HomeMy WebLinkAboutPermit Building 1986-05-22 (2)LINE
Legal Description
Job Address EIIERGY SOURCES:
l{ater Heater
Ranqe
Owner Pnc. '\-g- us-i-
Value of Hork:i t t z58Euc
I'lain_
Access.
Sq
Sq
Ftg
Ftg
Address a>-i n t l,lork
F Ga 'e., Build Single
659oetJrD; c;iJ&bzP 4DOi nir; Ae .JLq+ ,<r,>6zix:k(vt"
Construction Lender Oul (tfs, i -r+a,o (f;l;,l'f,(,r rht tae!.
Address Phone
name addrp s s \exoi res lone no.
Primary
Structural
El ectri cal
Hechani ca l
q
Pl umbi nq
I
q)
ELECTRICAL I.IECHANICAL
N0-FEE CHARGE NO FFF rHA AGF NO FFF CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
-
BTU' s
Relocated buildino
(new fix. additioial)New circuits alts
or extensions
Floor furnace
and vent
S.F. Residence(l bath)SERV ICES Recessed wal I
Soace heater and vent
Ouplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa rate
blater service Change in existing
res i dence
Stationar-v evap.
coo l er
Sewer multifamily, corrm. or
Industrial Vent fan withsinole duct
Storm Sewer 0f Vent system apart from
heatinq or A.C.
coMl.l./IND. FEEDERS Mechanical exhaust
hood and duct
I nsta I I /a l ter/ rel ocate
distrih- fpeder<llood stove,/heater
0f
ISSUANCF OF PFPJIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l{Al.lE(please pr.int IGNATURE*
I.JHERE STATE LII,I REQUIRES thatshalI not be vali,l untiI the ]abel
the Electrical work be done by an Elechas been signed by an Electrical Supe
tri
rvi
cal Contractor, the electrical portion of this pernitsor and returned to the Euilding Division
ng
st 0reqon
the Bui
f exempt
.055 will
eI tedcomp foront t and doap!',cert i ttha a n 10nt s true'IfycorrectaandndIfurtherIcertthataIandfy'|rkwoany DE srfonned Iha be 'Idone accorda wl th the sOrdi nance theof ciofIfied tySpriandtheLawstheofteStaot'I ni theto workDertang descri here ibed n and that NO YOCCUPAHC l{t I1 beof madewlructurehouttthe'I ISSperm on of di'|Di I 't onng I further Irt tha tqe '!tratis onfymyreg V'I theth IBu deI r s
any
rdBoa sI nI 1fu 1 force and effect as redIrequ 0Rs 055701by that I ba 'Is forsthe 1 onexempt noted hereon andonl thatsubcontrv'ac andtors whoempoyees are n I I ncea thwlcomo 7o0Rs 0nused thi s ectProjbe
/t)
TOTAL VALUATI
ue
0ther
Zone_IypelCons t.Ftg. l,lain.re Zone Bedrooms Occy Load Sq. Ftg. Access x VaFlood Plain Stories .0ccy Group Sq. Ftg.
Plan Ck. Conm/Ind
65%/8ldq Per Fee
Systems Develoommt-
Charqe f!.57)\)wSUILDING PERI'IIT
Charges and
Surcharges
_____Iz
"2.
Plan Ck. Res
3OXlBldq Per Fee \
FencePLUI{BING PERMIT
Charges and
Surcha rges DSf,to
Slderal k
ELECTRICAL PERIIIT
Charges and
Surcharges A/C Paving Tota'l Comb. Permit
Curb Cut
IIECHAIIICAL PERHIT
Charges and
Surcharges
/.<l*)'o0
(oo TOTAL
O
.<
Ftg . Other
PLUI{BING
t
corqBrNATIoN AppLICATI0N/PERMrT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
T7-I3732. example- Lot l. Block 3, 2nd Addition to
SEFin-6-field EstatesC. Name, etc. of owner and construction Iender0. Energy Sources1. examole-^------..--]-a. examo I e-
squaF?6Ea
alr qas
E
F
l. exampie- 1250 sq. foot house, 500 sq. foot garage2. examiler JT-new project,.check-new.- if aOoitioi,
check add, etc.
Building permit informat'ion:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into fami)y room3. examole - convert single family residence into
FiGEIuFant ( change of -use)
Value of work as defined in Section 303 (a) of theStructural Specialty Code
DESIGN TEAM AND CONTRACTORS
G
H
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriite
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, I'lechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Etectrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be .installed
8. Full Plumbing, Mechanical, and Electrical Schedulesare availabie at the Building Division1. To conserve space on the permit form the schedules
have been abbrevrated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult the
fu'l I schedu lesC. BUILDING DIVISION STAFF I,IILL 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 generai contractor is.not authorizedto sign the electrical Iabel.
App'licant to sign and date
lJhenever possible, the initial application witl be used asa worksheet only. Where possible, Building Division Staffrill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
si gna ture.
Fees and Charges
PIan check fees are due and payable at the time'of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
II.
III.
IV
V. FOR OFFICE USE ONLY
PER}4IT VALIDATION
{
0
I
Permi t Cl erk \!r
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
<-PLANS REVIEWED
si I nature \-,6
;rtan. A*t