HomeMy WebLinkAboutPermit Building 1990-02-23L
COI1BI IIATION APPL I CAiIoN/PERMIT 5-3753
EIIERGY SOURCES:
Hea t
ilater Heater
Ra
/*s (Job Address
Legal Descri ption (
,
0wner TR85-]\Lt)Val ue of
Sq. Ftg. Access._
Sq. Ftc. 0ther
_l,lew_AddJl ter_Pep.
_Fence_Demo_Chan gel U s e
0ther
. Ftq. l'la
nfo l^lo rk
i den
n
Att .e., Build Single -
7 r41Ad('rr1,r,4 4rJ/ 4J
Constructi on A.0& A.t)'p -c<.r\oo,t y'".t
Addre s s
name
Phone
lq)a
I
I
s
E l ectri cal
St ruc tura I
Pri
Hec han i ca I
name a ddres s lics. no.)exDl rps ohone no.
2 47-te)>
EI €3 I
PLUI.{B I NG ELECTR I CAL MECHAN ICAL
I )O(2
n
FEE CHA RGF NO FFF CHARGF NO FFF CHARGF
Each single fixture furnace/burner to
BTLI' s
Relocated building
(new fix. additional)A
New circuits aits.or extensions 3,9 ;0 Floor furnace
and vent
S. F. P,esidence(l bath)SERV I CES Recessed wal I
Space heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol i ance vent
seDa rate
[,later servi ce ge i n exi sti n-o
dence
Chan
res i Stati onar-v evap
coo'ler
Sewer multifamily, comm. or
Industrial Vent fan with
sinole duct
Storm Sewer 61 amps.Vent systern apart from
heatinq or A.C.
cor,il.l./IND. FEEDERS Mechanical exhaust
hood and duct
I ns ta I I /a I ter/re1 ocate
distrih- fppdprs l'Jood stove/heater
D>^0f amps ,Ya Z,tzt. Ca.srn. l,-<>4
4o Dr,>ABra./rrlrZ
,+'B 7**..r
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES z<-:;o TOTAL CHARGES
by an Electrical Contractor, the electrical portion of this permittrical Supervisor and returned to the Build.ing Division
t{Al.lE(please print IGiIATURE,)
I
9o€Jas
' 0reqon
the Bui
xempt
5 vril
HAVE etedI I ca'I It nthe r t acomp here erta 'Iapp 'Irmat hereonon s'I tnb.y at a ruefy
cond trrec a Ind rtfu rhe '|cert t tha nd Ia woIfy rk Isha beI 'Idone anperformed rd cean thwl het 'I0rd a ncesn ofcc0 the Ci ty'If efi dI nda theSorng Laws theof taS te
any
of n n'I 'I theto kwor 'Idesc r bedrtas he Ire n thaand NCt wlOCCUPAHCY IDE I madebeftust ruc wlre tthou the 'Iss no ofpermi d 'I Di 'ls onI fu crther IertIng that s'I rat 0nti thl,rt the I'IfyregmyBu der sany
rdBoa '|Is n Ifu forceI a nd aseffect redulreq ORS 070r 55 atth I f 'Ibathebys s for 'It I0n noteds hereoexemp tha fandnIbcSUractorsont)anv I es arewho n1emp0ye I an'I wice 7 nth0t?5 i 05c0mD I usedbe n0 1th s tecproj
WHERE STATE LAt,l REQUIRES that the Etectrical work be doneshall not be vali.l until the label has been signed by an Elec
FOP. OFF]
Valuex
Load
Zone ,z'thR Iyoe/S q. #tn. tl.i n
C:5'8,
S q. Ftg. Acce
0ther
xr Value
lue
Const.?-zV . Units
s / Occ.y Group Sq. FtgFlood PIain S tori e
ToTAL VALUATI0N_
Fire Zone Bedrooms 0ccy
Plan Ck. Conrm/Ind
65%/81dq Per Fee 27€Svs
Cha
tems Deverqe ( 1.5%
opmentBUILDING PERI'lIT
Charges and
Surcharges ---,/5.=--2 Plan Ck. Res
30%l91dq Per Fee
FencePLUI,IBING PERMIT
Charges and
Surc ha rges Demo
li
X!{ewarrELECTRICAL PERt|IT
Charges and
Surcha rges I Total Cornb. FermitAF-eaving
Curb CutHECHANICAL PERMIT
Charges and
Surc ha rge s 255oTOTAL
c
Address
Residence of
SQ. FT.
I
COMBINATION APPLICATION/PERMIT (CAP)
Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot 1. Block 3, 2nd Addition to
Sprin-gfield Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
hea t/el tri cal or forced air gas
wa ea EC or solar
1.,example-2. exampl e-
Square footag
e
e or valuat ot] ,1. example- 1250 sq. foot house, 500 sq. foot garage
2. exampie- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. exa1np|q - convert single family residence into
r-estaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specia)ty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui)ding
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 fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful1 Plumbing, Mechanical, and Electrical Schedules
are avai lable at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful l 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 electricalsupervisor, The genera) contractoris.not authorizedto sign the electrical label
Applicant to sign and date
Hhenever possible, the initial application will be used asa worksheet only. 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 gnature.
Fees and Charges
Plan 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 charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
E
II.
III.
IV
PERMIT VALIDATION
6-n qD
)-1 ts3
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
s i gnature ate 5e-Zname