HomeMy WebLinkAboutPermit Building 1984-02-13INSPECTION LINE
725-37 69 COMB I T APPL I CAT I IT
Job Address
l-e ga 1 Des crt p t I on 5-3 I a
Owne r
EIIERGY SOURCES:Heat LOf/€
lJater Heater
Ranqe
Sq. Fto. I'la n
Sq. Ftg. Access
Sq. Fto. 0ther_
ller.r AddfAl ter Pep.
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Val ue of l,lorkJfry.*
Address Phone Bui I cii n
Farni I y
q Pernrit Info: Describe liork(
Residence tlith Attached Garaqe
..e., Build Single
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Construction Lender Ettlsf,u,a, .b@2 7Z ># 6UE oF
Address Phone ./--r / ./Zt,,ra 4e ,?r*/a
name address I ics. no.exo l res 10ne no.
Pri
Struc tura I
El ectrical
l''lec han i ca I
RS name add res s (lics. no.'exD 1 res (ohone no.
Gene I /.a,
PI
I
PLUIlB I NG ELECTR I CAL MECHAN ICAL
FEE CHARGF NN FFF rHA AAF NO FFF CHARGF
Each single fixture Residence of
SQ FT
furnace/burner to
gTtt, s
Relocated buildino
(new fix. additional)New circuits alts
or extensionsaua 2?Floor furnace
and vent
S. F. Residence(1 bath)SERV I CES Recessed wal l
Soace heat-pr and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
separate
hiater service Chan
res i
ge in existing
dence
Stationary evap
cool er
Sewer multifamily, comm. or
I ndustri a I
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system
heatinq or A
apart from
.c.
cor'f.r./rND. FEEDERS Mechanical exhaust
hood and duct
I nsta I I ,/a I terl re1 ocatedist-rih- fcpdprc l,lood stove/heater
0f amps
ISSUANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES /a.e TOTAL CHARGES
t.IHERE
sha l I not
STATE L,1tl REQUIRES that the Etectrical work be done bybe vali:l until the label has been signed by an Electri
'an Electrical
ca1 Supervisor
Contractor, the electrical portion of this permit
and returned to the Building Division
HA V E I N ED the comp e te appl
and
0reg
the B
ed by
'I ca ti on fo r t a nd do he re b.y ce rt fy th a t a I I 'I n forma t l on he reon i s true
the CityI be made
and correct, and I further certfSpri
anyrdi
ysu
ngfield and the Laws of
ify that any a I I work Derfo rmed s ha I I be do ne '|n a cc ordance wl th t he Ord i na nc s oftheStateof0nDErta'I n I ng to the wo r k de sc r 'I bed here 1 n and th at NC 0ccuPAr'lc wl 'Ifstructurev/l thou t t he ,l ,l of 'I I d 'I vlpermssonun9Di 'I on I fu rt her cert I fy tha t m.y reg 'I s tra t I on url th t he Bu 'I I de r sBoas in full force and ffect as requir 0Rs 7 0 1 05 5 tha t 'I f exemp t the bas i fo exemp t I noted hereonon'I bcon trac tors d l r.rho
s r 0n s an d tha tanernpoyeesare'|n c0mD I 1 ance wl t h 0t?S 701 0 55 wl 'I I be us ed 0n th 'I s p roj ect
llAl.lE(please print S IGNATURE DA,IE2
7o Co ns t Z-A/ u nits So. Ftg. l4ain ValFire Zone Bedrooms 0ccy Loaa U.l , 59.rtg. access eS?. ?f,x.______Val
ueu"@€
Fl ood Pl ai n Stories , ,0cc.y aroup 8-2 Ftg.0ther Val
BUILDING PERI.IIT
Charges anC
Su rc ha rges
___%.Oa
-lv
Plan Ck. Comm/Ind
65%/Bldo Per Fec 12-70 Svs
Cha
terns Deverqe (1.52 opment
Plan Ck. Res
30%/B1dq Per Fee
PLUI,IBING PERMIT
Charges and
Surcha rges
Fence
D6mo
Sidewal k
A/C Paving Tota'l Comb. Permi t 8q
I,IECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL 7/.za
I
TOTAL VALUATION-
ELECTRICAL PERI:IT
Charges and
Surcha rges
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. exampie- Lot l. Block 3, 2nd Addition toS[nffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. exampl e-2. exampl e-
Square footag
air gas
E l. example- 1250 sq. foot house, 500 sq. foot g
2. example- if new project, check new - if addi
check add, etc.
arage
ti on,
F. Building permit information:l. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. 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 desi
Division Staf
gn
f or construction delays, Building
must be able to contact appropri atejob sitepersons regarding design information or
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be instal ledB. FulI Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. 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 thefull schedu'lesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the labe] must be de'livered to the
electrical contractor for signature by his electrical
supervisor, The general contractor is not authorized
to sign the electrical label.III. Applicant to sign and date
[,lhenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type rvritten copy and return it to the
applicant at the time the actual permit is issued for his
s i gna ture.IV. 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.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION I
2 a:.::8{a)#
-a
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY:
permit applicant exempt from registration with the Builder's Board because:
Additional Proiect Information :
PLANS REVIEWED BY:
name s i gnatur date ?-?/
.V