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