HomeMy WebLinkAboutPermit Building 1983-07-15IIISPECTION LII.IE
726-37 69
MLD
COI.IBI IIATI ON APPL I CATION/PERMIT
hIFOMIATION ITNE
726-37s3
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Job Address l3 -t ) lAo HAuk BCu D -
EIIERGY SOURCES
Hea
l.Jater Heater
Ranqe
Sq. Fto
5q. Ftg
Sq. Ftq
I'la i n_
Access._
0therl-egaI Description
Va lue of l,lork: d6'3.ooo -Owner Ctu'1'c:nJ N irl L (3r?-'t
Address /j2-7 fura Hlr-tk Bt/D, PhoneJ/6"'8il/Builcli
Fami l y
nq
Re
Perntit info: Describe |^lork(
sidence llith Attached Garaqe 'e., Build Single
Atf. 0tr E:r,-.-i. Spfr<r
Construction Lender
Phone
name res s lics. no.exDt res Dhone no.
Primary
Structura I
E l ectri ca l
l'lec ha n i ca I
ACTORS name addres s I exn l res ohone no-
Ge ZYa s5-4
I
E I ectri ca I
ilechanical Aaa,tan 4 Pa,c 6- lo t t tr/u C>6dI_UlV 74c-/Gz/
PLUI{B I IIG ELECTR I CAL MECHANICAL
N0.FFF CHARGF NN FFF CHARGF NO FFF C HARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional)
I
New circuits alts
or extensions ar:o-
Floor furnace
and vent
S,F. Residence
( l bath'l SERV I CES
Recessed wal I
Snarp hpatpr and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
[.later servi ce Chan
res i
ge in existing
dence
Stationary evap
cool er
Sewer multifamily, conrm. or
I ndrrst-ri a I L-Vent fan with
sinole duct v ,4
L2
Storm Sewer 0f amps.Vent systenn a
heatinq or A.
part from
c.
COMI.I./IND. FEEDERS
Mechanicai exhaust
hnod and dtrct
Insta I I /al terlrel ocatedistrib. feeders l'Jood stove/heater
0f ALr. Du<T /"9
ISSUANCE OF PFRI1IT to €
TOTAL CHARGES TOTAL CHARGES
oOlb'TOTAL CHARGES a-c -oj1..L.
WHERE STATE Lli.l REQUIRES that the Electrical work be done by
shall not be valiJ until the label has been signed by an Electri
' an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building Division
I HAVE CAREFULLY EXIIHINED the comp 'leted application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify thdt any and all work De rformed shall be done in accordance with the 0rdinances of the City
of Spri
of any
Board i
ng
st
field and the Laws of the State of 0regon
the Buil
oertaining to the work described herein, and that l'l0 0CCUPAIICY wil] be made
ructure wi thout the permi
nd effect
ssion of di ng
701
Division.I further certify that my registration vrith the Builder's
s in full force a as required by ORS 055. that if exempt basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with 0l?S 701.055 wi sed on this proiect.
?\'7.t{"83I'lAi.1E(please print ,
F(
Zone---____-Tyoe/Const. Units Sq.Ftg. l4ain x Value-
Fire Zone Bedrooms 0ccy Load Fts.Val
Flood Plain Stori es Group Sq. FtS. 0ther x Value-
TOTAL VALUATION
BUILDING PERI'IIT
Charges and
Surcha rges
P l an Ck. Conrn/ Ind
65%/Bldq Per Fee \S T.oO Svstems Deve'
charqe (1.51 opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Dgmo
ELECTRICAL PERI|IT
Charges and
Surcharges
Sidewal k
A/C Paving Total Cornb. Permit
I,IECHANICAL PERMIT
Charges and
Surcharges
lY Curb Cut
TOTAL r3 prl6>
Addres s
v
cor.rBINATI0N AppLICATT0N/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map ReferenceI7-Ti4:2. example- Lot 1. Block 3; 2nd Addition toSpTTnEiela Estaresq. Name, etc. of owner and construction lender0. Energy Sources
PERMIT VALIDATION
t.
?.E. Squa
1.
2.
example- heat/electrical cei I ino/
examp le- waterheater/el ectr j ca I /ore tootage or valuation, etc.
or forced air gasr solar
example- l?50 sq. foot house, 500 sq, foot garage
elample- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. examp-le - remodel existing garage into family roomJ. exampte - convert single family residence into
- restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contaat appropriitepersons 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 adjaient
- to the appropriate item(s) to be installedB. Full P'lumbing, Mechanical, and Electrical Schedu'lesare available at the Bui lding Division1. To conserve space on the perm.it form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedujes you should consult thefu'll schedulesC. BUILDING OIVISION STAFF l.tILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULESD. 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 electrical labelApplicant to sign and date
l,lhenever possible, the initial application wi'l 'l be used asa.worksheet only. l,lhere possible, Building 0ivision Staffwill,prepare a type written copy and returi it to theapplicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charqes are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
{a rebs
II \tE3
t
III.
a
IV
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name s1 gnature date