevention (Outside Building): ❑ RPBA or ❑ DCVA <br />❑ Cap -off SNOT REQUIRED <br />❑ Reconnect Explanation/ Utility Permit #: <br />WNOT REQUIRED <br />Explanation/ Utility Permit #: <br />IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Not Including Cost Estimates) <br />❑ New Connection, Size ❑ New Connection, Size <br />❑ Meter Only, Size ❑ 3/" Detect Meter Only, Service Size <br />❑ Backflow Prevention (Outside Building): ❑ DCVA ❑ Backflow Prevention (Outside Building): ❑ DCDA <br />SNOT REQUIRED Uf NOT REQUIRED <br />Explanation/ Utility Permit #: Explanation/ Utility Permit #: <br />WATER DEPARTMENT COST ESTIMATE NEEDED -(If yes, PW Reviewer to send cost estimate request to Water Department) <br />❑ Yes, Quantity See attached for reference. <br />®'NOT REQUIRED <br />Plumbing Permits (Note: Permit Technicians to add all items selected below to Plumbing Permit) <br />❑ Water Service Line (behind meter), Size <br />❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) ❑ RPBA (for Domestic service) ❑ DCDA (for Fire service) <br />0 NOT REQUIRED <br />Building Permits (Note: Permit Technicians to add all items selected below to associated Building Permit) <br />SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br />.YES, Water: $ Z 11. go 14YES, $ 2� �� . c,6 <br />Sewer: $ ❑ See Attached Spreadsheet for calculations/credit <br />I&See Attached Spreadsheet for calculation*redit ❑NOT REQUIRED <br />❑ NOT REQUIRED <br />Additional Checklists: <br />ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br />Ild YES — TYPE <br />AL See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br />8-Digital copy attached to permit record, Permit # ?%-4 180 8- a S-7 <br />❑ NOT REQUIRED <br />FIRE SPRINKLERS REQUIRED? <br />❑ YES —Type <br />® NOT REQUIRED <br />Reason: <br />PUBLIC WORKS PERMIT REQUIRED? <br />.YES, Permit # PW 160 9- 66 -7 <br />Pi-Stormwater NPDES Tab Completed in TRAKiT KADA Tab Completed in TRAKiT ❑ Inspections Added in TRAKiT <br />❑ NOT REQUIRED <br />Worksheet Completed By: Date: ��23 f �B <br />Worksheet Checked By: Date: _ <br />REVISED 8/6/2018 <br />