HomeMy WebLinkAboutPermit Signage 1989-10-24IN
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TI1
69
L
c0t4BI ICATI
Job Address 1 57 O Mo
EHERGY SOURCES
Hea t
l,later Heater
Ranqe.
n-
Sq. Ftg. Access.-.--
Sq. Ftg. Other__
l,lew Add AI ter Pep.
___1...-e n c e_Oemo C hi-n g e / U se
0ther
I
Legal Description
Value of llork:owner Viilliamsburg Bank
Arl<lress 1 57 0 Mohawk BIvd.Phone 7 26-n scr
Fami dence l,li
r€. , 6Ui Id SIng le
1 300Sprinqfield, OR. 97477 Hook uo siqn-
Construction Lender
Addres s Phone
DESIGN TEAM name address 'I CS. nO.exDl res phone no.
Pri mary
Structura I
El ectri cal
Mechani ca I
name address''I i cs. no.pYnl rFq )nhone no-
Genera l
Pl umbi nq
El ectrical Beacon Etectric 2585 Roosevelt BIvd., Eugene 97402 20-53C 10/01 /90 461-0291
I'lechanical
PLUIIB I NG ELECTRICAL MECHAN I CAL
FEE CHARGF NO FFF CHARGF NO FFF CHARGE
Each single fixture Residence of
SQ FT
furnace/burner to
BTLI ' S
Relocated building
(new fix. additional)
New ci rcui ts al ts.
or extensions
Floor furnace
and vent
S. F. Residence(l hat-h)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
sFDa ra t-e
l^later servi ce Cha
req
nge in existing
i dpnce
Stati onar.v evap
cool er
Sewer multifamily, conm, or
IndustriaI
Vent fan with
sinqle duct
Storm Sewer 0f amps.
Vent systern apart from
heatino or A.C.
coMr.r./IND. FEEDERS
Mechanical exhaust
hood and duct
Insta l I /aI ter/rel ocatedistrib. feeders llood stove/heater
0f
1 Sign Hook up .75 5.00
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES 15.75 TOTAL CHARGES
l.lHERE STATE L,1ll REQUIRES that the Electrical work be done by an Electrical Contractor, the elec
shall not be vali:t until the label has been signed by an Electrical Supervisor and returned to the
trical portion of this permit
Building Division
E FULL t comp e ap p ca t I on for perm l t and do hereb.y cert t a t n forma t 'I on he reon 'i s true
the CityI be made
iIder's
and that
and correct, and I further certify that any
State of
sion of
and 'I I work Der fo rmed s ha 'I 'I be do ne 'I n a cc ordance wl rh t he 0rd i na nc e s of
of Sprinoof any st
Board i s
fi e I d an d the Laws of the 0regon pe
the Buildi
rtaining
ng Divisi
701.055.
to the wo rk de sc r 1 bed here 'I n and th at NC OCCU PAHC'wl I
ruct ure wl thou t the permis
nd effect a
on I furtherf exempt
.055 rvil1
cert .I fy th at m.y reg 1 s tra t 'I on v/l th the Bu
'|n fu I I fo rce s requ '|red by ORS tha t 'I t he ba s 1 s for exemr)t I 0n I s n oted he re0n
on ly s ubcon trac tors and emp 'I oyees who a re I n c0mp I I ance wl th 0r?s 7 0 be u sed th pro,j ec t
liAt'lE(please prl nt) Gary E. Johnsen St rE 10/24/89
Zone st.Uni t s Sq. F tp
(g
. l'lain Val ue
Fire Zone Bedrooms 0ccy Load F . Access I Up
Flood Plain Stories 0cc.y Group Sq. Ftg. 0ther_-_----_-x Val llP
TOTAL VALUATION
BUILDING PERT.IIT
Charges and
Su rcha rges
Plan Ck. Corm/lnd
65%/B1do Per Fee
Svsterils Deve
Charqe (1.57
opment
Plan Ck. Res
30%/BIdq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Dgmo
ELECTRICAL PERIIIT
Charges and
Surcharges
Sldewal k
A/C Paving
Curb Cut
Tota'l Comb. Permi t
NECHANICAL PERMIT
Charges and
Surc harges TOTAL
re tllork(
Ga ra op
:TORS
COMBINATION APPLICATION/PERMIT (CAP)PERMIT VALIDATION
Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43?. example- Lot 1. Block 3, Znd Addition to
SFFTnITield EstatesC. Name, etc. of owner and construction Iender0. Energy Sources
jzq0
l. example- heat/electrical ceiling/o2. example- waterheater,/electrical/orE. Squaie footage or valuation, etc.
r forced air gas@
I I 57l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:l. example - construct single family house with an
attached 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
2-
H
Structura I
DES IGN TEAI,I
Special ty Code
AND CONTRACTORS
To avoid design or construction de)ays, Building
P
Division Staff must be able to contact a
persons regarding design information orcorrections, etc.
ppropr i a tejob site
II Abbrevjated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere 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. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF l,llLL 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 general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
fJhenever possible, the initial application will be used asa worksheet on1y. l,lhere possible, Bui)ding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.
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. Al l other fees and charges are due andpayable when the permit is issued.
I
III.
IV.
I )MV. FOR OFFICE USE ONLY Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY:
Permit applicant exempt from registratjon with the Builder's Board because:
Additional Project Informat'ion:
PLANS REVIEWED BY:
name S1 9n ature date
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