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HomeMy WebLinkAboutPermit Plumbing 1987-4-24 'rTrisPffiIOII UilE . )726-3769 ' . Job Address 7/ n JYt ~ legal Dmription 1'7 03 "5tJ'G/';< Dwner/!Jn}V p~- T~ ~ AJdr 'f:r71,j (" . h/l; -, Ph n h/I-'} I Bui~(;lna P~rmit Info; Describe \'lork{l'.e.. Build Single 0/'7 t.<-f/1lL. 00/7 / Fa~11v neS1dence Il1th ~ttached r,araQe~ '33tL1/lUsirJl( f6J/LfItf)J.. f/ll(l{M--r~ I . --TIn/if JL-- I ' - . I OCJ~tJ 0 I I I . IIFDR11AT:.:/ L.., 726-3753 So. Ftq. "iaio ~C1. ~tg. Access. Sa. Ftg. Other tleN Add /t.lter ~eD. --Fence Demo Change/Use Other - - v() r-;:J i~ F- Ranoe ValuE' of Hark: Construction lender nam~ Phone address 1 ics. no. eXOlres hone no, Primary !lechanical CONTRACTORS (n~rne' r:., ~~~~v Structural Electrical Gen~r~l Plumbino (address) (1 ics. no.) (/'xo;rpc; ", (ohone no.) Electric?] t.lechaniCQ' PlUlIBIrIG ELECTRICAL MECHANICAL 1':0. Each single fixture --ITL' CHARGE '.1lW Residence of , , 11 . I furnace/burner to BTli's I HL. !!!ARliE. -----/RelOcated building (new fix. additional) S.F (I b Dup Add -J~!ate Sewe SQ, FT. r New circuits alts. or extensions Stor . Res 1 dence I I ISERVlCES Recessed wa 11 athl I . 'n,eo 'Hoe ,n"--"ent .- I lex (1 bath) each . itional bath Temporary Construction ADOI iance vent I seoarate r servi ce Chanoe in eXlstlno Stationary evap. reo i doneo . cooler multifamily, comm. or Vent ran \.d tM ! r Industrial sinale duct - I Of amps. Vent sySteM apart "from I m Sewer heatina or A.C. CO:~'1. II NO, FEEDERS Mechanical exhaust ! hood and nuct Install/alter/relocate I \-iood stove/heater niotrih foodor, I Of amps. ~ ISSUA/!CF OF PFRtIlT RGES TOTAL CHARGES TOTAL CHARGES Floor furnace and vent _____I =1 TOTAL CHA fIHEP.E STATE l.\!'1 REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical nortion of this oer~it shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division . I HAVE CARE FUll Y EXAlllNED the comn 1 eted apn 1 i ca ti on for ,oermit, and do hereby cert ify tha tall in fa",a t ion hereon is true and correct, and I further certify that any and all work oerfarmed shall be done in accordance with the Ordinances of the City of Sori n9 fi e I d and the laws of the Sta te of Ore~an De rta i ni ng to the work descri bed herei n, and tha t 110 OCCUPAIKY "i 11 be made of any structure without the permission of the Building Division. I further certify,that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exemDt the basis for exemntian is noted hereon, and that only subcontractors and employees who are in comoliance with OP.S 7~1.055 will be used on this ~roject. IlA~'IE(please print) \JU-\ ~ A (2.1\,) 0 CJ; SIr,~IATURE-d~ a, .'~ DATE L( -;) 1./.::12 Fu~ o;;iLt 0SE O~Y I Zone TYDe/Const. -. -- .,. lJnits Sq. Ftg. flain x Value Fire lone Bedrooms Occy load Sa. Fta. Access , Value Flood Plain Stories Occ,Y Group Sq. Ft9. Other , Value BUIlOIilG PERI,lIT Plan Ck. COIlVTl/! nd I Charges an~ ----------- 65t/Bldo ~pr Fpp Surcharges Plan Ck. Res I - 30:/BldQ Per Fee PlUI1BlIlG PERMIT ----_J{:i}!!~_ Fence Chi! rges and Surcharges .ft,O D';R1o I . ElECTR ICt,l PERI:lT Sidewalk Cha rges and ------------ Surcharges A/C Paving ~I t1ECHANICAL PERijlT Curb Cut , Charges and ------------ Surchari)es I TOTAL VALUATIOtl ~Systems Development CharDe 0.5') I ITotal ! TOTAL Comb. rermi t (6.0D . .. ; , COMB[NATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100, Lane County Map Reference 11 OJ 43 I 2. examole- Lot 1, Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- ]250 sq. foot house. 500 sq. foot garage 2. examole4 if new project. check-new - if addition, check add. etc. F. Building permit information-; 1. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole ~ 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. OESIGN TEA;,I AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or jab site corrections. etc. I!. Abbreviated Plumbing. flechanical, & 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. BUILDING DIVISION 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION (3 0 ~ /.fa to lo~q-~1 j 8 fo~fforo permtfc ~i:r1-f/) J cc ; ~ 1 Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature j date