HomeMy WebLinkAboutPermit Plumbing 1987-04-06Job Address
l-eqal Description
Ranqe
l.later Heater
EIIERGY SOURCES
Hea t
Owner
Va l ue of tlork:
Sq. Ftq. l.iai n_
:q. ftg. Access._
Sq. Fto. 0ther_
J,lew_Add A.lIeil[ep.-
_Fence_Demo_C ha n ge / U se
-other-
Addres s Phone .e., Build Single
aml dence
ut n Des llo rk
th t
ion LenderConst
Addre s s Phone
name addres s lics. no.)exo i res ohone no.
Pri ma
41.{oO
l'lechani cal v
St ructura I
El ectri cal
name a ddres s (lics. no.exo i rps )ohone no.
era l
V*
Ele rt I
PLUIlB I NG EL ECTR I CAL MEC HAN I CA L
N0.FFF CHARGE NO FFF CHARGF N0,FFF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTLI' S
Relocated building
(new fix. additional )
New ci rcui ts al tsor extensions
Floor furnace
and vent
S. F. Res i dence(l bath)SERV I C ES Recessed wai I
Soace heatpr and vFnf
Duplex (l bath) each
Addi ti onal bath Tempora ry Constructi on Apol iance vent
s epa ra te
l,later servi ce Change i n exi sti nq
res i dence
Stati onar-v evap
coo l er
Sewer lndustrial
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
C()MI.1./IND. FEEDERS iulechanical exhaust
hood and duct
\h,\Instai I /al ter/re1 ocate
di stri h, fppdprs liood stove/heater
0f 5.
AdI
ISSUANCE OF PFRt,lIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
by an Electrical Contractor, the electrical portion of this pern.ittricai Supervisor and returned to the Building Division
llAl.lE(please print))
DA
for oe
oerfo
AH VE INEEXAIl tD he eted D 1 cI ta onI rmi tcompap nda heredo c rte ti th ta Ia I1 f orrnan it onbyv he 'Ireon ts rundaco rrec t nda fuI rther cer fti tha atv a and II wo rkny srmed ah II dobe 'Ine n acc nceorda th het 'i0rd ncna 5e theof ci tySr10fidIofendathengLawstofshetate0reoofonartn,l 'IDE tto wohe drk se rtc dnqbe nherei a thnd ta 0c PAI,ICCU w'lY iI be madeSrutaofuctwlrehottunytheissnofperm i the ui dI nI I I s I fu hertI r 'It hat t s Icerfytrat on thtdl het UB II r sdern.y regIns'|rdBoa fu II for nda feef'act S urecl red 7ORS
g
0 051by t tha f ex5 t ba is frsor 1t Ionthe an dexemDnotShereoned tha tn0Iu bcos ,antr t0c ars nd oI who aempyees re nI I anic0mD ce ht 700t?s 1 0 55
emp
sri I t 1h0nedusbeI tsecr)
IGiJATU
OFF I
WHERE STATE L,lll REQUIRES that ttre Electrical work be donesha'lI not be vali.l untiI the label has been signed by an Elei
x
x
x
oelCons t So. Fits
lueGroup
Zone
ToTAL VALUATIoN_
Val ue
Fire Zone Bedrooms
Flood Plai Stories
tg. l4a i n
Load Sq. Ftg. Access
Ftq.0ther
Val
Plan Ck. Conrn/Ind
65%/81dq Per Fee
opmentSvs
Cha
I
)
tems Deverqe ( 1.51
BUILDING PERI,IIT
Charges anC
Su rcharges Plan Ck. Res
-€€*!6f,ilq-TtrF]Ee
PLUt4BING PERMIT
Charges and /Surcharges b
_t
oem\
SidewalkELECTRICP.L PERI:IT
Charges and
Surcha rges A/C Paving Total Cornb. Permit
Curb Cut
I,IECHANICAL PERMIT
Charges and
Surc ha rqes TOTAL
INSPECTION LI
726-37 69
N RIIAT t
726-37 3 _
L
c0l,lB I ilA APPL I CAT I
N
N
]TORS
I O/1 -l
I
tt
l'.lechani cal
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GO
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County
17 03 43
2. example- Lot I. Block 3, 2nd Addit
SEifnlFietd Estates
C. Name, etc. of owner and construction ID. Energy Sources
l. example- heat/electricgl ceiling/o2. ellqrnpie- waterheater/electrical/or
E. SquareT66-tage or valuation, etc.
1. example- 1250 sq. foot house, 500?. example- if new project, check new
check add, etc.
Map Reference
,ion to
ender
r forced air gasr.l*-
sq. foot garage, - if addition,
F. Building permit information:1. example - construct singie family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single fami'ly residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction de)ays, Building
Division Staff must be able to contact appropr.iate
persons regarding design information or job sitecorrections, etc.II. Abbrev'iated Plumbing, Mechanjcal, &Electrical Schedulesin the description
ectrical Schedu les,
the No. Boxes adjacent
instal led
A. Except where blank spaces occu r
and El
on ly
to be
portion of the Mechanjcal
the appiicant need fill-ito the appropriate item(sFull Plumbing, Mechanical
n
)
and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electr.icalsupervisor. The generai contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Hhenever possible, the initial applicat'ion will be used as
a worksheet on)y. Where possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actuai permit is issued for his
s i gna tu re.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wili be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
III
IV
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
soSqAr,
4 a 4 1
Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration w'ith the Builder's Board because
Additional Project Information:
PLANS REVIEWED BY:
name s'i g na tu re date