05201632 Permit File
CITY OF DUBLIN
Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
C E R T I F I C A T E OF O C C U P A N C Y
P E R M A N E N T
Issue Date . . . . . . 4/28/08
Parcel Number . . . . . 273-008385
Property Address . . . 3833 CARBERRY DR FR
DUBLIN OH 43016
Subdivision Name . . . SCIOTO CROSSING
Legal Description . . . 7885 SAWMILL RD
R19 T2 1/4T2
32.933 ACRES
Property Zoning . . . . PLANNED UNIT DEVELOPMENT
Owner . . . . . . . . . SCIOTO CROSSING DEV. LLC
Contractor . . . . . . PRESIDENTIAL CONSTRUCTION, INC
614 923-4000
Application number 05-00201632 000 000
Description of Work . 5 OR MORE FAMILY DWELLINGS
Construction type . . . 5B - UNPROTECTED COMB
Occupancy type . . . . RES > 3 UNITS FIRE SEP
Flood Zone . . . . . .
Special conditions
THE RESERVES AT SCIOTO CROSSING - BUILDING 10
Approved . . . . . . .
i Official
VOID UNLESS SIGNED BY B LDING OFFICIAL
CITY OF DUBLIN
t
Division of Building Standards a 5800 Shier Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
COMMERCIAL MULTI-FAMILY INSPECTION SIGN-OFF
Project Name: 'The au+ iZ Fio Mi _ JbQj6 .1
Application No: Oe - Project A dress: ft (VLrjp4er9X4 1.
General Contractor: Building Code: pit O
Use Group: 3 Construction Ty e:'X
DATE APP/DIS P. DATE APP/DIS INSP.
Sewer Tap 1, r1 6h Insulation i1 1e ~Ep
Footing~m tr4A.6A, e2 PAWIleff- aaeL Fireplace I /V
Foundation Above Ceiling Electric
Electrical Underground Above Ceiling HVAC
Plumbing Underground `j **Above Ceiling Sprinkler 31 a~
Pre-Slab C' ~ k Above Ceiling Structural
• Electric Service - y Final Electric C
.9 le&
Rough Electric Final Gas-3:Gz~ Jn~.~
- I/ 7~
Rough Plumbing `04 , fry Final Plumbing
ough HVAC~t L~ Final HVAC,
Q h Gays! r nrS1r~ GL **Fire Prevention
Z8 g
**Rough Sprinkler 3 G Zoning Final
Separation Walls Engineering Final
Fr ingl~~aCjc D~~IL Occupancy ~p-
**Please call Washington Township Fire Department at 889-2347 to schedule these inspections.
r j ......:q .{.K,rt, y... .-q c -•r,... -x. .es. err m. a w
CITY OF DUBLIN
Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
APPLICATION FOR HVAC PERMIT
Date Application No. O C;'00a U
Job Address e r Parcel No. '
Subdivision SS~ Lot No.
Owner Name 1 C~ 5 ~1T 1 QA ~0 n 5A (u CTS on_ Telephone Contractor Name 1 R CLl ? Telephone 10~ t t0 't
Contractor Address gig c~ Z h 4W LL50
ublin Registration No. 38
Residential:
Sq. Ft.
$40.00 Minimum plus $20.00 for each additional 500 Sq. Ft. or fraction thereof over 1000 Sq. Ft.
(Replacement units, minimum fee)
Commercial:
New/Addition Sq. Ft. Alteration
New/Addition: $40.00 Minimum plus $20.00 for each additional 1000 Sq. Ft. or fraction thereof over 1000 Sq. Ft. Q ® y
Alteration: $40.00 Minimum plus $10.00 for each additional 1000 Sq. Ft. or fraction thereof over 1000 Sq. Ft.
3% State of Ohio Surcharge (commercial only) `
/ Total $
JOB DESCRIPTION /
This permit is granted on the express condition that the said work shall in all respects, conform to the ordinances of the City of Dublin and all
the laws of the State regulating construction, installation, repair and alteration, and may be revoked at any time upon violation of any
provisions of said laws.
