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Home My WebLink AboutPermit Building 1986-08-19-lwd IIISP 7?6-0rr LittE TION,TION APPLICATI ERMIT i.l 69 c0rlB I N 7?6- Job Address l-egal Description EIIERGY SOURCES: Hea t Ra l,later Heater Owner Val llork:GA rtg. R..e-- Sq Sq Sq . Ftg. tlain Ftq.Other Add res s Phone tI .e., Bun Farn nf, Ni o: Des n9be liork ed Gara Construct i nn Lender Addres s Phone $ $ on Pri Structura I El ectri cal l'lechanica I III name Genera l PI cal han i PLUIlB I NG ELECTR I CAL MECHAN I CAL FFF CHARGE NN FFF CHARGF il0 I FFF I CHARGF Each single fixture Res idence of SQ. FT furnace/burner to BTL|' s Rel ocated bui I dinq (new fix. additional ) New ci rcui ts al ts.or extensions FIoor furnace and vent S. F. Pesidence Ll bath)SERV I C ES Recessed wal i Soace heater and vFnt Duplex (1 bath) each Additional bath Temporary Constructi on Apo) iance vent s eDa ra te [,]ater service res i dence Change 'i n ex j sti ng Stationary evap cool er Sewer mul ti fami ly, conrn. or I ndustri a I Vent fan with si nol e duct Storm Sewer 0f Vent systern apart from heatinq or A.C. COMI.,!./IND. FEEDERS Mechanical exhaust -hood and ductInstal I /al ter/rel ocatedistrib. feeders l'lood stove/heater 0f amp s. ISSUANCF OF PFRITIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ,TE L,ll',l REQUIRES that the Electrical work be done by an Electrivali'l until the label has been signed by an Electrical Sufrervi cal Contractor, the electrical port.ion of this peni.itsor and returned to the Building Division HHENE STA shali not be S I GiIATURE rE g- /7-* by ty made exempt I HAVE CAREFULLY EXAITINED Lhe completed apolication for oermit, and do here certify that a.ll information hereon is trueand correct, and I further cert.ifvof Soringfield and the Laws of the that any and a1 State of 0reoon 'I work performed shall be done i n accordance with the 0rdinances of the CiDertaininq to the work descri bed herein, and that ItC 0CCUpAItCy will beof any structure without the permission of the Buil ding Division. i further c ertify that m.y reqistration vrith the Builder,sBoard is in full force and e ffect as required by ORS 701.055, that if the basis for exemption is noted hereon, and thatonly subcontractors and ernfil oyees who are in comciiance with 0l?S 701 .055 will be used on this Droject rrAlrE(prease print) CA G:lf ;1.^! Plan Ck. Conrn/lnd 65%/81do Per Fee Svs Cha tens Deve'rqe ( 1.5x opmentBUILDING PERIIIT Clrarges and Su rcha rges Plan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Dgmo Sidewal k ELECTRICAL PERI:IT Charges and Surcha rges A/C Pavi ng Total Cornb. l.ermi t I,IECHANICAL PERHIT Charges and Surc ha rges Curb Cut TOTAL //.75 UI rLslbrt ILAt.t ( name i addre s s Flood Plain Stories _0cc.y Group Sq. Ftg . 0ther Load So. Fto.Fi re ts So. Ftg. t,tai //.7{ coMBTNATI0N AppLICATI0N/PERHrT (CAp) I. Applicant to furnishA. Job AddressB. Legal Description l. example_- Tax Lot .100, Lane County l'1ap ReferenceI7l3-432. examole- Lot l. Block 3, 2nd Addition toSEifnliield EstaresC. Name, etc. of owner and construct.ion lender!. Energy Sourcesi. examole- heat/electrical ceilinq/or forced air qasz. examo I e- waternEaTEiTETEErir cElTor soIaF- l. examoie- 1450 sq. foot house, 500 sq. foot garage2. exampTe- -if new project, check-iEw - if uOaition, check add, etc.F. Building permit information:1. example - construct single family house with aneffiIed garage ?. examole - remodel existing garage into family room3. eGmplE - convert single iafrily"resia"nc. into --" restaurant (change of use)G. Value of work as def.ined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building0ivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrect.i ons , etc.II. Abbreviated Plumbing, t"lechanical, & Electrical SchedulesA. Except where blank spaces occur .in the descrtption-portion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes aOjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedu'lesare available at the Bujlding Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbrev.iated schedules you should consu.lt thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricajsupervisor. The general contractor .is not authorizedto sign the electr.ical IabelIII. Applicant to sign and date Hhenever possible, the.initial application will be used asa.worksheet only. Where possible, Bui lding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wil) be processed until thesefees are paid. All other fees and charges are due andpayable yJhen the permit .is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION bbtuq2f to'\\'\U Perm'i t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from regjstration with the Builder's Board because: Additional Project information: PLANS REVIEWED BY: name c i gnature da t" 3^/?&