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~
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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