Signature of licensed contractor or homeowner
Division of Building Standards f
CITY OF DUBLIN
Division of Building Standards - 5800 Shier-Rings Road - Dublin, Ohio 43016
Phone: (614) 410-4670 - Inspection Line: (614) 410-4680
Application Number . . . . . 05-00201632 Date 9/23/05
Pin number . . . . . . . . . 536024
Property Address . . . . . . 3833 CARBERRY DR
Parcel Number . . 273-008385
Alternate Address . . . . . . RESERVE SCIOTO CROSS 10B
Tenant nbr, name . . . . . . 10 RESERVE SCIOTO CROSSING
Application description . . . 5 OR MORE FAMILY DWELLINGS
Property owner . . . . . . . SCIOTO CROSSING DEV. LLC
Contractor . . . . . . . . . PRESIDENTIAL CONSTRUCTION, INC
Structure Information
Construction Type . . . . . 5B - UNPROTECTED COMB
Occupancy Type . . . . . . RES > 3 UNITS FIRE SEP
Permit . . . . . . COMMERCIAL BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 220.00 Plan Check Fee .00
Issue Date . . . . g1Aq10s Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 160.00
1.00 60.0000 THOU COM BLDG PLAN REVIEW 60.00
Permit . . . . . . LOW VOLTAGE ELECTRIC PERMIT
Additional desc . .
Permit Fee . . . . 50.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 30.00
1.00 20.0000 THOU COM ELECTRIC LOW VOLTAGE 20.00
Other Fees . . . . . . . . . COM BLDG INSPECT NEW/ADD 230.00
COM CERTIFICATE OF OCC 120.00
SURCHARGE FEE - ELECTRIC 1.50
SURCHARGE FEE - BLDG 17.10
Fee summary Charged Paid Credited Due
Permit Fee Total 270.00 .00 .00 270.00
Plan Check Total .00 .00 .00 .00
Other Fee Total 368.60 .00 .00 368.60
Grand Total 638.60 .00 .00 638.60
r
' \ " ~"-"'C
This permit is granted on the express condition that said work shall in all respects,
conform to the ordinances of the City of Dublin and all laws of the State of Ohio
regulating construction, installation, repair and alteration and may be revoked at
any time upon violation of any provisions of law.
CITY OF DUBLIN
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
APPROVAL
THIS IS NOT A BUILDING PERMIT. IT IS A RECORD OF OUR REVIEW OF DOCUMENTS
SUBMITTED WITH YOUR APPLICATION FOR A BUILDING PERMIT.
September 19, 2005
RE: RESERVE AT SCIOTO CROSSING, BUILDING 10, TYPE B
APPLICATION NO.: 05-201624 3813 Carberry Drive 1,389 Sq. Ft.
ADDRESS: 05-201625 3815 Carberry Drive 1,478 Sq. Ft.
05-201626 3817 Carberry Drive 1,233 Sq. Ft.
05-201627 3819 Carberry Drive 1,144 Sq. Ft.
05-201628 3823 Carberry Drive 1,389 Sq. Ft.
05-201629 3825 Carberry Drive 1,478 Sq. Ft.
05-201630 3827 Carberry Drive 1,233 Sq. Ft.
05-201631 3829 Carberry Drive 1,144 Sq. Ft.
05-201632 3833 Carberry Drive 1,144 Sq. Ft.
05-201633 3835 Carberry Drive 1,233 Sq. Ft.
05-201634 3837 Carberry Drive 1,233 Sq. Ft.
05-201635 3839 Carberry Drive 1,129 Sq. Ft.
05-201636 3843 Carberry Drive 1,144 Sq. Ft.
05-201637 3845 Carberry Drive 1,233 Sq. Ft.
05-201638 3847 Carberry Drive 1,329 Sq. Ft.
05-201639 3849 Carberry Drive 1,226 Sq. Ft.
APPLICANT: Robert Shepherd, Kontogiannis & Associates
The plans dated August 24, 2005, for the captioned project have been reviewed for compliance with the
provisions of the Ohio Building Code (OBC - January 1, 2002) for the purpose of issuing an APPROVAL.
