HomeMy WebLinkAboutPermit Building 1989-12-20Cc)MBi
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Construction Lender
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Value of llork
Ranqe
776-37
l,later Hea ter
Job Address
Legal Description
owner
Address s i denc Attached Ga
ETIERGY SOURCES
TI IT
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IPhoneAddres s
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Structura I
El ectri cal
Mechanical
exDl res (phone no.addres s (lics. no.name
J
S/El ectri
hani
MECHAN I CALELECTR I CALPLUHB I NG
a
FFf CHARGFFFFTHARGFNOFEFCHARGENON0.
furnace/burner to
BTLI' s7.5b /2alo
Residence of
FTSQ,6 Each single fixture tr Floor furnace
and vent
Relocated building
(new fix. additional)/(1
New ci rcui ts al ts
or extensions
Recessed walI
SDace heater and ventSERV I C ESS. F. Residence
( I bath)
Duplex (1 bath) each
Apol iance vent
seoarat-eTemporary Constructi onAdditional bath
Stationary evap
cool er
Change in existing
res i dencel,later serv ice
Vent fan with
s inole duct
multifamily, corm. or
Indust-rialSewer
Vent systern apart from
heatinq or A.C.0f amps.Storm Sewer
Mechanical exhaust
hood and ductc0Mr.1./rND. FEEDERS
l'Jood stove/heater=*
Insta l I /al ter/rel ocate
d'i strih- feeders2,2-D9/% ./-*
<,2 ,/<7'0f amps.4
d 7@k24ss72)'z -t--a ,4 fu<a2976ara (,2 ?v*a 6 -4'2172.2H4 Gp?kz4-raFl -
=vt ?7€'tqzzbzt- 4/5%rfu-5i:.<
>;AfuDdssuANcF oF PFRt,ur4
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES /?.*
WHERE STATE LAI.J
sha I I not be val i'l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of
until the label has been signed by an Electrical Supervisor and returned to the Building Division
this permit
DI\TE/Z- >d-87I'lAl.'lE (pl ease pri n S IGNATU
v
/o('/ n
anyrof 0regon
he Buiof any
Board
permi
'f ect
n rmafo t on reonhe t erusfthaticafoonrtrmIadondherecertYepebYEDCARHAVELEFULcomp
thwl 0rdthe na nc of cthesn
app
and nceorda tyaworkshrmedabenedoaandtndafuerthrrtthaLrrerfocorreccefy
I,tc wl be madePAnthI.t0andrtathetorwodekrscrtfeanddLtheawsftheSta te DC gSpng
Bu der shetthv,ltradsvlonfutherathrutctutwlutssoft0ntDirehothesv
nda tthanheotedreonstbanthafesfuforcendaefsredORS
ng
701a 055 trequiby
0on ube505nawlnce0t?sth 7utracbconandto rs who rea compIyempoyees
Flood Plain Stor:es 1y'2 €r/lZ, occy eroup4L4/Z-Zq. Fts
Fire Zone
/
x
x
T,'Yle/Const. 4/.V Units x %rEnat,"3744e-
Bedrooms r 0ccy load 2OZ Sg. Ftg. Access
0ther
Tone CZ Ftq. l1a j n
Value
Value
lvll-l,q 5{l-l
Plan Ck. Corrn/Ind
65%/B1do Per Fee
rlq3 .33tL Svstems Deve
charqe ( 1.51
opment fl"4.BUILDING PERNIT
Charges and
Su rcha rges
_?_?f.,fe__
4?.za Plan Ck. Res
30%/Bldq Per Fee Zr**v/4?/*b4,<
Fence 42r*.*z (Zrzae*< PPLUI4BING PERMIT
Charges and
Surcha rges
_/24-=_
Dgmo z.5s>2.-
Sidewalk 7n-?f - //6,26ELECTRICT.L PERIIIT
Charges and
Surcha rges A/C Paving Total Comb. Permit ,'/ 7r.'24?Mt-#tfltt r ql.soI,IECHANICAL PERMIT
Charges and
Surcha rges
/a 79,6f/na{ b-7,Wn +aB TOTAL
5q. Ftg. Access.-
Sq. Fto. 0ther--
I'lew Add Al ter P'eP.
