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OLT • • <br /> PUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 215 DORN AVE UNIT C & D Permit#: C1803-001 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW DUPLEX(C&D) <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: (gtta l Calculation& Cost Est.) <br /> %New Connection to main plus / connections to building New Connection, Size 1� v Per Cost Estimate <br /> ❑Alteration s " 0 Meter Only, Size -0 Per Cost Estimate <br /> ❑ Repair Z 01 Water System Development Fee Total: $ 3/ gtr9.,a <br /> ❑Cap-off, quantity Sewer System Development Fee Total: $ S 1 ZI oa <br /> ❑ Reconnection to stub 4 r- owe,0 Water Service Line(behind meter), Size <br /> ❑ Backwater Valve r . 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED k wr dnk ❑ NOT REQUIRED <br /> Explanation/Utility Permit#: Explanation/Utility Permit#: 71(1r c{m^+ <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size 0 New Connection, Size -0 Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑Water System Development Fee Total: $ 0 Backflow Prevention(Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA RNOT REQUIRED <br /> 0 NOT REQUIRED Explanation/Utility Permit#: <br /> Explanation/Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(lf 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-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): ❑ DCVA(for Domestic service) 0 RPBA(for Domestic service) 0 DCDA(for Fire service) <br /> INOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> OMSr SYSTEM DEVELOPMENT FEES: TRAFFICMITIGATION <br /> ❑YES, Stormwater YES,Traffic Mitigation Total: $s�M/k(,l f(j� "'" b®D <br /> ❑ See Attached Spreadsheet for calcul ions 0 See Attached Spreadsheet for calculations/credit <br /> O NOTRt4U4R�I� /oil aI Q`C <br /> n ` 4 -� f� L„_ 0 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 /> YES—TYPE: ElI�SFR DUPLEX 0 ADU ❑ INFILL DWELLING 0 MULTI-FAMILY ❑ COMMERCIAL <br /> 12 See Attached Letter,2 copies(Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Ear Digital copy attached to permit record, Permit# ?i.J I$0 3 <br /> WI Saved to Address Folder in Development Tech File ,C pa o3.00 I <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> 'E YES—Type 13b <br /> ❑ NOT REQUIRED <br /> Reason: lotkki - ViNgs rerrt, Srtatturs <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ❑YES, Permit#PW t SC 3" of <br /> ,�Stormwater NPDES -b Completed in TRAKiT JB.ADA Tab Completed in TRAKiT .'Inspections Added in TRAKiT <br /> O NOT REQUIRED <br /> Worksheet Completed By: _'�s ' ice► Date: Smor <br /> Worksheet Checked By: r Date: lag 261 1 <br /> REVISED 2/22/2019 <br />