The review was based upon the following criteria:
Use Group: R3
Occupancy: One Family Per Unit
Area: 20,159 Sq. Ft. Total
Construction Type: VB
Automatic Sprinkler: 13R
The architectural plans are sealed by George J. Kontogiannis, architect #3784 and Glenn A. Halmbacher,
Engineer #58079, all to comply with the requirements of OBC Section 106.3.4.1 and have been reviewed,
therefore, in accord with OBC Section 106.3.1.
OBC 106.3.1 Approval of construction documents. When the construction documents have been
determined to conform to the applicable provisions of the rules of the Board in accordance with the
procedures set forth in Section 105.3.1, the building official shall endorse or stamp such plans as approved.
One set of construction documents shall be kept by the building official. The other set(s) shall be returned
to the applicant, kept at the work site and shall be open for inspection by the building official or the building
official's designated representative.
TA0FFICE\WP\D0CS\D0C\Approval 2005\05-201624-201639 Reserves Q Scioto Crossing, Bldg I O.doc
V
RESERVE AT SCIOTO CROSSING, BUILDING 10
Applicant: Robert Shepherd, Kontogiannis & Associates
Application NoM 05-201624-201639
September 19, 2005
Page 2 of 3
This APPROVAL does not preclude the acquisition of separate permits for plumbing, mechanical,
sprinkler or electric. Permits and fees for these items must be obtained from the Building Division prior to
the start of any work in these areas.
The following items are required for code compliance, but are not necessarily covered in detail in the construction
documents. This list is a reminder to the design professional and contractors of issues which are to be satisfactorily
dealt with in the field.
Item 1. OBC 109.2 Lot line markers required. Before any work is started in the construction of a
building or an addition to a building to which the rules of the Board are applicable under Section
101.2, all boundary lines shall be clearly marked at their intersections with permanent markers or
with markers which are offset at a distance which is of record with the owner.
Item 2. OBC 1063.1 Approval of construction documents. When the construction documents have
been determined to conform to the applicable provisions of the rules of the Board in accordance
with the procedures set forth in Section 105.3.1, the building official shall endorse or stamp such
plans as approved. One set of construction documents shall be kept by the building official. The
other set(s) shall be returned to the applicant, kept at the work site and shall be open for inspection
by the building official or the building official's designated representative.
Item 3. OBC 105.7.2 Posting. The certificate of plan approval shall be posted in a conspicuous location
outside of the building and in the front part of the premises on which is, or will be the approved
building or equipment to which the approved plans relate. The owner and the contractor shall, so
far as possible, preserve and keep the certificate posted until the completion of the work to which
the approved plans relate.
Item 4. OBC 106.4 Amended construction documents. If substantive changes to the building are
contemplated after first document submission, or during construction, those changes must be
submitted to the building official for review and approval prior to those changes being executed.
The building official may waive this requirement in the instance of an emergency repair, or similar
instance.
Item 5. OBC 109.1 General. Construction or work for which an approval is required shall be subject to
inspection by the building official and such construction or work shall remain accessible and
exposed for inspection purposes until approved.
This includes f:restopping and draftstopping (Chapter 7 OBC), mechanical work; piping, ducts
and systems (Chapter 3 OMC), structural members and connections (Chapter 16 OBC), and
electrical work (Chapter 27 OBC). All systems and elements covered by code are to be inspected
and approved before being covered.
Item 6. OBC 1103.1 Where required. Buildings and structures, temporary or permanent, including their
associated sites and facilities, shall be accessible to persons with physical disabilities.
OBC 1103.2.1 Specific requirements. Accessibility is required in buildings and facilities, or
portions thereof, to the extent indicated in ADAAG Section 4.1 and this chapter.
T:\OFFICE\WP\DOCS\DOC\Approval 2005\05-201624-201639 Reserves @ Scioto Crossing, Bldg I O.doc
RESERVE AT SCIOTO CROSSING, BUILDING 10
Applicant: Robert Shepherd, Kontogiannis & Associates
Application No.# 05-201624-201639
September l9, 2005
Page 3 of 3
Item 7. All electrical will comply with the requirements of Article 27 OBC and the National Electrical
Code, NfiPA 70, OBC approved edition and is subject to the approval of the electrical field
inspector.
