HomeMy WebLinkAboutPermit Building 1986-08-18L-t_11\\5N
SP
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69
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COHEI iIATION APPL IcAIION/PERHIT ilf 0rutA'riL
7?6-3753
Job Address
l-egal 0escription l.later Heater
Ranqe
EIIERGY SOURCES:
Hea t
Owner ffi\
,&\I u*w'w'lh)o
Sq. Ftg. Access.
Sq. Ftg. 0thernew!3oa)4,qlIer-p-:-
_Fe nce_0emo_C ha-n gel U s e0ther
So . F tg. I'la I
Pyllt::nS Pe.nrit InfoLanl lv lrest0ence l.li th
^ttached
Garaoe )
Addre s s
Constructi nn nder
Phone
\r
Addres s Phone
name
I
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El ectri ca I
Structura l
Pri ma
n ameA
Genera I
!'lechani ca I
Elec
l'ocha n i
PLUIlB i NG ELECTR I CAL MECHAN I CAL
3 Each single fixture Res i dence of
SQ. FT
furnace/burner to
BTLI' s
Reiocated bui lding
(new fix. additional ),/'or ex i ons
New circuits alts Floor furnace
and vent
i dence
1 SERV I C ES Recessed wal l
Duplex (l bath) each
Addi ti onal bath Temporary Constructi on Aoo'i iance vent
l.la ter serv i ce Change i n exi str ng Statr onar_v evap.
I
Sewe r mu'l tifamiiy, conrr. or thVent fan
lno
S to rrn 0f Vent system apart from
c0r4t!./IND. FEEDERS ex haus ti'1e cnanrca
I nstaI I /a I ter/reI ocate llood stove/heater
0f I
ISSUAIICF OF PFRIIIT
TOTAL CHARGES Z2 TOTAL CHARGES 2?-{o TOTAL CHARGES
HHEN E TE 1NLl SRE tREQU tha t F ec rt ca wor bek do ne a n Ib.y e ca trCon c'a rto the e ect r caashon ort 0n of htp s tvau,Jbet perr;lntthebeahabeessnnedansbyEecctriasorndaSupe rv dreturne to th Be ui d D s onng
a n-y
of
q
VE LY D the comp eted apnl i catj on r Dermit, and do here by certify that ail inioand correct, and I further rnnation hereon is truecerti f_v tha t and all work oerformed shall be do ne in accordance with theof Soringfield and the Laws Ordinances of the City
0CCUPAI,ICY wi I I be made
of the State oreoon oertaininq to the workhe Building Divisjon. I furt described herein, and that l{Cof any structure without the permission of t her certi 1cy that m.y stration with the Builder,sreq iBoard is in full force and ef fect as requi red by ORS 70i.055, that if exemot the basis for exemotion is noted hereon, and thatis project.only subcontractors and emD'l oyees who are in comcliance with OpS 701 055 r.rill be used on th
DoN s-ruTs^AANl{AtlE(please print)
I GiIATURE
CE
Val ue
e*lue
lu
S o . Fto. l,la i n
cy Load Sq. Ftg. Acce
ts
Va
Zonu Ce________fyo"/Cons t
TOTAL VALUATIOII
i occy Group B-? sq. Ftg. Other
Fi re Zone________..lBedrooms 0c
Flood Plain Stories
an Ck.ind opmentDeve
1. 5z
s tems
rQe ao
BUILDIIiG PERIIIT
Charges anC
Surcha rges .oz
Sa
ld
k. ResPan "2, g3
FencePLUI,IBING PERMIT
Charges and
Su rcha rges
-<./r*__
Derno
SidewalkILECTRICAL PERI:IT
Charqes and
Surcha rge s
2?-5:a
-/o A/C Pav i nq Total Conb. lermit 7.
Curb Cut
IIECHANICAL PERHIT
Charges and
Surcha rges TOTAL / 7/ 7z_
iI isnD
It Y'l t r{
:{ t-
COMBINATION APPLICATION/PERMIT (CAP)PERMIT VALIDATION
Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax
l7-05T3
2. examole- Lot
SEiInliield EC. Name, etc. of own9. Energy Sources
l. examole- heat2. ExamEi?- wate
E. SquarETt6Tase or
Lot .100, Lan
l. Block 3,
s ta tes
er and const
/electrica l
e County Map Reference
2nd Addition to
ruction lender
cei I in or forced airl gas
a ter EC ca or solar
va I uati o0,c.1. examole- J2_50 sO. foot house, 500 sq. foot garage2. gMrT"- J?-iew project, check-iEw - if aaOitioi,
EIEEr-Tdd, etc.F. Bui )ding permi t information:1. examo'le - construct single family house with an;ttacIEd garage
2. examole - remodel existing garage into fam.ily room3. examoTA - convert singie iamity-resiaence iniorestaurant (chanqe of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design informat.ion or job sitecorrections, etc,IL Abbreviated Plumbing, I'lechanicai, & Eiectrical SchedulesA. Except where blank spaces occur in the descript.ionportion of the I'lechanical and Electrical Schedujes,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Piumbing, Mechanical, and Electrical Schedulesare available at the Building D.ivision1. To conserve sDace on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated scnedules 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 labei must be delivered to theelectrical contractor for signature by his electricalsuoervisor. The generai contractor is not authorizedto sign the eiectricaj label.III. Applicant to sign and date
I'Jhenever possible. the initial appl ication wil I be used asa worksheet only. l.Jhere possible, Bui)dinq Division Staffwill prepare a type written copy and return it to theapplicant, at the time the actual permit is issued for h.is
s i gna ture.IV. Fees and Charges
Plan cneck fees are due and payable at the time of theapplication, and no plans r.Jjll be processed until these
fees are paid. A1l other fees and charges are due and
payable vrhen the permit is issued.
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V. FOR OFFICE USE Oi{LY Permit Clerk
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI'ICY:
Permit applicant exempt from regjstration with the Builder's Board because:
Additional Project Information:
PLANS REVIEI^IED BY:
name Si gnature date ?' 7-.46