HomeMy WebLinkAboutPermit Building 1987-04-27IilSPECTIOil LIirE
7?6-37 rt9
Pri mary
Structura I
Electrical
lJechanical
Pl umbi n
EI
LiiY
Ct)IIB I iIATI ON
UI SPR
APPLICATI ERMIT
Electrical work be done by an Electris been signed by an Electrical Supervi
726-375i
MEC HAN I CAL
Apol iance vent
ent systenn apart from
orA
ISSUAIICE NF PFP.IlIT
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I/HERE STATE Ltt,t REQUIRES rhat theshall not be vali.i untii the Iabel hi cal Contractor, the electrical portion of this oern.itsor and returned to the Building Division
Job Address b3g
o-4a/l-egal Description / ? -O 3 _ J 1 _
Ranoe
llater Heater
EIIERGY SOURCES
Hea t
fil - LStohz-'yt of l,/ork:
QAr<>a a. d 6
So. Ftq. Iiarn_
Sq.5tg. Access._
So. Ftq. 0ther_llel Add Al ter leo.
Jen-e_Derno Change/Use
0ther
Add rcs s Phonc nq l'ernrr t i nf o: D-aarr be t]orlf
Residence llith nttached Garaoe
Uui
Fan
Itliilv e., Build Single
qw 2/4ab;z- d ^e/24. /4&1ry-
nstruction Lender /5Zo /
,Ld*z-ui-\ u /r
.\dd res s Phone v
DESIGN TEAII nanre add lics. no.( exoi res (onone r
C TR nre
PLUIlB I NG ELECTR I CAL
ii0.FEE C HARG F N0. I FFF
Each single fixture furnace/burner to
BTLI' s
Relocated bui lding
(new fix. additional)New circuits alts.or extensiont Z+2*FIoor furnace
and vent
S. F. Residence
[] bailr)SERV I C ES Recessed wa I I
Soace heater and vpnt
Duplex () bath) each
Additional bath Temporary Constructi en
[,]ater servi ce Change i n exi sti ng
res i dence
Stationary evao
coo I er
Sewer multifamily, connn. orindustrial Vent f an r^r'i thsinole duct
Storm Ser,rer 6rTeN'h 0f s
c0i4r!./IND. FEEDERS hanical exhaust
Insta I I /a l ter/rel ocatedistrib, feeders l'Jood stove/heater
0f
TOTAL CHARGES t<oo TOTAL CHARGES 2-g TOTAL CHARGES
llAl.lE(please print)s I Git,RE
0reoon
the Bui
E NEXAIl I ED co c ta on f,et ed o r trmimpapi)DE a dond c rte ttha a nhe re bv fy trrna on hereon s truendacotrrecandrthfurerthattndaaaworkrmedoerfofynyhabedonenordaccncthwit0rdiheancetofcheftySoredanngfdLthefoawsthSetateofDEartnntowotheresdcrrdsbeherenndathatOCCUPilcY,AHC wi ma debefotrstUucnyw1reoutththerm'i s o nDE of d n D vl onq fu hert cer rt t tha re Sfy o v/rn h eth Bui dtm.y q er srdBoafunsfrcoaendeecffratsrequ i red 70Rsby 0 505 t tha t ex the femo t ba s s or s tedno nhereo a nd tha tonbcU0nvtrac0trsndawhoaemr)oyees re n comc an wice ht 7oOPS 1 0 thoned
OFF 0i
TOTAL VALUATIOII
Load Sq
+E
JYoelcon s t E-N ,n-,.
otner &Zr/aazx@.fraa lue
Val
eroup H-Z l AZSq. Fts
Zone
Ftg. Access r Val ue.
Fire Zone Bedrooms
Flood Piain Stories
Ftq. l'lain
ndan Ck. C Deve
1. 51e(s teris opnrentBUILDING PERI.IIT
Charges anC
Surcha rges
5o
,(oL an Ck
o1
FencePLUt4BING PERMIT
Charges and
Su rc ha rges
5,Oo.,0c Demo
Si dewa 1 k
ELECTR ICAL PERI,iIT
Charoes and
Surcha rges o
22,50
Total Comb. PermitA/C Pavi ng
Curb Cut
IlECHANICAL PERI.IIT
Charges and
Su rc ha rge s TOTAL /*5.r2
0wner
rHAOr:E I FFFH0. I atl
Residence of
sQ. FT.
qPDa ra tp
tutfiltJ,Ph Fa
FtjlTW- JMtro,
.I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot l. Block 3, 2nd Add.ition toSlrTngTieid Estates
C. Name, etc. of owner and construct.ion lenderD. Energy Sourcesl. examol e-2. Exaffi'Ie-E. squarE-T6oTag
hea t/
wa ter
eor
at s
l. example- 1250 sq. foot house, 500 sq. foot garage2. elamplE: Tffiew project, check-nEw - ir aaoitioi,
check add, etc.F. Building permit information:1. exampie - construct single family house with anattached gara_qe
garage jnto family room
amily residence into
2. examole - remodel existing3. -qlqmlle - convert single f
iEstE-urant ( change of -use
)G. Vaiue of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,1 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except ylhere blank sDaces occur in the descriptionportion of the Mechanicai and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate .item(s) to be installedB. Fuil Plumbing, t'lechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorized
III to sign the electrical label
Applicant to sign and date
IV
l,lhenever oossibie, the initial application will be used asa worksheet onjy. Where possible, Bui lding Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actuai perm'it is issued for his
s i gna tu re.
Fees and Charges
Plan check fees are due and payable at the t.ime of theappiication, and no plans wi1 1 be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLYV
E t,g tt/
PERMIT VALIDATION
Permi t Cl erk
nf
v->?-g I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
,?,*)U /r? A t N mp.ry*flrh ) ruz ruft/l%,t )?4L
T-I
Permit appljcant exempt from registration with the Builder's Board because:
Add'itional Project informat jon:
PLANS REVIEWED BY:
da tenamesigna tu rel:
Doro,Dvu
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