Item 8. The existing electrical conductors, if removed, abandoned, or altered, shall be accomplished to the
electrical field inspector's approval. Electrical work found not to meet the code's standards shall
be corrected to the electrical field inspector's approval.
The start of construction indicates acceptance of all of the conditions listed above. This review does not preclude
the necessity to conform with provisions which may have been omitted or overlooked in the review process, but
which are requirements of the code. Ultimate responsibility for legal compliance with the Standards of Safety rest
with the registered design professional, the tenant and the owner. Approval will be valid only upon receipt by the
City of Dublin, Division of Building Standards, of one signed copy of this addendum to the submitted plans.
TO REQUEST AN APPEAL HEARING,•YOU MUST sent a written request, listing the items to be appealed and
the relief sought and a copy of this order to:
Robert Price, Chief Building Official
City of Dublin
5800 Shier Rings Road
Dublin, Ohio 43016
Reviewed and Signed,
Martin F. Strayer obert Price
Commercial Plans Exa Chief Building Official
Owne r Owner's Representative ate
JIF AX~(- -d
Print Name and Title as Signed
T:\0FFICE\WP\D0CS\D0C\Approva12005\05-201624-201639 Reserves @ Scioto Crossing, Bldg l0.doc
07/12/2005 17:14,FA% 6142244736 KONTOGIANNI& COMPANIES SABATINO 11003/003
CITY OF DUBLIN sago shier Rings Road
Division of Building Standards Dublin, Ohio 43016 90W 06C
COMMERCIAL BUILDING Telephone: 614-410.4670
PERMIT APPLICATION "ection Une: 614.410-4680
a Facsimile: 614-761.6566 10 &If ~ L
813 ~ S, 38?4 1 ~tq , 3843 r a ? 3 3 33, 383 383
PROJECTi INFORMATION /off
ees 311. 31q3, 38'YS; 38ql, 38`I CAf-y Qe?t ProjedsgFig.
rojeat Dame e 5 oTb ciLos t H
brow cost of Conatuction ~ Per* NUMrer 2'7 - oD $ .
ROPERTY OWNER INFORMATION
Owrw Now (Conbot Person it owned by a Corporation S+.y t , i o
CASS1sJ4 VG/. LLG Address
tN stab Get l Ap 4601-1
• `Ci agcy F ~ b co E~ia#
NT INFORMATION (If Applicable)
tact Name
timw p&y : --Address
stet ZP
Fa~c E
RCHITECT, ENGINEER, OR OTHER DESIGN PROFESSIONAL INFORMATION
p ionliName Georg a J. Kanto iannigido RegNumber 3784
yp Rantog is Associates A~~ 400 Sou reet Suite 4OU
xy- Coltsnbus State OR Zip 4321
14- - OS -224-4 tests Ldiron to i s.can
ERAL CO~NT1rntNEORNtAT10N (Must be a City of Dublin Registered Contr actor)
DE , jY1tF E1-L pubis Regriatt 04-3154
t~brne Presidential Construction A 3895 Standridga ]Ume _
Dublin State OH ~p 4 1T
614-923-4000 X 6 Fax 1 - - ;ri PREP,
I AVIT OF OWNER AUTHORIZATION'FOR REPRESERiTATION.
r.
ote ."This person will be contacted with all official correspondence. All s natures must be ORIGINAL
ees Representative Robert She Relatbnsh>p to Prcti Architect
panyName Kontogianhis 09@004es Position l'rznci Telephone 1 _ 224-2083
I, Ron Sabati no (please print), the owner appCrcant, hereby authorize Robert Shepherd
act as my representative and agent in an matters. pertaining to the processing,and approval of this appficaom including
rnodifying the project, and I agree to ound by lions agreements made by the designated agent.
igmature of Property Owner
Date:_~
I,_ Robert Shepherd: the Owner or the Owner's Representative, have'read and
understand the contents of all 3 pages of this pplication.` a information contained-in this Application; attached exhibits
and other information submitted is ete a d in sp true and correct, to the best of my knowledge and belief.
