HomeMy WebLinkAboutBuilding Mechanical 1987-09-10lr{tt APPL I TIO -37 53
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L llL
COIlB I
Job Address i 35 A Mo HAUjR BL/.D,
Leqal Description
Ranqe
!.later Heater
EIIERGY SOURCES
Hea t
0wne r TEA UA rI5
Val ue of l.lork
Ftg. I'iain
9tg. Access.
gel Use
er
_Fe nce_Demo
_0r her
5q
Sq . Ftq. 0ther
l,lew Add Al
Addrcss , Phone scrlnq
R,F niI es'i d NC Ga
rkl^lo i
ra
Pernri t n De
t,ti th /1t
Construction Lender
,\ddres s Phone 1
name add no
Primary
Struc tura I
4t)Electrical U 1
l'lec ha n i ca I
TCT0RS n ame address )lics- no.)gxpi res )phone no. )
Genera
Pl um
ctrical
l.'tec ha n i I
PLUIlB I NG ELECTR I CAL
Each sinqle fixture Residence of
FTSQ
furnace/burner to
BTLI' S
Relocated building
(new fix. additiona l )
New ci rcui ts al tsor extensions FIoor furnace
and vent
es i denceS
SERVICES Recessed wal I
Duplex (1 bath) each
Additional bath Temporary Construct i on Apol iance vent
l,later service Change in existing Stati onar-v evao.
Sewer multifamily,comrn. or th
i
Vent fan
Storm S r amp s0f
A
Vent systenr apart from
COI4T!./IND. FEEDERS exhau stitlechanca
Instal I /al ter/rel ocate Llood stove/heater
0f amp s.
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
IiHERE STATE L,,1I.I REQUIRES that t
sha l l not be val i l unti l the l abe l
he Electrical work be done by an E1has been signed by an Electrical Su
ectricai Contractor, the electrical portion of this oermitpervisor and returned to the Building Division
l{Ai1E (pl ease pri nt I GiJATURE DATE Q-t O -s7
and
of
of
Boa
onl
HA E YL thexAtlEN e a ccomr)p at on for trmil-)DC and heredo c frte th ta a n t on reonhe s tbvv ruerrcortnadefu rth ertc t ha t nda afy tJor DEk forany rmed ha be nedo n cca rdao cen twi t 0rhe d ncna theof Ci tySoredndthSng fi e Ld ws eth teta 0reof oon oe rta n to het rWO d e rc bed ereh n an td thanq OCilc PACU t,lc tvl madbe etrsnytuwirethucouttheermtpssnotheof3udDsnofnqrtUrhecertthttvm.y ra t vrion tth Bhe u de rreqfnSrduforcendaffecatsredrequ0ns07055thafbyttthexemDeabfr0emDextonnotshereonedand th tbcuvtrac0n0trsandernpsawhorecomcnoyeeceanthwlSOR701055Ubeedonthectro,j
Ftg
Ftg
Ftg
Val ue
Value
TOTAL VALUATiON
X
X
x
Val u
0c
0c cy Load So
T'yDelConst.
L5 So.7o
c.y Gro
l'la i nFire Zone Bedrooms
Flood Plain Stories
Acces s
0the r
C ndPan Ck
C rge 1. 5z
stems Deve opmen tBUILDING PERI,IIT
Charges anC
Su rcha rges
eeBld
an Ck. Res
FencePLUt4BING PERMIT
Charges and
Surc ha rqes Demo
SidewalkELECTRICAL PERIIIT
Charqes and
Surcha rges Total Cornb. lermitA/C Pavi nq
Curb Cut-F-
5Y:
I1ECHANICAL PERI,lIT
Charges and
Surcharges TOTAL \5
NJ
'-.9or
00
no
MECHAN ICAL
:€., Build Sing\
I
l/
seDarattr
dictrih feodor<
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of I
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i
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(
coMBINATI0N AppLICATIoN/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map ReferenceT7-0:-13
2. example- Lot I. Block 3, Znd Addition toSEFlIqfietd EstatesC. Name, etc. of owner and construction IenderD. Energy Sources
PERMIT VALIDATION
1. exampl e-?. examo I e-E. SquaiE-T66tas
hea t d air qas
wa te
eor1. examole- 1250 sq. foot house, 500 sq?. example- TT-new project, check-new -
check add, etc.F. Building permit information:
foot garage
if addition,
1 examo I e
;idifr-ed
- construct singie family house with an
garage
TI
2. examole - remodel existing garage into family room3. qlrnSl. - convert singie iaiiiy-resioence inioiesEurant (change of-use)G. Vaiue of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contatt appropriitepersons.regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechan.ical, & Electr.ical Schedu.lesA. Except rvhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, I'lechanical, and Electrical Schedulesare available at the Buildinq 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 shoutd consult thefull schedulesC. 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 electricaisupervisor. The general contractor ii not authorizedto sign the electricai labelAppiicant to sign and date
Hhenever oossible, the .initial application wi'l I be used asa.worksheet only. Where possible, Building Division Staffwill prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no pjans t^ri11 be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is jssued.
FOR OFFICE USE ONLY
III
IV AEo-er + /o/T?
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit appf icant exempt from registration with the Builder's Board because
Additional Project Information :
PLANS REVI EI^JED BY :
name Si gna tu re da te