HomeMy WebLinkAboutPermit Building 1983-08-25N LINE
C()MBI NATI ON APPLI CATION/PERMIT69 -3753
Job Address EIIERGY SOURCES
Heat
llater
Sq
Sq
Sq
Ftq. l'lain
Ftg. Access.
Ftg. 0
l,lew IGE[ep.
Use
m,JJ
_o
-Ox
Legal Description
""LE/"D 0),our
Address .4--l-u,i/Phone Bui'lclino.Perm
Fami I y Resider
n scr
ra 'e., Build Single
Cons truct r
Phone U
name addres s exDr res ohone no.
Pri ma
Structura I
El ectri cal
Mechanical
n ame address (l'i cs- no exol res ohone no- )
\
Pl umbi
El ectri ca I
ttlechani cal
PLUt{B I NG ELECTR I CAL MECHAN I CAL
FFF C HARGE NO FFF THAACF NO FFF CHARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' s
Relocated buildinq
(new fix. additional )
New ci rcui ts al tsor extensions
Floor furnace
and vent
S. F. Res i dence
( I bath)SERV I CES Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seoa ratp
tlater service Change in existing
res i dence
Stationary evap.
cool er
Sewer multifamily, conrn. or
Industrial
Vent fan with
sinole duct
Storm Sewer 0f .amps.
Vent system apart from
heatino or A.C.
c0Mr.1./rND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al terlrel ocate
di stri b. feeders [,,lood stove/heater
0f amps.
ISSUANCI OF PFRI{IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
I,'HERE STATE L{I,I REQUIRES thAtshall not be valij until the labe
tlte Electricai work be done by an ElectriI has been signed by an Electricai Supervi
cal Contractor, the electrical portion of this permit
sor and returned to the Building Division
CARE FUL L comp app ca ti on fo r 0e rml t and do hereb.y cer tha +a '1 nfio rma t 1 o n hereo n is true
the City
be made
and
of
of
Boa
onl
c0 rrec t a nd T f U rthe r cert ,l f_v t ha t any and a1
te of Oreqon
n of the Bui
I work oer fo rmed S hall be done
work descri
further cerf exempt the
.055 w'i'l I be
I n accor da nc e wl t h the 0rd I nan fSori
anyrdi
ysu
ngfi e) d a nd the Laws 0 f th e S ta DC rta 'I n 1 ng to the bed herei a nd tha t NO OCCUP Ar.t wl l 1structurewlthoutthepermlss'I I di n9 Di vl s 'I on I t 1 fy tha t my re g 1 stra t 'I n vJl th the Bui I der s
s '|n fu I I force a nd effect a s req u1 red by ORS 701 05 5 tha t ,l ba s 'I s for exempt 1 0n 'I s no te d hereo n a nd tha L
bc 0n trac tor s and emr)0yees r.lho a re 1 n comD I I ance WI t h 0tls 701 us ed on th 1 s p roJ ect
l.lAtlE (pl ease pri nt 3n7r,t &,/sz IGNATURE rE f -zf-/5
Zone__Tyoe/ Cons t -ts So. Ftl,. ilai Val ue
Fire Zone Bedrooms.Load Sq. Ftg Acces s X lue
Flood Plain Stories 0cc.y Grou Val ue
TOTAL VALUATION--
Ftg. 0ther
U ,1 -
Pl an Ck. Conrm/Ind
65%/8ldo Per Fee 1
rVe
57
opment
e
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
D6mo
ELECTRICAL PERI1IT
Charges and
Surcha rges
Sidewal k
A/C Paving Total Cornb. Permit
I,IECHANICAL PERHIT
Charges and
Surc harges
Curb Cut
IOTAL 3't bb+
Addres s
: ltsF oilr Y/
BUILDING PIRMIT
Charges anC
S u rc ha rges
PERMIT VALIDATION
,46, E3
Permi t Cl e
C\uoX-
-r(
t:
btrfiq
COMBINATION APPLICATION/PERHiT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot l. Block 3, Znd Addition to
Springfield Estates
C. Name, etc. of owner and construct'ion lenderD. Energy Sources
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
FEEtiiFant (change of-use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI4 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, Mechanical, & Electrical 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 installedB. Ful1 Plumbing, l'lechanical, and Electrical Schedules
are avaiiable at the Euilding Divisionl. 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 thefulI schedulesC. 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 label
Applicant to sign and date
lJhenever possible, the initial application will be. used asa worksheet only. I'lhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
s i gna ture.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans wiil be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
II.
III.
IV
v
I
e ec rea2
tn or forced air qast/eiectrical cei
E. Squa r valuati 0n, e
or solar
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
datenamena tu res'l g
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