ignature of Owners R resentative. Date:
Building Standards Division Use Qnl Date Received Building Standards
t?rJ a , `st a Q lD~
gRPlicatton Number U
eoh"'ER AL UMOMGPERMFrAPPLIG7ION Pao. I W 2 P.VAS=LD(itFORM=Y MMAPP.W52 Fa *RL0.20t Dale: 02(l 6100
07/12/2005 17`.14 FAX 6142244736 KONT06IANNIS COMPANIES SABATINO Q002/003
CITY OF DUBLIN
Division of Building Sa tandards -
COMMERCIAL BUILDING PERMIT APPLICATION
Project Name_-Ne t2a sier.~Ie syArt* t~2o'ss ~ , Permit Number
PROJECT INFORMATION
rldhn 10 T pE
NOTE: The following information is to. be completed by the Design Professional, registered in the
State of Ohio who was Primarily responsible for the preparation of the construction documents.
Scope of Projects 4pot.,- tg L;wx M 6wp4 Vot 6cK4cio mi t1 ivw15 - - - -
n?'T"'ed PS9.31 11 dt .5.
TYPE OF WORK (Check all that apply)
A. New Structure
B. Addition ..41re Wall Yes 'g No
C. Afterabon Article 34 Yes " No
D, Change of, Use Entire Structure Partial
E_ Change of Occupancy,-_, Entire Structure Partial
Previous Use(s) Use Group(s)
ANALYSIS OF NEW STRUCTURE, ADDITION, AND/OR AREA TO BE ALTERED
A. Occupancy Description ~Al-- Use Group(s) , -V:4H
B. Mixed Use. Yes Non-separated =Separated
No'
C. Type of construction 5 I ffe. ~tVI lL F IfL 5YS`~'L
D. Fire resistive construction Fire Test design Numbers
Exterior Walls hr.
Fire Wails 2 hr. iKL• 0`11
Floor/Ceiling ~I hr. OL. • L9
Columns/Bearing Wall hr:
hr. - V too
Exit Enclosures
Shafts hr.
Corridors hr.
Tenant Separation 1 hr. 01,,• **4
E. Floor Area/Floor Occupant Load/Floor Egress Capacitffloor Y Number of Exits
Basement t
1sf t4
2nd ( A--
3rd r ,
4th & above
F. Allowable maximum floor area (first floor footprint)
Does the above include street frontage increase? es . No'
Does the above include increase for sprinklers? Yes No
G. Number of stories above grade- 1
Height_ 1!3 - Basement Yes F__1 No _
COMMERCIAL SU DING PERMfr APPLICATION Page 2 of 3 P_%PASS*LDW0RMS%C0MMAPP.VJ82 F0nTW BLD-201 Dale: lanim
r
CITY OF DUBLIN
Division of Building Standards
COMMERCIAL BUILDING PERMIT APPLIC, iMQ
H. Horizontal exits Y:s
No
I_ Limited sprinkler system , N
J
. Fall automatic sprinkler system Yes No
K. Standpipe`.. system Yes No
L. Smoke control/Removal system Yes No
M. Unlimited area,building. Yes No
N. Manual fire alarm Yes No
0. Auto fire alarm Yes No
P. Handicap accessible route (exteriors interior). Yes No
Q. StrUctura I Loads provide table of design loads with construct'tpn documents
EXISTING STRUCTURE ANALYSIS.
(Complete for all alteration or addition projects)'
A; Occupancy Description Use Group(s)
B. Mixed Use: . Yes Nan-separated =Separated- E-1
G. Type of construction J
D. Floor Area/Floor Occupant Load/Floor Egress Capacity/Floor Number of Exits
Basement;
1st
2nd
3rd
4th & above
E_ Allowable maximum floor area (first floor, footprint)
Does the above include street frontage increase? Yes No
Does the above inciude increase for sprinklers? Yes No H
F. Number of stories above grade
Building Height Basement Yes
a Noo:
G. Horizontal exits Yes
No.
