HomeMy WebLinkAboutPermit Demolition 1989-7-7
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726-37;3
Sa. Ftq. /-lJ,in
~q. HI]. Access.
SQ. Ft~. Other I
llc\~ Add /I.lter ['.co. 0
-rence Demo Chanl)e/Use ;
I Owner (~"'-'X'^~' (')~\...1~~ I V.lu, or Hork: Other- - I \
,\ddrcss ~\V\ r-:~\'LV\\-\ Phone 'llUi!l;inOP~rnlit Info: llcscrlbCI'Jork(l.c., ihnldSlngle (\f\;
C. y.,('":j-.. t-\ ~\ 1 \ fM:l11y f!.esldcnce Uith f\ttached (;,lraoe) ~ I
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726-J7ti9
Job Address ~
(~:-C) ,
t Ll ] Y U'fSi'H lra;fl [LU
~:nCOIV1BQ\JXIM I O,N ^PPLl C^ T I ONI PERMIT
E!IERCiY SOURCES:
Ileat
\'Ia ter Ilea tcr
.,
LeIJal Dc~cription
Rdnqe
Primary
Structural
~1echan i ca 1
CONTRACTORS),.
Genera 1 -:.J
Plumbino -7(
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ELECTR I CAL H((IIAN I C^L I
Electrical
(teClr\ca 1
t'~ch.'1nical
I
PLUI1B \rIG
-Eh
Hf I CIIARef JHl_
r:-rr rllARGL -1!.Q......
F r F r 1.1AR.GL
sq, FT.
furnace/burner to
(HU's
Each single fixture
Res i denee of
Relocated building
(new fix. additional)
New circuits aIls.
or extensions
Floor furnace
and vent
S.F. P.es1oellce
(I bc1th)
Duplex (1 bath) each
ISEnVICES
I
Recessed wall
Soarp h~.'1tpr .'1nd vpnt
Storm Se\'/er
Of
amps.
P.pu\ iance \lent
'iPOiu'ate
Stationaryevap.
cooler .
Vent fan hli th
sinole duct
Vent sySlC~ apart from "
heatlno or A.C.
~lechdnica I exhdust
hoon ,1 nd duc t.
Additional bath
Sewer
Temporary Construct ion
ChanfJc in existing
res.idrJlce
multifamily, conll:l. or
Inrlustri.ll
~!a ter servi cc
CO"'\.!l NO. f([O[RS
[Ins tJ 11 /a 1 tel'frel oea te
distrib. feedpr~
Of amps.\
\-Jood stove/heater
I^l;
I SSIJ^t:Cf or prRll1T
\.
IJlA:IE(Please print)
I
TOT^L CH^RGES
TOT^l CHARGES
that the Electrical \'Iork be done by an Electricill Contractor, the electrical rortion of this perli\it
label has been signed by an Electrical Surervisor .1nG retumed to the Building Division
at I \n(orr.\at\oP. hereon is true
om 7- ;Z K'7
Zone Tyoe/Cons t.
Fire lone 3edrooms
Flood Plain Stories
FO~ OfFICE USE Oill.Y
lJni ts S~. Ft~. Ilain
Occy load Sq. Ft!]. Access
6ccy Group. S~, rtg. Other
...
x
Value
Value
Value
x
x
TOT^L V^LU^TlOlI
BUILOIIIG PERI,IIT
Char'les an~
Surcharges
II J ,
~~+(-~-
__Aid ___, _, rence
!CK:..:.7 Demo
___J_____..:..:.-' Sidew.lk
..1 Ale Pavjll~
I Curb Cut
I
Plan 0..
6S!/Bldo
PI.n Ck.
JO~/Oldn
COlll1l/lnd
p.pr rpp
ncs
f>er Fpp
Systcr.JS Development
Char<1p. (1.51';)
PLUtm I NG PERM IT
C~argcs and
Surcharges
,EL[CTRIC/.,l p[Rr:1T
Charqcs and
Surcha rge5
I1ECIIA/IICAL P[P./11T
Cha rgc sand
Surcharl)es
Total (omb. Permit
ft::
I
I TOTill
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COMBINATION APPLICATION/PERMIT (CAP)
r. Applicant to furnish
A. Jab Address
B. legal Description
1. ~xam21e- Tax Lot lOa, lane County Map Reference
1/ U3 43
2. example- Lot 1. elock 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
1. exam~le- heat/electrical cel1in~/or forced air QdS
2. examplc- waterheater{electrlcal/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house, 500 sQ. foot garage
2. exam~le- Tflnew project. check-new - if addition,
check add. etc.
F. Building permit information":
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. eXdmole - COnvert single family residence into
.restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 AND CDNTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s} to be installed
B. Full Plumbing. Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form 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. BU1LDING OlVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
~
.
PERMIT VALIDATION
n/SC
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...
I
permit~\D~
..
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
.
date