HomeMy WebLinkAbout15189 Springdale St - CofO (3)i
APPLICATION F011ZERTiFICATE F OCCUPANCY
CITY OF NTINGTON BEACH J "�
n• DEVELOPMENT SERVICES '
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THIS USE WOULD BE DESCRIBED AS;
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No Metrical SEnice o on f f�^ ' u r t a r s
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SUPPLEMENTAL INFORMATION (FOR OFFICE USE ONLY) Zf)NIit_"r
GGUPATsl tap`)LJt . PLAN 4 Hk ",4C Prr C 4 I ARKING SPA'
OCCUPANT i C`}AC.+ . __. ._ _ .. HFAL Fli DFP T APPH<3VAL
NOOF _._._ _ .. _." _. _ :..._ PI�t„1! A:r1t:'hd. .,._._.. _.' _ 77a'"s(f,SREL A.i20_
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:"01"iNC
WELOWENT MOWN
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SUPPLEMENTAL INFORMATION
-
j
1,
BUSINESS ADDRESS I.) j?j �; ��' �uL" �./�"%:5 si
f
2.
Person to contact in case of emergency: F`dtP7`
Telephone number.
3.
Does the building in question have electricity?
Dyes
❑ No
'
a* If No, are you requesting that the electricity be
Pry es
turned one
tJNo
4.
The building is sprinklered?
)KXes
�
5,
operations will produce dust/snood shavings or similar
ONo
material?
OY'es
No
'
6.
Operations will involve the repair or replacement of
QYes
automobile par s?
0
'd
If yes:
(a) Describe the components repaired or replaced,
Oyes
(b) Does the operation involve the use of an open flame?
I
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 5o persons.
PNes
o
8.
The fo i sr�aa g est describes my operation:
`
office Only
Retail a es
Warehouse
Manufacturing/Distribution d c ` t es ribe process and end
product)
Restaurant Take out Foo
Medical/Dental
Other (describe)
(,0562D) fly/H/f�S)
t
3
s r
A
«. .. ,M l'
.: S€i£�uE;��:�v::,�:, _N:���iMATC7N (Contanueci`
Does the operation involve any of the fallowing
materials? Oyes
0
I e r ln" smote gUantlties`
- ...
Material
Quantity
1.'Flammable liquids
Class I -A
Class I-B
Glass I-C -
2. Combustible liquids
Class II
Class III-
' 3. Combination flami;nablt ? ....r.e
4. Flammable gases
5, Liquefied flammable
6. Flammable fibers-- loosc,
7. Flammable fibers - bale(
8. Flammable solids
9. Unstable material
1Q. corrosive liclui.cts
ll. Oxidizing material - cja,yes
12. Oxidizing material _ i �Jz
l3. Oxidizing material sol i j.
14„ Organic 2eroxides
15, Nitromethane (unstable �materj.4s)
16. Ammonium nitrate' _
17. Ammonium nitrate- compound .mixtures
containing more than 60
by weight
18. Highly toxic material and
poisonous, as
19, Smokeless 2owder
20. Black sporting powder
I herebycertify that the <jbfive information is true and correct to the
best of my knowledge,
p
S gnature
Date