H. Limited sprinkler system.
Yes No
1. Full automatic sprinkler system Yes No
J. Standpipe system Yes No
K. Smoke control/Removal system Yes No
L. Unlimited area building - Yes No
M. Manual fire alarm Yes No
N. Auto fire alarm Yes No
O. Handicap accessible route (exterior & interior)- Yes No
P. Structural Loads: provide,,table of design loads with construction documents
the Design Professional, have read
and, understand the contents of this application: The infotmationcontained In this-application,
attached exhibits and other information ubmitted; incomplete and in all respects true and correct,
to the best of my knowledge arid :b f
Signature of Design Professional.
Date:
COMMERCIAL BUILDING PERMIT APPLICATION Page 3 of 3 P: SZLDGtFORMS%COMMAPP.W82 Fo m7k BLD-201 Date: 10/11/99
r
Presidential Construction, Inc.
The Reserve at Scioto Crossing (216 Condominium Units)
Schedule of Addresses and Unit Types
August 24, 2005
Building # Address Street Unit Floor Unit Type Unit Name Garages Sgft
10 - Type "B" 3813 Carberry Drive 1 E Windsor N 1389
3815 Carberry Drive 1 F Rio N 1478
3817 Carberry Drive 1 B Savoy N 1233
3819 Carberry Drive 1 A Regal N 1144
3823 Carberry Drive 2 G Windsor N 1389
3825 Carberry Drive 2 H Rio N 1478
' 3827 Carberry Drive 2 D Savoy N 1233
3829 Carberry Drive 2 C Regal N 1144
3833 Carberry Drive 1 A Regal A 1144
3835 Carberry Drive 1 B Savoy A 1233
3837 Carberry Drive 1 B Savoy A 1233
3839 Carberry Drive 1 Al Raleigh A 1129
3843 Carberry Drive 2 C Regal A 1144
3845 Carberry Drive 2 D Savoy A 1233
3847 Carberry Drive 2 D1 Charleston A 1329
3849 Carberry Drive 2 C1 Raleigh A 1226
CITY OF DUBLIN
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
APPLICATION FOR GAS PIPING PER UT
Date 10- 10- O i~' Application No. ~j,
/ " U I (D YL,/
Job Addres s-3 3 3 > r 1`ir•K-6 (4 -e,~1 1)0kV'F- Parcel No. Z43- 0 g 3$ S
Subdivision SEQJF O J•C Lot No. to c3 .A
Owner Name ~~a~ ~oMES Telephone 9a3- yoo~
Contractor Name &)Q AaA jJ { Go =MC Telephone 4011- a l e3
Contractor Address a a 5 s S• ` ~y S 1 Dublin Registration No. q4 -Oy
( ) Residential (Commercial Alter Existing ( ) Addition to Building ( ) Replace/Repair Existing
Type of Pipe to be Installed: ( ) Iron (XSST ( ) Other
Min. Pipe Size Required: 112? in. Regulator Size 42 3-)-,S000 BTU Max.
Gas Appliances BTU/HR
Range
Water Heater 1- `4o,QCZ)
Dryer
Gas Logs
Log Lighter 1-a Sj OOO
Furnace(s)
Other:
FEE $70.00
3% State of Ohio Surcharge (commercial only) ' 1D
Total - 1 S Oj 000 Total $ el i rz),
JOB DESCRIPTION Stmt CSS ilJ &,tiM ~I~LJJb
This permit is granted on the express condition that the said work shall in all respects, conform to the ordinances of the City of Dublin and all
and a
lteration, and may be revoked at any time upon violation of any
the laws of the State regulating construction, installat7~L
provisions of said laws.
Signature of licensed contractor or homeowner
Division of Building Standards
i
1,
CITY OF DUBLIN
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 462-3865 (Franklin County)
Application No. CJ -;_)01(10
Date y~ew ? Remodel ? Residential ommercial - 4~ APPLICATION FOR PLUMBING PERMIT
The undersigned hereby applies for a permit to do plumbing and an inspection of same at the following location in accord with
Chapter 4101:2-511 of the Ohio Administrative Code, and all regulations of the Franklin County Board of Health.
