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Home My WebLink AboutPermit Building 1986-07-17COHBI ERMTTICATI 726-37 L AP Job Address & Legal Description Ranqe llater Heater EIIERGY SOURCES: Hea t -ot6( IOwner?).p Val ue tlork Sq. FtO. Access._ Sq. Ftg. OtherJ,lewJdd_AlaerT!:- _Fence_Demo_C han gel U se 0ther . Ftg. l.lain Address q?g PhoneIt €kral t In scr l.lo rk e.,I i G ng e rCons truc t i on Le Address Phone oo so s \) name Pri ma Structura l EI ectri cal l{ec han i ca I PLUIlB I NG ELECTR I CAL M EC HAN I CAL FFF CHARGE NO FFF CHARG F ilo I FFF CHARGF Each single fixture Residence of furnace/burner to - BTLI' S >Q. Relocated buildinq (new fi x. addi ti ona I ) New circuits aits. or extensions2 oA rwTe Floor furnace and vent S.F. P.esidence(l bath)SERV I CES Recessed wal I Soace heatpr and vpnt Ouplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seoa ra te l.la ter serv i ce e in existing en ce Chanq resid Stationary evap. coo I er Sewer Industria l multifamily, conrn. or Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C.c2>grrr.*,/s*COI4I.!./IND. FEEDERS Mechan i cal exhaust hood and duct I ns ta l I /a l ter/ re l ocatedistrib. feeders Ilood stove/heater 0f ISSUANCE OF PFR!,IIT TOTAL CHARGES /s.TOTAL CHARGES ?e-;;o IOTAL CHARGES /f* llAl'lE(please print)I be done by an Electrical Con an Electrical Sufrervisor and tractor, the electrical portion of this pernit returned to the Building Division any of Ci ty madeany rd IXAIl EDN e ted I1 tca ,l n rcompap!')t'I and doDerm he re rtce i tb.y ha +a I I n rma to on'Ify ihereon truescondatrrecandIfurtherIerttthafya1Irkl^/Oand shaoerformed II donebe nI ccoa rdanc e wl ht 0the 'Ird nan ces theofSortfoIedndathng fi e wsLa theof State 'Irta 1 n theto wo k0regonoegr desc ir hbed Iere n and tha t ilc CY0ccuPAt{'IWI beIfo5treructuthouwlttehIsoniofpermtheBu1'I d.i vlDi ts on fuInq cert'irther tha t s ttra 0ni'fy m.y reg i thvt1 the Iut der sBoas'|nI f u I1 andforce fecef ast '|red ORS 7req 0 05I 5 ttha I fby the bas si rexemptfo '|Ionexempt ns heoted reon a nd th talonsvtrubconto rsac dan I s who Iernpoyeeare n I a'Icomo wlnce ht 7010t?s 055 be edus on th s'I ec tproj I,JHERE STATE LAI,J REQUshall not be vali.l until IRES that the Electrical workthe labei has been signed by TOTAL VALUATI ON Ftg. l,lain Val lue 'I u 05 t. Uni ts Flood Plain Stori 7o es occ.y Group Sq. Ftg. 0ther cy Load Sq. Ftg. AccesFire Zone Bedrooms 0c Plan Ck. Comn/Ina- 65%/81do Per Fep EA Systerns 0eGToEmEfr- Charqe (1.5C)'_d4.BUILOING PERNIT Charges and Surcha rges 6./o5D Pl an Res I FencePLUI,IBING PERMIT Charges and Surcha rges /? ao .6;0 Demo SldewaIkELECTRICP.L PERIIIT Charges and Surcha rges A/C Paving Total Cornb. Permit z /7.2a Curb Cut T,IECHANICAL PERHIT Charges and Surcha rges * .4o TOTAL 3tz.Ts I II5PECT I ON 7?6-37 69 \r ul al.n I .)luI{ tLAt.1 (addrpss ohone no. SQ. rr. ) * ( F.e' ' , PERMIT VALIDATION Permi t Cl erk (,aqct E.ll-bU COMBINATION APPLICATION/PERHIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descrjption t. example- Tax Lot 100, Lane County 17 03 43 2. example- Lot l. Block 3, 2nd Addi sp-Fingfi el a Estates C. Name, etc. of owner and construction0. Energy Sources1. examole- hea2. EIaFi-I6- watE. Square footage o t/electrical cei I i 'Map Reference tion to I ender or forced air gas car valuation,l. example- 1250 sq. foot house, 500 sq. foot garage 2. exampie- if new project, check new - if addition, ctrEET-aod, etc.F. Building permit information: 1. example - construct singie family house with an attached garage 2. example - remodel existing garage into family room3. example - convert single famiiy residence intoiEtaurant (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 job site corrections, etc.II. Abbreviated Plumbing, i{echanical, & Electrical SchedulesA. Except where biank spaces occur in the descriptionportion of the Mechanical and Electrical Schedu'les, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Ful l Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. 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 thefull schedulesC. BUiLDING DIVISION STAFF WILL FILL OUI ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electrical supervisor. The generai contractor is not authorizedto sign the electrical label.III. Applicant to sign and date t.Jhenever possible, the initial appl ication will be used as a worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to the appiicant at the time the actual permit is issued for his signature.IV. Fees and Charges Plan check fees are due and payab)e at the time of theapplication, 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 erhea ter,e ec tr or sol ar PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Perm'it applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s'i gnature da te V2/-%