The URL can be used to link to this page

Home My WebLink AboutPermit Building 1984-08-09NE COMBI L I CATI IT L Job Address 70 EIIERGY SOURCES: Hea l,later Heater . Fto. l'lain_ Sq. Ftg. Access.--- Sq. Ftq. other _l'ler^r_Add Al ter_Pep. _Fence_Demo Change,/Use 0ther (}.- \9h a+ Ds Legal Description n Val ue of l.lork:4, ^Ko, obOwner Address vtonQzl/- )-,*/ n n scr :€. r ng e Construction Lender bao-rl-Z\ I d Addres s Phone // DESIGN TEAI.1 name addre s s I ics. no exrir res phone no. Pri ma Structura I E l ectri ca I l''lechani cal name ('\addres s lics- no-)( exn i rps'nhnnp nn Genera I ;5' 1<tt -<1vliuaPl umbi no El ectrical l'lechan ical PLUI.lB I NG ELECTR I CAL MECHAN I CAL FFF CHARGF NN FFF CHARGF N0.FFF CHARGF Each single fixture Residence of sQ FT furnace/burner to BTLI ' s Relocated buildinq (new fix. additioial) New ci rcui ts al ts or extensions FIoor furnace and vent S.F. Residence(l bath)SERV I CES Recessed wal I Soace heatpr and vent Duplex ('l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate l,Jater servi ce Change in existing rpc i dpncp Stationary evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatino or A.C- c0r.il.1./rND. FEEDERS i'4echanical exhaust hood and drrct I n sta I I /a I ter/ re1 oc ate di stri h fppdprc l'Jood stove/heater 0f amps. ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for and correct, and I further certify that any and all work pe of Soringfield and the Laws of the State of 0regon oertainiof any structure without the permission of the Building Div Board is in full force and effect as required by ORS 701.05 only subcontractors and ernployqes who are. in cgmpliance wit D". " ,.1 J- k, ".1 l<..- 'Dermit, and do hereb.y certify that all information hereon is true rformed shall be done in accordance with the 0rdinances of the City ng to the work described herein, and that NC 0CCUPANCY wilj be madeision. I further certify that m.y registration urith the Builder's 5, that if exempt the basis for exemption is noted hereon, and that h 0l?S 701.055 wi lI be used on thi s Dro,ject. I om7-?{/I'lAl'lE(please pri nt)I GNATURE FOP. OFFICE USE OiILY Zone--Type/Const. Uni ts Ftg Ftg Ftg l'la i n x Val ue Fire Zone Bedrooms 0ccy Load Sq.Access 0ther Val Flood Plain Stories Group X Value TOTAL VALUATION- BUILDING PERMIT exq_Charges and Su rcha rges Pl an Ck. Cornm/ Ind 65%/B1dq Per Fee Svs Cha tems Deve' rqe f1.5% opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Demo ELECTRICP.L PERI,IIT Charges and Surcha rges Sidewal k A/C Paving Tota] Cornb, Permi t IIECHANICAL PERMIT Charges and Surc ha rge s Curb Cut TOTAL eq /1 INS PECT I ON 726-37 69 INFORI,IATION LTNE 126-3753 Range \") E f)- ()\ iur :am re Work ( I Garaop t D - A-041 U COMBINATION APPTICATION/PERMIT (CAP) i. Applicant to furnishA. Job Address B. Legal Description 1. example- 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 IenderD. Energy Sources PERMIT VALIDATION /L # bl vs-: v1q/ry 1. example- heat/electrical ceiling/2. eGmplE waterhEateTeTeEtil ca]7o Square footage or valuationl-GTc. or forced air gas E r soTar II. 1. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check-iEw - if addition,Elec[add, etc.F. Building permit information:1. example - construct singie 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 theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job s.itecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto theB. Full Pl appropriate item(s) to be installed umbing, 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 instal led are not covered on the abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF llllLL 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 authorized III.to sign the electrical label. Appiicant to sign and date IV Whenever possible, the injtial application will be used asa worksheet only. ldhere possibie, Building D.ivision Staffwi1'l prepare a type written copy and return .it to theapplicant at the time the actuai 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. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLYV Permit Clerk PROJECT CONDITIONS TO BE SATiSFIED BEFORE OCCUPAI{CY: t(usT b€/:L)tQ-t {t-J "//T d Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY name s'l gnature date P ,4)