HomeMy WebLinkAboutPermit Sidewalk 1990-07-06TION LINE
69 COMB i ON AP ,T IT
i.,
Job Address \)\
Legal Description c l,later Heater
Ranqe
EIIERGY SOURCES:
Hea t
,1 1
0wner
Val ue
Sq. Fto. r.lain
sq. Ftq. RcceI]
l',ler.r Add Al ter 9.ep.
_Demo Change/Useence-F
-Otner
Sq. Fto . 0ther
Addres s Phone Descri be
d ceFarni I
Bu .e., Build Single
Constructi on L D\O I
Addre s s Phone
DEs I GN TEAI.I name addre s s 'ics . no exoi res Dhone no.
Pri mary
Structura I
E I ectri ca I
Mec han i ca I
Genera I
PI umbi
hanical
PLUI.IB I NG ELECTR I CAL MECHAN ICAL
FFF CHARGE FFF CHARGF NO FFF .HA PGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTU' s
Relocated bui lding
(new fix. additionai)New ci rcui ts al ts
or extensions
FIoor furnace
and vent
S. F. Res i dence
( l uatn)SERV I CES Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seoarate
Ilater service Change in existing
res i dence
Stationary evap.
cool er
Sewer
I ndus tri a I
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer .amps.0f Vent systenr apart from
heatinq or A.C.
COI,II.I./IND. FEEDERS Mechan'ical exhaust
hood and duct
I nsta I I /a I ter/rel ocate
di stri b. feeders l,lood stove/heater
0f a mp s.
ISSUANCF OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAli REQUIRES that the Electrical work be done by an E'lectrshall not be vali,l until the labe] has been signed by an Electrical superv
ical Contractor, the electrical portion of this pernitisor and returned to the Building Division
l.lAt'lE ( pl ease pri nt )S IGNATU 7 -6- 7
ToTAL VALUATIoil_
.x Va lue
0c cy Load
Value
5q. r
Val ue
tg .0ther
ts
Gro
Zone_TyDe/Cons t
Fire Zone Bedrooms
Flood Plain Stories
Ftg. l'lain x
Ftg. Access x
Plan Ck. Corm/Ina
65%/81dq Per Fee
Systerls Devei ooment
Charoe (1.51)
BUILOING PERI'IIT
Charges anC
Su rcha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Si dewa I k \3 qsELECTRICAL PERtlIT
Charges and
Surcha rges A/C Paving Tota'l Comb. Permit
Curb Cut
I,IECHANICAL PERMIT
Charges and
Su rc ha rge s TOTAL (3 ts
^)
namF pYnl ro<
I0 n*l,fu\\ \ s6rr\L
frI o
El ectri cal
itn
Ci ty
made
s true
the
be
sI der'
and tha t
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources1. exampl e-?. exampl e-
Square footag
heat/electrical cei l in or forced air gas
wate
le or
ea er e ectr ca or sofar
E val uation, e LL
II.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.F. Build'ing permit information:1. example - construct singie family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert singie family residence into
iEIEuFant (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 site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fiIl-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful i schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The genera) contractor is not authorizedto sign the electrical label
Applicant to sign and date
Whenever possible, the initial app)ication will be used as
a worksheet oniy. l,lhere possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gnature.
Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
III
IV
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
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Perm'it Cl er
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Bujlder's Board because:
Add'iti onal Proiect Informati on :
PLANS REVIEWED BY:
name s'ignature date