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HomeMy WebLinkAboutPermit Plumbing 1987-04-29il SPECTIOII LIiIE 5- 37o9 COIlB I iIAT I LICATI D P E RI',II T -t :,r: 7 -3751 IJob Address II ,*r.ll:'.rytio1 1 103 eS3Z t7ooo Hea EIIERGY SOURCES: l,later Heater Ranoe Val ue of l,iork Sq. Ftg. Access Sq. Ftq. Other llerv Add AI ter--P€-o. - _fence_O-mo Chanqe/Use 0ther tg. l.iain Phone ( q Owne r Addre s s Buil<.inq Pernrrt lnfo: Describe-i.Jo7kl-Fanily Residence lli th_ nttacheA,Cfraoe ngS (3{l Constructi on Lender Addre s s Phone Pri ma ry name Structura I A\?qElectrical l-lechani cal n P tlec PLUIIB I NG ELECTRICAL Each single fixture Res i dence of furnace/burner to BTLI' s Rel ocateci bui (new fix. add ding tional ) New ci rcui ts al tsor extensi ons Fl oor furnace and vent S S den ce SERV ICES Recessed wal I Duplex (l bath) each Addi ti onal bath Temporary Construct i o_n Apof iance vent l,later servi ce Chan i n exi sti ng Stat onary evap Sewer multifamily,comm. or n l^ri tht Sewe r ent system apart from eati lss,.c01,1t1./IND. FEEDERS stechanical ex Insta I I /al ter/rel ocate lJood stove/heater 0f ISSUAI']CF OF PFRI'lIT TOTAL CHARGES .=-TOTAL CHARGES TOTAL CHARGES I,JHERE STATE LlI,l REQU shal I not be val il unti I IRES that the Electrical work be dothe label has been signed by an E) ne by an Electrjcal Contractor, the electrical portion of th.is oern.itectrica'l Supervisor and returned to the Building Division l{Al,lE(please print)SI oon Buiany rd HA \/tr YLL E XAIl tNID e ted aC t fornacompp !-)t an doDerm he reb ce rt t tha a fn o rrna t hereoon n trfycondarrectadnfucrthe r ert t ha L a nd a t^/O rfyany rformedDC has ac corda ncndonbe e wl ht rh rd0 n cesan f the C tyfSorfoedndathngewsLatheofStetafo0renrtathtoeworknclDCde scri hebed re n nda t nil 0 UPCC CY'Ail rvi mabe deorewistruthouLLheSermrspofonhetdDSofu rt r t thangheCrt S ttra o l,/rn ht Buthe dertl SBoafSnUforcendaffecatSreq u re d S0n 701 t tha055 f s sbyexemDt no s tedno nhereo a nd tha tonubctrac0ntvoandrsempwhoreancomcoyeesanwice0t?sth 0 trl055 edUS 5 ro.jD Fire Zone Bedrooms 0ccy Load Sq Ftg Ft! Ftg Zone X x U ni ts ( 0c c.y Group SqStorie TOTAL VALUATi nit Val ons t Value Val ue l'la i n Flood Plain Acces s 0ther Plan Ind c De ve 1. 5c s teris rge opmenBUILDING PERI,,lIT Charqes anC Su rcha rges Plan ld Pe srF FencePLUi4BING PERMIT Charges and ISurcharges l t_s_._s_.bo Demo SidewalkELECTRICAL PERIlIT Charoes and Surc ha rges Total Cornb. I'ermi tA/C Pavi ng Curb Cut I,IECHANICAL PERI.tIT Charges and Su rc ha rge s TOTAL \=,m O( a.r {oa I'4ECHAN I CAL I lJ,,, n .€. ' ( addres s exn i rcs ohonc no l l\tn F'F F aLtAo/:E t!n FIF sQ. FT. Snacp hcai'er and rronf qFna ra tp 6g amps. (BPb dictrih fpedpr< LL7 ^Aa v\ s tha I 'I FOP OIFl 5\"1lR1da Ppr Feo COMBINATION APPL I CATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to sp-IJngTi el d Estates C. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION J. example- heat/electrical ceiling/o2. example- waterheater/e'lectrical/orE. Squa-re tootage or valuationl-ETE. - r forced air qas sol ar 1. examole- 1250 sq. foot house, 500 sq. foot garage2. ExamEiArlT-new project, check-new - ir aoaitlon, check add, etc.F. Buildinq permit .information: 1. example - construct singie family house with an;ttacfied garage 2, examole - remodel existing garage into family room3. Sl.@ - convert single iam.ily-resiOence intoiEsTt-urant ( change of "use )G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.1 AND CONTRACTORS To avoid des ign or construction delays, Bui lding Division Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, ilechanical, & Electrical SchedulesA. Except rvhere blank soaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fjll-in oniy the No. Boxes adjacentto the appropriate item(s) to be instal ledB. Full Plumbing, llechanical, and Eiectrical Schedulesare 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 abbrevjated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF l^JILL 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 general contractor is not authorized bgtTg II v,z7r1/ III to sign the electrical labelApplicant to sign and date i,,/henever oossibie, the initial app)ication w.i ll be used asa worksheet only. I^Jhere possible, Bu.i lding Division Staffwill preoare a type written copy and return it to theapp)icant at the time the actuai permit is issueci for his s i gna ture .IV. Fees and Charges Plan cneck fees are due and payable at the time of theapplication, and no plans r^ri11 be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration w'ith the Builder's Board because: Additional Project Information: PLANS REVIEWED BY name Si gnature da te