-Fenile-oerno C h5-n ge/ U se
0ther
:TORS
Ott >-x ,
H \r-r t,or ,P.l.:\la
?,/-tz ,
ToTAL VALUATI0N_
PERMIT VALIDATION
Peimit Clerk
Ac(\
br.rLL
\\
I
COMBINATION APPLICATiON/PERI'IIT (CAP)
II.
III
IV.
Applicant to furnish
A. Job Address
B. Legal DescriPtion
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. examole- Lot l. Block 3, 2nd Addition to
Sprinqfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
l. example- heat/elect!-ca-l-cei 1 in3/o
2. example- waterheater/electrlca l/or
E. Square footage or valuation, etc.
l. example- 1250 sq. foot house' 500
2. diample- if new project' check new
check add, etc.
r forced air gas
solar
sq. foot garage
- if addition,
V
F. Bui lding permit information:
1. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examEfe - convert single fanrily residence into
FESTi-urant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SPecialtY Code
H. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays' Building
Division Stafi must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.
Abbreviated Plumbing, Mechanical, & E.lectrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules'
the applicant need fill-in only the No. Boxes adiacent
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedules
are avai lable at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful l schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrica'l contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label '
Applicant to sign and date
Whenever possible, the initial application will be. used as
a worksheet oniy. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applitant at the time the actual permit.is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of the
application, and no p)ans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
FOR OFFICE USE ONLY
PRoJECTCoNDITIoNST0BESATISFIEDBEFoRE0CCUPAIICY:
eb aC Su eerdrdSBoahtBeurtnotW1hSItaftromIncaetregPrmatxempepp
Addit'ional Proiect Informat'ion :
PLANS REVIEWED BY:
name Z,€-dat e ,/2-?-87signa tu re
IIi'l
I NSPEC
726-37 COMBI APPL I CATI ON RMIT 7
4 EIIERGY SOURCES Ftg. Mai
Job Address ./) -.{1
-
Hea
llater Heater
Ra
Value of l,lor k:/t'YOwner
\
N
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Address {qr</Y. )4. 7a:. o4\"!na?Builciihq Pernrit info: Descrit
Fami'l y Residence I,lith Attachet ra
..e., Build Single
struction Lender
Address Phone
DESIGN TEAM name address tcs. no.exDt res
Pri ma ry
Structura l
E l ectri ca l
Hechanical /*Z vff /,h;cA,
name a ddres s I i cs. no. ) ( exoi res ohone no. )
Gene ra I
Pl umbi nq
El ectricai
r,rechani ca r,hZYaZ /,Vf.-o
PLUI{B I NG ELE CTR i CAL MECHAN I CAL
N0.FEF CHARGE N0.FFF CHARGF NO FFF CHARGF
Each singie fixture Res.idence of
SQ FT
?/
furnace/burner to
!/roartHat'' '
a
2.7 /*7&
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extens ions
Floor furnace
and vent
S. F, Residence(l bath)SERVICES
Recessed wa l I
Snace hpater and vpnt
Duplex (l bath) each
Addi tional bath Temporary Construction Apol iance vent
seDarate
blater service Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, conrn. or
Industrial 6 Vent fan with
sinole duct a ,/P
Storm Sewer 0f amps.
Vent system apart from
heatinq or A.C.
