HomeMy WebLinkAboutPermit Mechanical 1984-05-09INS
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COMBI AP CA ERMIT 7?-3
l-egal Descri ption
Job Address EilERGY SotRCESHeat_LT
Ra
l,later Heater
-J
Owne r Xtlttf-)varue of K7n
l,leur
. Access
,_C hange/Use
ller. [et. -
Sq. Ftg
Sq. Ftq
tg. l.la
Addres s Phone
Ga ra
Bu 'I n
h Attache
scr ..e., Build Single
0 rIP)a >A
Construct'ion Lend$(
Addres s Phone
p
DESIGN TEAI{name addre s s 'I ics . no.exDl res ohone no.
Pri mary
Structura I
E l ectri cal
Mechanical
name addres s (ernires)lics. no.)ohone no.
Genera l
Pl umbi nq
EI ectri I
)l ffi[
\\PLUHB I NG ELECTRI CAL I'4ECHAN I CAL
FF CHARGF NN FFF CHARGF NO FFF CHARGF
Each single fixture Res idence of
FTSQ
furnace/burner to
BTLI' s
Relocated bui lding
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES Recessed wal I
Soace heater and vent
Duplex (l bath) each ;wbu#trMb 3 (
Additional bath Temporary Constructi on Apol iance vent
seDarat-e
[^la ter servi ce ge in existing
dence
Chan
res i
Stationary evap
coo l er
Sewer Tndustrial
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer 0f s.Vent system
heatino or A
apart from
.c.
c0t1r.t./IND. FEEDERS Mechanical exhaust
hood and duct-
Instal i /al ter/re1 ocatedistrih- feeders l'Jood stove/heater
0f S
L,rnLn efin-/,
U
ISSUANCI OF PFRI,IIT @
TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES )90
WHERE STATE LIN REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
tlAl'lE(please pri SIGNA
0regon
the Buiof any
Boa rd
I t anatnoforca ce rt t atha trma hereonon s truepr)comp
and nda a t^/0 krcorrectandfurrtheticerthaaL nhadonebe ncaccordas 0rd n cesan 0 tf ChethetheWIpefy tyrlof
ny
offiedandtheofLawshettas nlSpn9terta to het dwork c r'lCS hereibed n and th at NC 0cc ,AI,ICYUP wl be madengDC
rut c retu thouwl thet SS ofnspermi d n D s on hefurt r cer t tha t re s ttra 0 vJln theth UI de rIfymyg
force and asnS the bas s for on s hereonnoted and thateffectexempt
Proj ectonly subcontractors and ernployees used on
required by ORS 701.055, that if exempt
are in comcliance with 0l?S 701.055 wil
Flood Plain Stories 0cc.v Group Sq
Ftg
Ftg
Ftg Val ue
TOTAL VALUATION-
x
x
st its l{a iZone
0ther
Val ue
Val ueFire Zone Bedrooms 0ccy Load Acces s
Plan Ck. Conrn/lnd
65%/81dq Per Fee
Svsterxs Develooment
charqe (1.5q)BUILDING PERNIT
Charges and
Surcharges
ee
Plan Ck. Re
30%/Bldq Pe
srF
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewal kELECTRICP.L PERI1IT
Charges and
Surcharges A/C Paving Tota'l Cornb. Permi t
Curb CutI1ECHANICAL PERMIT
Charges and
Surc harges 1D---TOTAL
,g\
l^lork
o0fr-nfi,[) llnt,
\1s \.c
tN
1
40
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
PERMIT VALIDATION
2.exampl e-
Spri ngfi
Lot 1. Block 3, 2nd Addition to
eld EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. exampl e-2. examol e-
E. Square footag
air gas
te?fiq51example- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check acid , etc.
2.
F BuiIding perm
i. example -
attached
rit information:
construct single family house with an
garage
II
2, example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Eiectrical 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 thefull schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDUI.ESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical iabel
Applicant to sign and date
l,Jhenever possibie, the init'ial application wil] be used asa worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
PIan check fees are due and payable at the t'ime of theapplication, and no plans will be processed until thesefees are paid. Ail other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III
IV.
V Permit Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informat'ion :
PLANS REVIEWED BY:
name S'I gnature date
q M
I
(