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Home My WebLink AboutPermit Building 1990-11-16IL6- 1co\\Bt Job Address EI\ERq\SOURCI.S: Heat Legal DescrlPtion PhoneAddress 0wne . ttg. Access ' ----',r$HH\ffiil!q \\atqSq. -0ther\a1ue I I At t!- Ire., Bu'i lrl 5lngte I Constructi "\( Address Phone name addre s s 'I CS. no 10ne n0. Pri Structura I El ectri cal Hechani cal name a ddres s ICS. nO-exD l res ohone no. Ge ra ha ni I PLUI,,IB I NG ELECTR I CAL MECHAN I CAL FFF CHARGE NN FFF llt{apGF NO FFF |^HA RGF Each single fjxture furnace/burner to BTU, s Relocated buildinq (new fix. additional)New c i rcui ts ai tsor extensions Floor furnace and vent S. F. P.esidence(l bath)SERV I CES Recessed wal l Space heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate l^later servi ce Cha res nge in existing i dence Stationary evap cool er Sewer multifamily, comm. or I ndu stri a I Vent fan with sinole duct Storm Sewer apart from .c. Vent systen heatinq or A cor4r.r./tND. FEEDERS Mechanical einaust hood and ductInstal 1 /al ter/rel ocate di stri b. feeders l,Jood stove/heater ISSUANCF OF PFR!,IIT l.lAl,lE(please pr IGNATURE Val ue ToTAL VALUATI0N_ bytri 0 -af F Zone cy ln ad x Val ueUni ts Fire Zone Be d ro oms x x Const Group Sq ' 0regon the Buiany ard permi ffect exemp t55 wi the e 'II tca on rappcomp trmt a nd0e he re cert ath at II 1b.y fy 1rmat hereon0nnda s trueIndatc0rrecrrthefu1certthatfyaIIworkandshrmedIaIperfobenedonIccwlordancetth0rdhen1ancesffotLhe'Imf0andIIed tyfawsLhetSpngeth any ofSta te 'Irta 'In toDE w0the derk rSC 1ng bed 1here n nda ttha 0ccNC ,ANUPo W1 II madbe esructuretwtthoutss'Ithe on of diI Di svl 0n'I fu hert rIng cer ti tthafy straI t vJlregmy th Buithe IIBo der ssn.I Iful fo rc nda e sa I redrequ 0Rs 7 051 5by ttha 1 f +bas s'I forthe I I sexempt no hereoted n ndaon thatsubcontr'actoly rs nda I s whoernpoyee are n'I 1 ance'I wl h 'I IcomD0r?s 7ot 0 be edus on th s'I ectroJp tec carlEI Ian Con tortrac the Ie tec car'l I on'I fo thiport s tpermi a Su rvt rSO an retdpe tourned Buthe I'I d '|n ID 'I ,ls ons TOTAL CHARGES TOTAL CHARGES l'la i n Val ue. Access 0therFl ood Pl ai n_-Stori es TOTAL CHARGES Ftg Ftg Ftg I^JHERE STATE LAI,I REQUshall not be vaiiC until IRES that the E]ectrical work be donethe label has been signed by an Elec Plan Ck. Commfid 65%/B'ldq Per Fee Systerns Deve Charqe (1.52 opment BUILDING PERI.IIT Charges and Surcharges Plan Ck. REa---._- 30%/81dq Per Fee -\ Fence bi s,sPLUI^,IBING PERMIT Charges and Su rc ha rges Dgmo Sidewal k ELECTRICAL PERIIIT Charges and Surc harges A/C Paving Tota'l Comb. Permi t Curb Cut T,IECHANICAL PERMIT Charges and Surc ha rge s TOTAL 1 Residence of SQ. FT. 0f amps 0f ampe 21 II I ^tV1 coMBINATI0N AppLrcATr0N/pERMrT (cAp) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. example- heat/electrical cejling/2. ExamEl-e- waterheaTErleTEc trJill-/o Square footage or valuation, etc. or forced air gas E r soTar II 1. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct single family house with an attached garage2. example - remodel existing garage into famiiy room3. example - convert single family residence into resTa[Fant (change of use)G. Value of work as defined in Section 303 (a) of the Structural 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 iob site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent \Albgto theB. Ful I Pl appropriate item(s) to be installed umbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fulI schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The genera) contractoris not authorized to sign the electrical label. Applicant to sign and date l,lhenever possibie, the initial application will be used as a worksheet on1y. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna tu re. Fees and Charges Plan 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. FOR OFFICE USE ONLY 1a qoIII. IV. V Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: permit appljcant exempt from registration with the Builder's Board because: Additional Proiect Information : PLANS REVIEI,JED BY: name SI gnature date