HomeMy WebLinkAboutPermit Building 1983-07-19INSPECTION LIIIE
726-37 69
UI I Y
COHBI |IATI ON
UF 5TKINbT I I D
PERMIT
INFORI1ATION LiNL
7?6-3753APPL I CAT
N
U
h
\0
\
Job Address f,/o S. Sgcol)D S-*,EIIERGY SOURCES
Hea t
l,later Heater
Ranqe
Sq. Ftq. l.1ain_
:q. ftg. Access.--
Sq. Ftg. 0ther--
_t,lewlddll ter_Rep.
_Fence_Demo Change/Use
_other-
Legal Description
T
Val ue of liork:4oaaowner $oAb6-J C* sprr (A!_
Address c/ o s. Scc--s d\ S-r. Phone)+[-W.7EuTIfinq P-ermit Info: Describe l'Jork('
I Familv llesidence tli th 4!!-e!-be-d-Ge1ggg
:e., Build Single
Fnkfl fr,sr.J oFF fr.J o <D^<cs F-BA*arrJ<.r16r.-\
Construction Lender 7-6*sz- C-ttA rt ts €-e5
Address Phone
DES I GI I TEAI,I name address exot res
Pri
Structura l \
Hechani ca I
name add res s 'lics. no.exDt res ohone no.
Genera I S'.q7 F--
Plumbino
I ectrr'ca I
PLUI1B I NG ELECTRICAL MECHAN I CAL
FEE C HA RGF NO FFF CHARGE FFF IHARGF
I
Each single fixture u"f,-,Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)x New circuits alts.
or extensions - ?-2 ot4 tr6/7c /r Floor furnace
and vent
S. F. P.es i dence(l bath)SERV I CES
Recessed wall
Soace heater and vent
Duplex (l bath) each /l- < ()* 17 -/ ata
Additional bath Temporary Constructi on
Apol iance vent
<FnaratP
l.later servi ce Change in existing
res i dencp
Stationary evap
coo l er
Sewer e multifamily, comm. or
Indrrctrial
Vent fan with
sinole duct
Storm Sewer 0f o Vent systern apart from
heatino or A.C,
COMH./IND. FEEDERS
Mechani ca l exhaust
hood and duct
InstaI | /aI ter/rel ocate
distrib. feeders-l,lood stove/heater
0f amps-I 4n<. Hly ;-
ISSUANCE OF PERI'IIT /A.4
TOTAL CHARGES
dD /5:4TOTAL CHARGES l2*TOTAL CHARGES
WHERE STATE LIN REQUIRES that the Electric
shal] not be valil until the label has been si
al work be done by an
gned by an Electrical
Electrical Contractor, the electrical portion of this pernit
Supervisor and returned to the Building Division
N ED the apfil i cati on
and al l work
0regon oerta
the Building
r Derm 'I L an d do he cer t I fy tha +a I 'I '|n rma t on i s true
the CitYI be made
ilder's
and that
and cot
of Spr
of any
Boa rd
rrec t
'ingf i
struis in
ubcon
an d I frU rthe r cer t I fy that any
State of
sion of
DE rformed s ha I 'I be done 'I n accordance th +he 0rd i nances of
nl the work d r1 bed here I d t hat NC 0ccu PANCY w1 'I
e I d and the Law s of the I ng to es c n an
ctu re wl t hou t th perm 1 s D 'I 1 s I n I fu rtherf exempt
.055 wi l
cert 'I 4.,th at my regi s t ra t I on v/1 th the Bu
I 1 force and f fiect a s requ I red by ORS 7 0 I 05 5 tha t 'I t he ba s 'I s for exempt 1 on 'I s noted hereon
I v s trac tors and ernp I oyees who a re 'I n comc I I ance w1 t h 0t?s 701 be used o n thi s proj ect,
I'lAtlE(please print)I
Zone Tyoe/Const. Uni ts Srl . Ftg . t'la i (_----'Value
Fire Zone Bedrooms
Flood Plain Stories
Load Fto Access x Val ra ,= ,.
otn""kr, frCbtqP €Z uslt)s ?@'@Group-Sq. Ftg
TOTAL VALUATION
BUILOING PERi'IIT
Charges and
Su rcha rges
8,oo
-/ "-
_--?Plan Ck. Cornm/lnd
65%/B1da Per Fee /8.-?.6 teris 0
7.57
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges . ?ct
Fence
Dgmo
ELECTRICP.L PERI,IIT
Charges and
Surcha rges
€6
.(o
Sidewal k
A/C Paving Total Cotttb. Permi t 6?.68
HECHAT'IICAL PERMIT
Charges and
Surc harges
ao
.26
Curb Cut
TOTAL 87.48
E l ectri ca l
----.f,-:-:
---12,
COMBINATION APPLI CATION/PERMIT
I. Applicant to furn.ishA. Job AddressB. Lega l Description
(cAP)
c.
D.
l. example- Tax Lot 100, Lane County Map ReferenceI7-I'IT32. example- Lot l. Block 3, 2nd Addition toSpringfield Estates
Name, etc. of owner and construction Iender
Energy Sourcesl. example- heat,/electrical ceilinq/o
- ?. exarlolE waterhEIErZe-lETiltfforE. 5quare tootage or valuation, etc.l. examole- 1250 sq. foot house, 500?. example- JT-i'ew project, crreit new
check add, etc.
r fqrced air gas!el-er-
sq. foot garage
- if addition,
II
III.
IV
F. Building permit information:l. example - construct single family house with anattached garage
?. examp]e - remodel existing garage into family roomJ. exanpte - convert single family residence into
^ EIiilrant (change of-uie)- "' '
G. Value of work ai defined in Section 303 (a) of the. Structural Specialty CodeH. OESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuiidingDivision Staff must be able to contait appropriitepersons.regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechanical and Electrical Scheiules,the applicant need fill-in only the No. Boxes iajii.nt_ to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Divisionl. To conserve space on the-permit form the schedu.teshave been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de.livered to theelectrical contractor for signature by his.i"ii.iiui -
supervisor. The general coniractor i!.not authorizedto sign the electrical labelApplicant to sign and date
l,lhenever possible, the initial application will be used asa.worksheet only. Uhere possibt!, gultaing Oivision-iiaiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued io" fris
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 theietees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONIYv
PERMIT VALIDATION
\qtg83
0KLe
Permit Clerk
4J4
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ig nature da t" ?-t3*8E