HomeMy WebLinkAboutPermit Building 1989-6-16 (2)
1 U/,I'ECllOll Llilf.
726-3709
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COI\BIIIMION APPLICATION/PERMIT
E!IERGY SOURCES:
"eat
I-later Heater
Ranne_
.
IIlfORllM;..'1 lid:' II
726-37,)
So. Ftq. /.ld in
~q. :tlJ. Access.
SQ. Hq. Other
rlCh' Add lI,lter [I.eo.
--rence Oemo Change/Use
Other- -
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~
II 111]
II
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JOb Mdress I / / 7 _<;' a '
le~d] De~criptjon
J'A .. ...s;- r-
Phone
Valuf of Hod::
$/3,/5/
Bui It;inQ Permi t Info:
family Residence With
Describe 1.lor~{ i.e.. Oui Id Single
f\t tached r.araQc)
Owner ~j' ~ t:.dJ;.)
,\ddrC5~A ,-,d
):/p I2OLJC-r.s
l_rD,
726 -j q --7/
;::< /J " J;" TT7.tO J-..HJ .<:
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I5 L--owti=12
Construction lender
..\LlJress
OE,llJil Tl^ll
{/ldme}
I'hone
{address}
(I ic<;. /10. \
{exniresl
(nhnne no. J
Primary
1--7 A .q k L 0 tJ.,r7 00
Structural ~ -1, f--h L- '-- t:;:,.J4/ Jr:i-CP'uJL
Electrical
!1echanicd 1
CONTRACTORS
{name}
(addreH 1
(1;('<;. no.\
((>)(01rp" \
(nh(\f\p no )
Genera 1
}....//r_K":=kJrl."'::- /~~_/ tc:=y t:17^-_LSr:
PlumbinCl
Electrical
t1echiH1'Ci\'
rJ IA/. I~,<)
PLUIIflI IlG
ELECTRICAL
MECHANICAL
'" r1Ii\RGE IIf) 1...f.ELIJ:1JAIlliL
furnace/burner to
OHl's
;;u. ,
-----lEach 'ingl. fixture
IRe\OColed building
(new fix. addit iona I)
IS.F. P.esidence
r I bath I
Duplex (1 bath) each
f'f (IIARG' JIlL.
Residence of
SQ, CT,
New circuits alts.
or' extensions
Floor furnace
and vent
!SERVICES
Recessed wall
Snarp hpa tpl'"' -'nrl ItPnt
Storm Se\'/er
or
amps,
Apoliance vent
seoaratl'>
Stationarv evao,
coo 1 cr ~ '
I Vent fan \'1ith
sinoJe duct
Vent syster.l apart from I
heatino or A.C.
Nechanical exhaust
hnnrl <'lna alJrt
Additional bath
Sewer
Temporary Construction
Cllanqe in existing
res i d(>nc(>
'mult{filmi"ly, conl!l. or
Indu<;tri;d
~!ater service
CoI'IL lIND, FEEDERS
Ilf,stall/al tel'/relocate
rli<;trih. f(>(>t1pr<;
IOf amps.
\'load stove/heater
ISSIJANCF nF P'P.lllT
I TOTAt CHARGES
Contractor, the electrical portion of this peri.\lt
and return('d to the Building Division
Zone M-.L,/ Tyne/ConH,
Fire Jane Bedrooms
~,
Units
Occy load
Occ.Y Group
SIGlIATVRE /.z,1 /i hi /' __~
rop. OfFICE USE Oitty
S~. rt~. 11ain x
SQ. Ftl]. Access x
Sq. Ftg. Other x
omi12/L-_1 A''l
IIM1E(pleilse flrint) I'--7A~.I<
Lr:::lA..L.l.-,."J#t,./
Flood Plain
Stories
Value
Value
Value
VALUATIOII /~, /S /
TOT^L
BUltolllG PERnlT
Charges an~
Surcharges
I Plan Ck.
. __-I-~r'-~-:?__....Q5%/fildO
Plan 0,
~.-;2." 30%fBldn
____________1 Fence
I O,emo
1
Conm/lnd
Ppr Ff>f>
Ifes
PI;' r Fer
16?-q.~
I
I
I
I
I
Syste~5 Oe~elopment
CharGe (1.5')
PLU'1BING PERMIT
C~arges clnd
SurCharges
. (lECTRICf..L PERI~IT
CharQes and
SurCharges
I1ECIlANICAL PERlilT
Char9~c:. and
SurcharfJes
Itota) (omb. rermit
1-
j'OTAl
/77GrP
,
.
.
COMBINATION APPLICATION/PERMIT (CAI')
PERMIT VALIDATION
/"
/ flY- 'j
I. Appl ieant to furnish
.A. Job Address
B. legal Description
1. example- Tax Lot 100. lane Counly Map Reference
II UJ 4J
2. examnle- lot 1. Clock J. 2nd Addition to
5,Prlllgf ield (states
L. Name. etc. of owner and construction IcnJcr
O. Energy Sources
1. exarnple- heat/electrical cell inCJ/or forced air oas
2. examole- waterheater/eleC(rlcar/or solar
(. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 SQ. foot garage
2. example- lfi)cw project, checkflCw - if addition.
cheCk add. etc.
F. Building pcmdt information:
1. example - construct sinyle farnily tlouse with an
attached g"lr4ge
2. examole - remodel existing garage into family room
3. eXdlllole - convert single family residence into
restaurant (change of use)
G. Value of \",ork. as defined in Section 303 (3) of tlH?
Structural Specialty Code
II. DESIGN TEN! AND COIHRACTORS
To avoid deS\<]1l or consll'ucliun delays. Uuihtiflg
Division Staff must be able to contact appropriate
persons regarding des ign inforlllat ion or job site
corrections. etc.
II. Abbreviated Plumbi(lg. Nechanical. & Electrical Schedules
A. Except to/here blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fi\1~in only the No. Boy.es adjacent
to the appropriate ltem(s} to be installed
8. full Plumbing. Nechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit (ann the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AIW
CIIARGES ON TIlE SCHEUULES
O. As noted on the CI\P. th~ \a.bel must be delivered to the
electrical contractor for signature by his electrlcal
supervisor. The general contractor is !!.2..!. author.ized
to sign the electrica1 label.
III. Applicant to sign and date
Whenever posslble, the initial application will be used as
cl worksheet only. Where possible, Bui lding Division Staff
."i 11 prepare a type wri t ten copy and re tUl'n it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check rees are due and payable at the time of lhe
application, and tlO plans \1ill be processed until these
fees are paid. All otber fees anti chdrqes are due and
payable when the permit is issued.
V, FOR OFFICE USE Or/LY
P,mit CI"t~ IYfIi.eflfJ
..
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAiICY:
Permit applicant exempt from registration with the Builder's Board because:
Add i ti ona 1 Project Informa t ion:
PLANS REVIEWED BY:
name_/ AV-?/91"- h.cz;~".l?
signature ~~r?'~
d ate t::::- //, .:;;'7 .
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