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Home My WebLink AboutPermit Building 1987-08-07I NS PECT I ON 726-37 69 Iilt CITY OF 5PI.ii'IGFIELD- COMBIiIATION APPLICATION/PERMTT 72 Job Address l-egal Description Owner llater Heater Ranqe EIIERGY SOURCES: Hea t Val ue of 0 l{er,t Add Al ter -Fence DerTro Ch -0ther- l.1a n ra nge So. Ftg Sq. Ftg Sq. Ftq Acces s 0ther D, / Use Address Phone q Permit Info: Describe l.Jork(i.e., Build Single llesidence Uith nttached Garaqe) Builc,in Fani ly Constructi on Lender 7 Addres s Phone os N LI} 0. -] DESIGN TEAI.I name address exni res )phone no. Pri ma ry Qtq, uqlSt ructura I I qElectrical I'lec ha n i ca I CONTRACTORS n ame addrcss ohone no. Genera I E I ectri ca I Itlec ha n i ca I PLU14B I NG ELECTRICAL [1EC HAN I CAL FFF CHARGE NO FFF NHA QC F N0.FEE CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTLI' s Relocated buiiding (new fix. additional ) New ci rcui ts al tsor extensions Floor furnace and vent S. F. Residence(l bath)SERVICES Recessed wal I Soace heater and vpnt Duplex (l bath) each Add i ti onal bath Temporary Construct j on Apoi iance vent sepa ra te l,later servi ce Chanqe in existinq res i dence Stati onary evap cool er Sewer industrial mu'i tifamily, comrn. or Vent fan with sinole duct Storm Sewer 0f amp s.Vent systern apart from heating or A.C, COMTI./IND. FEEDERS i'lechanical exhaust hqod and ductInstal I /a l ter/rel ocate di stri b. feeders [Jood stove/heaterLl amp$0f \1 ISSUAIICF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES L 1l'/REl,lHE TS TA E R U IEQ RES hat tlrt c ,] e ect Ir ac woI rk E I rndobenea ConectIca1 tortrac the e ecI r1t ICA t 0ni fp0r sthi rn1 thasIpeIbenotIvaI,l ntU II I bea hI seth ansbeen'I I byri catEIgned iby s0 anr rdSuperv deturne to t he Bu I'I d i n i I 1g IlAl''lE (pl ease pri nt S IGiIATU A\ TE 0Ps RE cNDthe e d tca0mp on rfoap!-)tDerm a dond h ere c rt t tha abvt n fovndacrrec0tafuthe rrnd tcer t ha at n an adf.y v work perfo shrmed a be nedo n cca ncorda e tthfSorfedandngtheLawsofhetS0reotaetoonrtDCannthetorr{o dg e r.lc dbe nhere i a thnd toatsrUnyturehoutthtepermssooUthdeonfurthecertrthatrestrafyrnygrBoadfunafo rce efnd ctfe a s u red 0 RS 0 05reclby 5 t ha f ex bathe S Semp t for e nxemDtonsubconvtrtoacrsndaernDawhorenoyeesancomDcethwl070155TJlbeUSednoth tec!rroj rrna t i on hereon is true S-4;./(|,,u he Ordinances of the City NC 0CCUPANCY rvill be madetion vri th the Bui I der,sis noted hereon, and that 0n 0F Val ue ToTAL VALUATI0N_ I Zone x X xup Val S q. Ftg. 0ther Load Const. Units.ValueFire Zone Bedrooms Fto. l,!ain Flood Plain Stories _Occ.y Gro Sq.Ftg.Access P t an Ct< . Conr.m7Tna -65%/Bldq Per Fee Systerns Deve Charqe (1.5c opmen tCharges and Su rc ha rges 56,5C )J BUILDING PERI,lIT Plan Ck. Res !0%/81dq Per Fee FencePLUt4BING PERMIT Char.ges and Surc ha rges Dgmo Sidewal k ELECTRICP.L PERI|IT Charges and S urcha rges Total Comb. PermitA/C Paving Curb Cut IiIECHAI'IICAL PERHIT Charges and Su rc ha rqe s 5q,3).TOTAL I COIIBINATION APPLICATION/PERIIIT (CAP) I . App l i cant to furni shA. Job AddressB. Legal Description 1, example- Tax Lot 100, Lane County Map Reference TZ-03-432. example- Lot 1. Block 3, ?nd Addition to SFrfnlFietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources I i. examol e- heat/_eleelr'rsgl_ggj-ljng2. ExamET-e- wa terhEaTEiTelE trlca7,E. SquarE-T6otage or valuation, etc. /or forced air gas or sofar II 1. example- 1250 sq. foot house, 500 sq. foot garage2. 1axami]e. -ir new projecl, check new - if additio;, check add, etc.F. Building permit information:1. example - construct single family house with an;tt=afA garage 2. example - remodel existing garage into family room3. 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 TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, l'lechanica l, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechani-cal and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installedB. Fu'll Plumbing, Mechanical, and Electrical Schedules are avai lable at the Bui Iding Divis ion1. 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 scnedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. Applicant to sign and date llhenever possibie, the initial application will be used as a r./orksneet only. Where possible, Bui lding Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. Fees and Charges PIan check fees are due and payable at the time of the application, and no plans vrill be processed until these fees are paid. All other fees and charges are due and payable vrhen the permit is issued. III IV V. FOR OFFICE USE ONLY PERMIT VALIDATION g-1 41 0us7b" Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: perm.it appf icant exempt from registrat'ion with the Builder's Board because: Add'itional Proiect Informatjon: PLANS REV I EI,JED BY : name SJ gnature date C-