HomeMy WebLinkAboutPermit Building 1979-07-100 E
COMB I ERI'1I T 726-37 536-
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Job Address
l-ega l Descri pt i on
nergy rc q n
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ter a r ter
fe '!'Inceemot on
I ue of work chang use o therr'ftek
Owner (name/address/phone)ng perm n r w0r
'I e fam. res. with detached ra
w(fia -1+{l AA/VAR.
Construction Lender (name/address/phone))I
I]ES I GN TEAM name n ress exoi res ohone no.
Pri ma
Structura I
J J IElectrical 4
Mechani cal
CONTI name addres s lics. no.exoi res (ohone no-
Genera I ?J9
Plumuino (
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El ectri cal I 'fuc, 'rl a 1nL+2fi
l''!echani cal t b-,^t,)I
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PLUI,IB I NG I I I IMECHAN I CAL ELECTR I CAL
t,t0.FEE CHARGF NO FFF CHARGF NO FFF CHARGF
Each single fixture furnace/burner to
BTL|' s Tl4oq'" "',SQ. FT 25.n 25.a
Relocated buildino
(new fix. addjtional )
Fl oor furnace
and vent
New ci rcui ts al ts
or extensions
S . F. Res i dence(1 bath)75.n %.tt Recessed wal I
Soacp heatpr ind vtrnt SERV I C ES
Duplex (l bath) each
l./Additional bath b,ub Mro'O
Apol iance vent
seDa rate Temporary Constructi on
l,later service Stati onar,v evap
cool er
Chan
res i
ge in existing
dence
Sewer 5 Vent fan with
sinole duct ?.n 6,nt multifamily, conrn or
Industrial
Storm Sewer
Vent systern apart from
heatino or A.C.0f S.
Mechan ical exhaust
hood and drrct coMr'r./IND. FEEDERS
l,lood stove/heater Instal I /al ter/re1 ocate
distrih- fepdprs
,L.ro 0.*0f amp s.
i.r'o ?,oo New ci rcui ts, al tsor extens i onsIw t9b1
rssuANcE 0F PERtlrT ),0O
TOTAL CHARGES 4q ,o TOTAL CHARGES It TOTAL CHARGES A.^
hIHERE STATE LAll REQUIRES that the Electrical work be doneshall not be valid until the label has been siqned by an Elect
by an Electrical Contractor, the electrical poition of this permitrical Supervisor and returned to the Building Division.
i HAVE CAREFI.ILL
and correct, and Iof Sprinqfield andof any structure wi
NAI'IE (please print)
EXAI'1 I NE D the c0mp I ted app I ,l ca +i 0n for pe rml t a nd do hereby c ertify that all jnformation hereon is truefurthercert,l fy tha t any a nd a I I t/O rk perf ormed S ha I I be d on e n ac CO rda I t h the Ordinances of the City
0CCUPANCY will be madetheLoftheStateof0re90nperta'I n I nq to t he !/o r k d cr he re n nd ththoutthepenmIInoftheBu,]l d I n q Di i s ,|on
S I GNATI] R DATE
FOR OFFICE USE ONLY
Zones Flood Plai sdtns ?- Type Const
Stori es Un i t s
Sq Ftg Value
ValueLoadOccyFt
BUILDING PERTIIT
Charges and
Surcharges
.aD Plan Ck. Comm/Ind
65%/B1do Per Fee Storm Sewer Connec
Pl an Ck. Res
30%/81dq Per Fee 0t her
PLUI4BING PERMiT
Charges and
Surcha rges
Fence 0ther
Sprinkler System 0ther
ELECTRICAL PERIlIT
Charges and
Surcharges
ao
TD
Demo Total Comb. Permit ,AL
A/C Pavi ng SDC
MECHANICAL PERMIT
Charges and
Surc ha rges -----llt ,Ul Curb Cut b
TOTAL sn.(tasidewar r1[ l*,7.to
,.1^,5q(?)Aht2.<,bfil-oz-14
b,v AB
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COMBINATiCN APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County l4ap Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
SprTngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
I. example- heat/electricaI ceiI ing/2. example- waterheater/electrical/o
Square footage or valuation, etc.
or f oj!e!_ !j r ga sr sol ar
E 1. example- 1250 sq. foot house, 500 sq. foot garage
2, example- if new project, check new - if addition,
check add, etc.F. Built.
ding permit information:
example - construct single family house with an
attached garage
example - remodel existing garage into family room
example - convert single family residence ;into
iesTiilrant (change of-use)
2.
3
II
G. Vaiue of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI.1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, l'lechanical,., & Electrica l 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 the appropriate item(s) to be 'instal?ad
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Div'ision1. To conserve space on the permit form the schedules' have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful 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 the
electricai contractor for signature by his electrical
supervisor. The general contractor.is not authorized
to sign the electrica l label .III. Appl icant to sign and date
Whenever possibie, the initial appl ication wil l
a worksheet only. Where possible, B.uilding Divwill prepare a type written copy and return it
be used
ision St
to the
AS
aff
applicant at the time the actuai permit is issued for his
si gnature.
IV. Fees and Charges
PIan check fees are due and payable at the time of the
appiication, 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.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION1-tc-n
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
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I I T
PLANS REVIEI^IED BY:
name s i gnature date -L-l,O -u
(