Job Address .O ParcelNo.Z-r3"11ng5Er~
Subdivision/Project Name D=E~2,eAm 0- S _ C , Lot No. / o 6 -14
Owner's Name T Telephone _F2 3
Contractor's Name C4-*- OG w -D"C- Telephone ~J ` I'- 2-14 3
Contractor's Addresses 4C Dublin Registration Number ti Z- -6 Does the sewer discharge into an individual sewage disposal system or sanitary sewer?
How far distant from any dwelling, well or cistern is the sewage tank? rg
What is the size of the main drain? Of what materials do the vent pipes consist?
Of what material does the house drain consist?
"INDICATE NAME OF CERTIFIED BACKFLOW TESTER Au uA-
INSTRUCTIONS
This form must be properly filled out and returned to the office of the City of Dublin at least four days prior to the date of the FIRST INSPECTION,
accompanied by a fee calculated upon the following basis:
RESIDENTIAL COMMERCIAL
Application for permit & first fixture $50.00 Application for permit & first fixture $60...-000
Number of remaining fixtures X $10.00 = $ Number of remaining fixtures X $12.00 = $ G1i2
Total Inspection Fee $ Total Inspection Fee $zea.
Re-inspection fee (based upon disapproved Inspection and collected by the Franklin County Board of Health ONLY) $45.00
Qty. Qty. t y.
Air Admittance Valve Garbage Disposal Showers
" Backflow Preventers Hot Water Heater Sterilizers
Bath Tubs Interceptor Sump Pump
Bed Pan Washers Kitchen Sink Trap Primer
21-
Bidet Laundry Trays Urinal
Chemical Sinks Lavatories Wash Fountain
Dental Cuspidors Mop Sinks Washing Machine
Dilution Sump Outside Faucets Water Closets
Dish Washers Roof Drains Water Lines
Drinking Fountain Rough-in Openings for Future Water Storage Tank
Floor Drains Sewage Ejectors Other
Garage Catch Basin GRAND TOTAL
iWATER TANK RELPLACEMENT FEE $35.00
Division of Building Standards
CITY OF DUBLIN
Division of Building Standards - 5800 Shier-Rings Road - Dublin, Ohio 43016
Phone: (614) 410-4670 - Inspection Line: (614) 410-4680
Date 10 045:~ Application No. 05 _ 600
APPLICATION FOR ELECTRICAL PERMIT
Job Address Q(2 Ar, Q rynC\r . Parcel No, c 2 3--n DEC 3 S
Subdivision "eain n~ ViD `mo t No.
Owner Name Ou17r~n1 ~(krx~ w!rephone 1 - 9 ;13~
Contractor Name Lom -42&r Roc-4 e- cp-:P~leph q L0 -9 - ---Z~q 9 n
Contractor Address Dublin Registration No. 12-5--ELI Le
Residential:
New Sq. Ft. n
Temporary Service $40.00....
$40.00 Minimum plus $20.00 for each additio Sq. ver 1000 Sq. Ft.
Low Voltage Systems: Square Feet
$40.00 Minimum plus $10.00 for each additional 500 Sq. Ft. f over 1000 Sq. Ft.
Commercial:
New Sq. Ft. Alteration/Addition q. Ft.
Temporary Service $60.00
$60.00 Minimum plus $60.00 f each additional 1000 Sq. Ft. or fraction thereof over 1000 Sq. Ft.
and up to 50,999 Sq. Ft. (sizes ve, See Fee Schedule)
Low Voltage Systems: Square eet
$30.00 Minimum (plus $20. for each additional 1000 Sq. Ft. or fraction thereof over 1000 Sq. Ft.)
3% State of Ohio Surcharge (commercial only)
Total $
JOB DESCRIPTION "C
This permit is granted on the express condition that the said work shag in as respects, conform to the ordinances of the City of
Dublin, all the laws of the State and the National Electric Code regulating construction, installation, repair and alteration,
and may be revoked at any time upon violation of any provisions of said laws.
Signature of licensed contractor or homeom er ( Division of Building Standards
Date: 1/1/2001