HomeMy WebLinkAboutPermit Building 1989-06-21tINSPECTION L
7?6-37 69 Cr)I1B I iIATI LICATI ERMIT 726-37 53
058 00
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l-eqal Description
Job Address /6 S Hea t
RGY SOURCES
t,,a ter llea ter
Ra nqe
S+ ftg. l'1ain_._-._-
!q. Ftg. Access.--
Sq. Ftg. Other--
llew Add AI ter P.eP.
-Fence Damo
-0ther-_Change/Use
Va I ue of l'lork :s TsuoYe*c-owner
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(-'^)e., euitO SingleDescr
Ga ra
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Re denF,rnri I
BuPhoncAddress g /o. 6ox 76
.4;ato,t (enooa- 7b f,Nreq;oL fpl, u/,* 98 tr t
Constructi on Lender
oc
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%ptqes & a)aPEAddre s s I)lron c
exDl res (phone no.lcs, no.namet]ESIGN ItAI.1
Primary
Structura I
Electrical
l'lechani ca I
l'i cs. no.'exDt res (phone no. )n ame ( a ddres s
L, ofot{/e,sr€A- /J3oz oG 7{zu4)
P
El ectri ca I
I,lechan'i cal
PLUIIB I NG ELECTRICAL MECHAN I CAL
FTF l^IIA PCFNOrEIC}IARGE FFF CHARGF NO
Each single fixture
_N0-_
Residence of
SQ. TT
furnace/burner lo
BTLI' S
7><'>
Relocated building
(new fix. additional )
New circuits alts.
or extensions2 eR ,&e,RG
Floor furnace
and vent
S . F, Iles i dence(l bath)
Duplex (1 bath) each
SL,RV I CIS Recessed wal I
Space hejlter and vent
AdditionaI trath Temporary Construct i on
llater service oe in existing
dpncp
Chan
res i
Apol iance vent
sepa ra te _
Stationary evap.
cooier
Sewer multifamily,
Industrial
conm. or Vent fan with
sinole duct
Storm Sewer 0f ,._--=-_-- amps.Vent system apart fronr
heatinq or A.C.
COMI,I./IND. FEEDERS
Mechanical exhaust
hood and duct
I nstal I /a I ter/rel oca te
d'i sl:ri b. fpeders t'lood stove/heater
0f anrp s.>q34rz:sz 2r-zt.*
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CI-IARGES 2?-6-,^ToTAL CHARGES ,)?sz< . z* +
I,JIIERE STATE Lltl REQUIRES that the Electrical work be done by ashall not be valil until the labe.l has becn sjqned by an Electrjca
ntIS IecIrical Contractor, the electricai portion of this permit
upervisor and returned to the Buj lding Division
and all work nerformed sha.ll be done in accordance with the 0rdinances of the City
0regon nertaining to the vrork described herein, and that t.l0 OCCIJPAI{CY will be made
on of the Bui.ldinq Division. I further certify that m.y reqistration with the Builder'srequired by ORS 701.055, that if exernpt the basis for exemption is noted hereon, and that
S IGIIATURE DATE C/rr/nl,lAl,lE(please p
I HAVE CAREFULLY EXAtitNED ttrilonrptete?ffi ddn! an herebv certi fy that al I information hereon i s true
and correct, and I further certif-v that anypringfield and the Laws of the State ofofS
of any structure wjthout the fiermissiBoard is in full force and effect as
only subcontractors and srnplsysss r^rhs are in comoliance with 0l?S 701.055 r.rill be used on this Dro,ject.
.intJD&e- 4,/n L(
tlS Il
an Conrn/ J nd
x
xsrt
T'YPelCon
s t Val
olelrl
Tone Z,
Load
es / occy Groupfui/F-ZSq
rrlq 7
l'la i n
vu1u"_2#---
TOTAL VALUATION
Flood Plain
Fire Zo Bedrooms
Stori
Acce s s
0ther
l'l!
Fto
Ftg
Uni ts_
r- Val ue
44 cz Systems Deve
Charqe (1.5{opmen t ,/y4.BUILDING PERNIT
Charges andSurcharges ,\3
P
Plan Ck. Res
30%/Bldq Per Fee t
FencePLUMBING PERMIT
Charges and
Surcha rges
Sidewal k
D6mo
ELECTRICAL PERIIIT
Charges and Ll
Surcha rges
3?-sa
Total Comb. Permit
Charges and
Surcha rges
___/t-_-__
U
I,IECHANICAL PERMIT
A/C Pavi ng
Curb Cut ///. 7 /T0TirL
]TORS
PERMIT VALIDATION
Pernti t Cl er
\L.
Hj4
COMBINATION APPLICATION/PERMIT (CAP)
Applicant to furnish
A. Job Address
B. Lega l DescriPtion
f. glgmp]S.- Tax Lot 100, Lane County Map Reference
17 03 43
2. examole- Lot l. Block 3, ?nd Addition to
SpTit-gfieto Estates
C. Name, etc. of owner and construction lender
D. Energy Sourcesi. gEIIf-q- heat/electricgl ceili!q/or fqrced air gas
2. examEl-e- waterhel-G7@r'iiqVor solar
E. Square footage or valuation' etc.
i.' example--1250 sq. foot house, 500 sq' foot garage
2. erafile- lT-new project, check new - if addition'
EIecR-add, etc.
II
F. Building Permit information:
i. .*ufipi. - construct single family house with an
attached garage
2. example --remodel existing garaqe into fanrily room
3. exaffiTa - convert single fanrily residence into
r-estaurant (change of use)
G. Value of work ai defined in Section 303 (a) of the
Structural SPecialtY Code
H. DESIGN TEAI'1 AND CONTRACTORS
io avoiA design or construction delays ' Bui lding
Division Stafi must be able to contact appropriate
p"ttoni regarding design information or job site
corrections, etc.
Abbreviated Plunbing, Mechanical, & [lectrical Schedules
A.- E;;;pa ,here blink spaces occur-in the description
po.iion of the Mechanical and Electrical Schedules'
Itre appticant need fill-in only the No' Boxes adjacent
to tn! appropriate itern(s) to be-installed
B. irfi pfri,bin'g, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
?. ii in" itenr(s) to be installed are not covered on- the aUUreviitiO schedules you should consult the
fulI schedules
C. BUILDiNG DIVISION STAFF l^IItL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. ni notea on the CAP' the labe'l must be delivered to the
electrical contractor for signature by his electrical
irpeiriso.. The general con'ractor is not authorized
to sign the electrical label.
Applicant to sign and date
ii'nEn.r.i potsibie, the initial application will be used as
i *o"iin.Li only.- where possible, Building 0ivision Staff
will prepare a type written copy and return it to the
.ppiiIi.'t-.i it.-ti*. the actuii permit is issued for his
signature.
Fees and Charges
Plan check feis are due and payable at the tirne of the
uppiiiuii"n, and no plans wiil be processed urrt.il these
i!!i i.. piia. All btner fees and charges are due and
payable when the pernrit is issued'
FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permi t eSdabecurBoaSIiedruBhteihttaonSrtreromfgtextempaniCapp
Additjonal Proiect Informatjon :
PLANS REVI EI,,IED BY :
s i gnature
name
date -6
t
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