HomeMy WebLinkAboutPermit Building 1988-08-02m
COI,IBI NATION APPLICATION/PERMIT 7
Job Address
Legal Description 00
EIIERGY SOURCES:
Heat
l,later Heater
Ran
. I'la
Sq. Ftg. Access.--
Sq. Ftg. 0ther__
_l'l er^r_Ad d-A I te r--Te p .
_Fence_Demo_C ha n ge/ U se
-other-[>St
N)
I value of vto"k, p,?fEOwner
Address f 0 (n scr .e., Build Single
Constructi
Addre s s I
name address 'lcs_ no-exD l res ohone no.
Pri ma
Structura I
E I ectri ca I
Mechanical
rmme address I lics. no.exni rps I (ohone no.
Genera I a-5 T
Pi u4bi ng
Itlechanical
PLUHB I NG ELECTR I CAL MECHAN I CAL
FFF CHARGE NO FFF CHARGF NO FEE CHARGF
Each si ng1 e fi xture Residence of
SQ. FT.
furnace/burner to
BTU' s
Relocated building
(new fix. additional )
New circuits alts
or extensions
Fl oor furnace
and vent
S. F. Residence
( I uattr )SERV I CES Recessed wal I
Soace heatpr and vpnf
Duplex (l bath) each
Additional bath Temporary Construct'i on Apol iance vent
separate
tlater service Change in existing
resi dence
Stati onar.v evap
coo I er
Sewer multifamily, comm. or
Industrial
Vent fan with
sinole duct
Storm Sewer
Vent systenr apart from
heatinq or A.C.
coMr{./rND. FEEDERS Mechan'ical exhaust
hood and ductaInstal I /al terlrei ocate
distrib. feeders I'Jood stove/heater
?,0f
\ l/l
ISSUANCF OF PFRI'IIT
TOTAL CHARGTS TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAt.l
shal I not be valid
' REQUIRES that theuntil the label has
Electrical work be done by an Electrical Contractor, the electrical portion of this permit
been signed by an Electrical supervisor and returned to the Building Division
EXAMI N ED the comp e apr)ca ti on fo r DE rml t and hereb.y cer ti fy t ha t I I informa t o n he reon I s truandcorrec t nd I fu rthe r ce rt 'I fy t ha t any and a1 I
te of 0reqon
n of the BuiI
work perfo rmed s ha I I be done I n accorda nc e t h the 0rd 'I nan ce S f the CityI be madeofSpr'l ng fi I d a nd the Laws 0 f th Sta pe rt a I n I ng to the wo rk d e s crl bed here i n and tha t NC OCCUPAN CY wl IofanysfructurewlthoULthepermrss'I di ng Di v1 s 'I on fu rt her cert 1 ty tha t m.y re g '|str,a t I on u/l t h the Bu 'I I sBoardIs'I n fu I I force a nd ef fect a S requ '|red by ORS 7 0 1 05 5 tha t I f exemp t the ba s 'I s for exempt 'I on no te d hereo n a nd tha tlybcononstractorsand empl
lktTH
oyee s who a re 'I n comD I I ance w1 th 0r?s 701 05s l|l 'I I be ed on th s p roj ect
tlAt'lE(p1ease print)E Bilulvct(S I GNATURE a_TE 2 arF
Zone Tyoe/Const tc Ftg. t,lain Val ue
Fire Zone Bedrooms 0ccy Load Sq. Ftg
Flood Plain Stories 0cc.y Group Sq. FtS
Acce s s Val
Value
TOTAL VALUATION-
0ther
BUILDING PERMIT
Ctrarges and
Su rc ha rge s
,50 Plan Ck. Comn/lnd
65%/81dq Per Fee
terns 0pmen
PIan Ck. Res
30%/81dq Per Fee
PLU!4BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICAL PERI|IT
Charges and
Surcha rges
Sldewal k
A/C Paving Total Comb. Permit
TlECHANICAL PERI,IIT
Charges and
Surc ha rge s
Curb Cut
TOTAL /o = y's
n
0f amps
der'
\
coMBrNATr0N AppLrcATi0N/pERMrT (CAp)
i. Appiicant to furnishA. Job AddressB. Legal Description
l. glaT?lg: Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat,/electrical ceilinq/or forced air oasz. example- waterheater/electr.icaj/or solai-E. Square footage or va'l uati6[lGTc.-
1. example- 1250 sq. foot house, 500 sq. foot garage?. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house w.ith an
attached garage
2. exanrple - remodel existing garage into fami)y room3. exemple - convert single iaili1y-resiaence inio
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI{ AND CONTRACTORS
To avoid design or construction delays, Build.ing
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II. Abbreviated Piumbing, Mechanical, &. Electrica'l SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Scheduies,
the appiicant 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 insta'lled are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL 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 eiectricalsupervisor. The generai contractor is not authorizedto sign the electrical label.III. Applicant to sign and date
Hhenever possibie, the initial application will be, used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual permit.is issued for his
s i gnatu re.IV. Fees and Charges
P'lan 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,
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
(,
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b
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name S1 gnature date