HomeMy WebLinkAboutPermit Building 1980-11-19 (2)l-ega1 Description
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COMBI APPL I RMIT - 3753
Job Address
lirL
-3
J
l-'lea t
E1-L
l.later Heater
Ranoe
Val rk:oc
Access._
0ther
. l'lain
!q. Ftg
Sq. Fto
Addres s Phone sidF
t In o scribe l^lo
h Attac .e., Build Sinqle
Construction Lender
Addres s Phone
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rx
I
Primary
l'lechani ca l
Structura l
El ectr"i ca I
nica1
PLUIlB i iIG
MEC HAN ICAL
4(r
lil
era I
unbi
I FFF I cuqpcr x0. I i rrr CHARGFiach single fixture Res idence of
SQ. FI
furnace/burner to
BTU' S
al )
Reiocateo bui ldinc
(new fix. addition,New ci rcui ts al tsor extensions Floor furnace
and vent
S. F. P.es i dence(l batn)SERV I C ES Recessed wal I
SDace heater and vpnfDuolex (l bath) each
Additional bath Temoorary Constructi on Apol iance vent
Sepa ra tel.iater service Change in existing
res i cience
Stationary evip
coo.ler
Sewer multifamily, corm. or
-Industri a I
Vent fan with
sinole duct
Storm Sewer 0f -amps.apart from
.L.
Vent systern
heati4g or A
COI{I.1,/IND. FEEDERS Itlechanical exhaust
hood and ductInstal I /al ter/rel ocatedistrlb. feeders l,Jood stove/heater
0f amp s.
ISSIJAI,ICF OF PFRIlIT
CHARGETOTAL S ATOT,L CHARGES TOTAL CHARG ES
5Tl.JHERE LlNATE I ESR hatREQU tt re 'I ectri 1a rkr.J0 be do ne na IE ctreby ConI tractor the j Ietr l rti 00n Lf shiIshanoltr-)o rmr tbeIIItunipeIItheIabesbeenhas'|angnedby EI t ri Ica Su soI andrr-)e rv rneoretu to t he B
,iul di i 1s n0ng
l.lAl.lE ( pi ease pri nt )5 iGi{ATURE TE
US
fy
Cj ty
made
0req
the B
of any
Board
YL rt LU L comohe e iI tca onted fo r ti aapPDerm donC ec lrt th ab.y t Ia iI fo rrnanfy 1t no nhereo ,|conda s trueandtrrecIfurrthertceILhaadIaIanvworkoe rfo rmed hs Ia beI do ne nl CCa orCance +th 0rdhe nan1 s fforSo1f thIanddngthewsLaofthetaSfoteon0eartnjItotherkwoedr.lngcs bed I nhere nd ath t ilc PAI,0ccu wt,rcYS I1 beurectwithourhtessIj,]upermonof dI n-I 'I s'I .II on fu rt rIhe cert i ha t i sfym.y tr t,a 0i vlin Lthsinreg Buhe 1'I derIfuIftrceondaefecta5uredreq07RS10055byha1texfttbathefrempIs0rsInotedononhereonandSntubcorexemp t tha tiyacantorsdemDIeso-,ve who rea nI IcoItD an'i ce 0t?sth i7o 505 It/t beI onused Ith s oro.ject
Uni ts
s terisP
Res
I Fee
X: val
0c c.y
an
X
lue
L57,
an
Co f
opment
TOTAL VALUATI
Val ueLoaci
INITET;!o-
+
Demo
Fence
3
Zone
Fire Zone -.-. Bedrooms
Flood Pjain Stories
BUILDING PERI'IIT
Charges and
Surcharges
PLUI4BING PERI,tIT
Charges and
Surc ha rges
. Ftg. Access
. Ftg. 0ther
o. Ftg. llain
SidewalkELECTRICAL PERIlIT
Charges and
Surcha rges
o,2 r)
-Jz-\?/
A/C Paving Total Comb. Permit
Curb Cut
I,lECHAIIiCAL PERMIT
Charges and
Surcha rges iOTAL 3131+
NAdd
()- L/L /) -t/ \:
ELECiRiCAL
_Z
COI'TBINATION APPLICATiOII/PERMTT (cAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- fax Lot 100, Lane County Map Reference,::
1/ UJ +i
?. examole- Lot l. Block 3, Znd, r/''' |.fTYSEFiiEiield Estares ru | '
C. llame. etc. of owner and constructi (i.
D. Energy Sources
1. exarcle- heat./electricai ceiii.z. e&!.rlE r.raterh-eEEilETEEIiIE-, . _E. SguaiE-i66-tage or vaiuation-LE- i, -
1. elajrole- 13!9 sq. foot house. 5,2. a,rfiE: Ji-i-er.r oroject, check-r
checK aoii. etc -F. 3ui)dir'1 pernit int"ormarion:1. exancie - aonstruct single famil3
ait.:cneo dsrege2. exanoie - remooel existing garage3- lryq -.onverr singie iariity-re
resiaurant (change of use)G. Value of rvork as cieiined in Sect.ion 30.
Struccura i Soecia l ty CodeH. DESiGi.J I:;i.,I AiJD COIITRACTCRS
To avcii dssign or construct.ion dela-vs,Division SEafr- nusr be able to contact apersons reqardtno desfgn informai.ton or
correctt ons . etc.II. Abbre.,,1ared Plunbing, ilechan.ical, & Electr,icaA- i.tcepc r.rnere blank spaces occulin the delcrri on o,' :ne :.,lechan i ca i and El ectri cal I;he appricanr neecj fj.l l_in oniy rhe i,ro. gc
:o rne alDrorriare.item(s) to be installedB. iui l Plul:oing, iiecnanical, and Electrjcal
are ava:lable at che Euilding Division
oF gPRTNGFIELD
CirY Hoil
PERI'IIT VALI DATION
Oregon
Pubti cw ofks
REC EIPT
Soringiieid '
't'Jl,tl;L tto.
.-,- n 4 ;1B j34r*D
9
1er
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i. io ccnserve soace on the permit form th ch
have been abbre'/iated2- If the item(s) to be installed are not cthe aDbre.rrared schedules you should conful I scneoulesC. SUILDIi,ic CiYiSiON STAFT WiLL FILL OUT ALL FEE
.HARGES Oii iHE SCHEDULES0. As noied on the CAP, rhe label must be deliverelecirical contractor for signature by his eiesuoervisor. The generai contractor is not. autto srgn ine eiectricai label.
Applicant to siqn dnd date
l.Jhenever possibie, the initial 6ppiication rvill bea worksneet oniy- l/here possibje, Build.ing D.i visiorwiii prepare a tyDe wrrtten cooy and return it to thapplicanc at the time the actual permit is .issueo fosignarure.
Fees anci Charges
g
'ic
III iv ed
A
H
t{ni
,,5 LLo
luRg-atc*r
o'--e,t
rl
IV
V
gHELI oi-l uRn 'ulL
PIan check iees are cue and payable at the time of thapplication. anci no plans rvill be processec until ihe!fees are oaic. ill other fees and charges are due anopayable yrhen ihe permit is issued.
FOR OFFiCE USE ONLY
PLANS REVI EI.IED BY
\-YJd
e{,-l
Permit Clerk
PROJECT CO|,IDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
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Permit appiicant exempt from regisiration with the Builder's Board because:
Additional Project Information
t:
name gnatu re date
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