HomeMy WebLinkAboutPermit Mechanical 1985-03-28CATI 53ITONLCOHBIN SPE
?6-3
,lob Address a
Ua ter Heater.
EIIERGY SOURCES
Heat
l-ega1 DescriPtion
5q. Ftg. Access.-.-
Sq. Ftg. Other--
tlew Add Al ter-Pep '
-F e ni-e-DE-mo-C h a n g e / u s e
-0ther
tg tia n
:€. r I ng e
Owner
Addres s
Phone
7?o/
Constructi on r
Addre s s
Phone
n
Structura I
E l ectri cal
Mechani cal
MECHANICAL
FI- FPLUHBI NG
ELECTRI CAL
NO
N0.furnace/ burner to
BTU' sResidence of
FTSQEach single fixture
=
I
Floor furnace
and vent
Recessed wa t'l
l{ew ci rcui ts al ts '
or extensions
SERV I CES
di ng
tional )
Relocated bui
(new fix. addi
i denceF,
Duplex (l bath) each
Additional bath
Apol iance vent
seDa ratqTemporarY Constructi on
StationarY evaP
cool er'i n exi sti ng
nce
Change
res i dellater servi ce
sinole drrct
lent fan wittr
T ndu stri a lnrultifamilY, comm' or
Sewer apart fromVent systern
heatinq or Aamps.0f
Sto Mechan cal exhaust
hood and ductcoMtt./IND. FEEDERS
t'lood stove/heaterInstal I /al ter/re I ocate
distrib. feqde-rs-
0f
T a
rssuANcE oF PFRllIr /O
bytriREQU
nti I
'I on'I f0 Sthi ttractoretheec,l t car1 permiEectrIca'I Con tI portan'I
E 1ectr be doneIworkcathethatRESIATESTLlI.II.IHERE I 'I Is 0nrnedtutheto'Iu1 d 'I Drengandac'I i orsEIecSupean1beahaIbeenS
.IsashIIbenotIVA,l'I u the bygned
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
only subcontractors and employees who are in comcliance with 0l?S 701.0
3-2Y-FrllAtlE(please print)IGNA
Ci ty
made
any
of
fyng
70
trma on'I hereon truscertitthaanfo.Idoherec'Iat foron I t b.y fyDermIEDNtheapl-)c0mp f thewl0rdn10anceshetthIIkworsIhabe'I tdone an ordanceccandndtcorrecaIndrtfurhertce,l hatta afy performed
th NCat wiOCCUPAI'ICY '|I bea1rttntoworkthebeddescniereh'I andfonIIdIndaLawstheoStatheiafo0reg0engsprngf
IIttrlthehder 5BuiIfD'I SI I n'I 'Id I rfu rthe rtce '|th at ,l trat onsotustrucwlrethethou t rmt ss 0n'I theof u IB m.y reqpe
and thatba1sforstiI0nnotedshereonthethaItf0551I
any
.rd exemps'I n1 Ifu force'I nda cteffe sa red ORSBoarequby
be on
Flood Plain Stories 0cc.y Group Sq
Ftg
Ftg
Ftg
l'la i n
Load
its
Val
I ue-
Access
0ther
ToTAL VALUATI0N_
Fire Zone Bedrooms
Zone
x Value
Plan Ck. Comm/Ind
65%/81do Ppr Fcp
Svstems Deve
charqe (1.57 opmentBUILDING PERIIIT
Charges and
Su rcha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surc ha rges Dgmo
Sidewa I kELECTRICAL PERI,IIT
Charges and
Surcha rges Total Comb. PermitA/C Paving
Curb Cut
I,'ECHANICAL PERI,lIT
Charges and
Surc harges 4a
/a_
IITAL )04:
zla-^>/0
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f.
t4
a
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COMBINATION APPLICATION/PERNIT (CAP)
I. Appl icant to furnishA, Job AddressB. Lega l Descriptionl. example_ Tl7_Tj_uS ax Lot 100, Lane County Map Reference
Z. example_ tot_l. BIock 3,2nd Addition toSffiffiie.lo Lstatesr,. name, etc. of rD. E;;;;y'i;;.;lr"nu" and construction lender
E
F
G
H
I I. Abbrevia ted Plumbin g, Mechanical & Electrical ScExcept where bl ank spaces hedul es
portion of the Mechan i ca I
occur in the descri ption
the app 1 i cant n eed fi l l-in and Eiectrical Sc hedu i es
to the a ppropriate item
only the No.Boxes adj a cen tB. Futl pl umbing, Mechani
(s)to be install ed
are available atl. To conserve
cal,and Electrical Schedulesng Divisionthe Bui Idi
have been a
space on the permit form the schedules
2. If the i
bbreviated
tem(s) to be instaljedted schedules you
are not covered onthe a bbrevi a should consul tful I schedul ES theC. BUIL DING DIVISION STAFF I^JILL FI LL OUT ALL FEES ANOCHARGES ON THE S CHEDULES
D.As noted on the CAP, ths label must be deelectricai cont ractor for si livered to the
supervi sor.The genera l co
gnature by his electricai
to sign the e lectrical labe
ntractor is not a uthori zed
I I I. Appt icant to sign and date
Hhen ever possible, the initia.l apprksheet only. l.Jhere possiblb,lication will be usedawoBui Iding Division Sta
AS
wi lt prepare a type written c
ff
appl i cant at the time the ac
opy and return it to the
signa tu re.tuai permit is issued for his
IV.Fees and Charqes
Plan.check feis are due and payable at the time of theapplication,,and-!g ptans wiit-oe proieisla until thesetees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLYV
lA # 6qqqL
PERMIT VALiDATION
Permit Clerk
3y
PROJECT CONDITIONS IO BE SATISFiED BEFORE OCCUPAI,ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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