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• • <br /> SPUBLIC WORKS REVIEW WORKSHEET <br /> PROJECT ADDRESS: 3333 NASSAU ST Permit#: B1803-048 <br /> TENANT: [Ten Name] <br /> DESCRIPTION OF WORK: CONSTRUCT NEW SFR <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: ✓ AISOMESTIC WATER SERVE: (Attach Calculation& Cost Est.) <br /> vil New Connection to main plus 1 connections to building ✓sf New Connection, Size v I"DOmiAt6-0 Per Cost Estimate <br /> ❑Alteration ._ 0 Meter Only, Size -❑ Per Cost Estimate <br /> Repair A f Water System Development Fee Total: $ 3 c1� , <br /> ▪ Cap-off,quantity Sewer System Development Fee Total: 2i 20 <br /> ❑ _._. <br /> ❑ Reconnection to stub ❑ Backflow Prevention (Outside Building): PBA or 0 DCVA <br /> ❑ NOT REQUIRED ❑ NOT REQUIRED / CM tree.. <br /> .. <br /> Explanation/Utility Permit#: (A(q d(' O( f 2 Explanation/Utility Permit#: LA(90Go-O( 6C 3!fl'SMi t, <br /> No a/3Du. <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): ❑ DCVA 1EC NOT REQUIRED <br /> ri(�. Di NOT REQUIRED Pr Explanation/Utility Permit#: <br /> ff 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 /> 00. 14 NOT REQUIRED <br /> I Plumbing Permits ote:Permit Technicians to d all tems selected below to Plumbing Permit) “, /GlOh,-0(LO <br /> kfre IS Water Service'L1'ne(b ind meter), Size ry11 DE,Iiirl(6 (I:U40("1( ) 6ttiGtv)i d in v <br /> f 1l.�J 41 C 't't�'-tcr-i+ <br /> - ❑ Backflow Prevent' (Inside Building): ❑dDCVA(for Do e is service) 0 RPBA(for Domestic service) 0 DCDA(for Fire servic <br /> ❑ NOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items elected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES Al go3-- TRAFFIC MITIGATION FEES: <br /> V YES, Stormwater Total:$ of .12 1 y Phn� ❑YES,Traffic Mitigation Total:$ <br /> 1 <br /> 0 See Attached Spreadsheet for calculations 0 See Attached Spreadsheet,�jor calculations/credit <br /> ❑ NOT REQUIRED L(5a34i N&ufikER.P DHPS0 7cL�Nl�'pi NOT REQUIRED _g jeL ys �o1hfri9 <br /> NEW CeNSTXJCTIOI'I <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes(new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> V 18(YES—TYPE: IX(SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING 0 MULTI-FAMILY 0 COMMERCIAL <br /> E(See Attached Letter,2 copies (Permit Techs to issue one cop to applicant with permits, scan one co yy to Jeffrey Marks) <br /> '�[Digital copy attached to permit record, Permit# PWlsa�DY (�Q/J, a t 7v/�IIP ad: <br /> gSaved to Address Folder in Development Tech File '`'` <br /> ❑ NOT REQUIRED <br /> IRE SPRINKLERS REQUIRED? <br /> / krYES-Type 15 b <br /> o NOT REQUIRED <br /> Reason: FI(QF e T <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> ' YES, Permit#PWri011-041 <br /> tf Stormwater NPDES Tab Completed in TRAKiT DADA Tab Completed in TRAKiT IEr Inspections Added in TRAKiT. <br /> ❑ NOT REQUIRED Aq p <br /> Worksheet Completed By: A v(. Date: /.9g/gOi l <br /> Worksheet Checked By: Date: <br /> REVISED 1/7/2019 <br />