COMI"I./IND. FEEDERS
Mechan i cal exhaust
hood and duct-
I nsta l I /a l ter/reI ocate
d i stri b. feeders l,Jood stove/heater
0f 4 fuPrerr*:,P ?n
ISSUANCE OF PFRI{IT
TOTAL CHARGTS TOTAL CHARGES TOTAL CHARGES /tsa
WHERE STATE
shall not be va
LAll REQUIRES that the Electrical wo'Ii:l until the label has been signed
rk be
by an
done by an Electrical Contractor, the electrical portion of this permit
E'lectrical Supervisor and returned to the Building Division
FUL L E XAM I N ED t he comp e te ap!-)
and
ca t 1 on fo r perm ,l t a he re b.y ce rt 'I fy t ha t a I I 'I n frorma t 'I on is true
the City'I be made
ilder's
and that
a nd co rrec t an d fu rth er cert 'I fy that any
State of
sion of
a I I t{,0 rk perfo rmed s ha I I be done I n ac cordanc e 'I t h th 0 rd 1 n ances of
bed 1 and tha r{0 0 cc UPANCY 'I 'lof Spri
of any
Board i
ng fi e I d an d the Laws 0 t the 0 re!0 n oe r Ld 'I n I n g to th e work desI further
i f exempt
1.055 rvi'l I
crl he re n t
t ru ct ure wt t ho ut the pe rmt s the Bu '1 I d I n9 D I I s I 0n ce rt 'I fy t ha t m.y re g 1 s tr,a t '|o n vir th t he Bu
s 'I n fu I I force a nd ef fe ct a s recl UI red by ORS 7 01 0 55 tha t the ba 5 'I s ftor exempt 'I 0n 'I s noted here on
on 1y s u bcon tr ac to r s and emp I oyees who a re 1 n COMD I 'I an ce wl th ORS 70 be us ed on th ,l s p roj e t
t'lAtlE(please print)IGNATURE T
zone <1 1 rype/Const.9,/ Units Ftg. l'lain x Value.
Fire Zone Bedrooms Occy Load ?az sq. Fts Acces s Val ue
Flood Plain ,,//Z.dr.S, occy erou/l/,?'2sq. Fts. lther4l/,/a- 2?%4 va1
TOTAL VALUATION
Stori es
BUILDING PER}IIT
Charges and
Su rcha rges
Plan Ck. Conun/Ind
65%/Bldq Per Fee
Svstems Deve
Charqe (1.5%
opmmt
Plan Ck. Res
30%/BIdq Per Fee
PLUMBING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERTIIT
Charges and
Surcha rges
Sidewal k
A/C Paving
Curb Cut
Total Comb. Fermit
I4ECHANICAL PERMIT
Charges and
Surcharge s
S2
?-? a TOTAL 77-?9
Sq. Ftg. Access.-
Sq. Ftg. 0ther--
l,lew Add Al ter PeP.
_-ienE-e-06-mo-Change/Use
-other_--.--
t_
l-egal Description
ronp nn
a2 -rtz4- .4,/- .- -z-- rE->' M+-7y2r'62 /
:TORS'
PERMIT VALIDATION
Permi t Cl er
t3c ('UL A
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal DescriPtionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to+.SpFlngfield Estates
C. Name, etc. of owner and construction Iender
D. Energy Sources1. 6xample- heat/electricgl celli!q/or fqrced air gas
2. example- waterheater/electrlca I/0r !9-l3IE. SquaiE-Footage or valuation' etc.
1. example--1250 sq. foot house'.500 sq' foot garage
2. exampTFJT-i-ew proiect, check-i-ew - if addition,
EfiecI'-add, etc.F. Building Permit information:1. exaipie - construct single family house with an
attached garage
2. example --remodel existing garage into family room
3. AETFTE - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structura'l SPecia ltY CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays' Building
Division Stafi must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules'
ttre applicant need fil|-in only the No. Boxes adiacent
to the appropriate item(s) to be installed
B. Ful I PIumbinb, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be instal'led are not covered on
the abbreviated schedules you should consult the
ful l schedulesC. BUILDING DIVISION STAFF t.lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractoris nol! authorized
to sign the electricaI Iabel.
III. Applicant to sign and date
Hhenever possibie, the initial appiication will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applitant at the time the actual permit is issued for his
signature.IV. Fees and Charges
Plan check feis are due and payable at the time of the
application, and no plans will be processed until these
flbs are paid. All other fees and charges are due and
payable when the Permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registratjon with the Builder's Boa rd because:
Additional Proiect Information:
PLANS REVIEWED BY
dale /ZgnaturenameR€/-< Si
L COMBI L T 725-3753
EIIERGY SOURCES:Sq n
Job Addres Hea t So. Ftq, Access.
l-egal Description llater Heater
Value of llork
B
.0j
Add ,\vn ".l1r-.o t n scr
l,ri th
..e- Suild Single
/r\Iri\
Cons t I , 8'["'l
Addres s Phone
DESIGN TEAI4 name address exDt res rone no-
Primar.y
Structura I
E l ectri cal
llechan i ca I
I
\7
El ectri cai
ilechanical
PLUI{BI NG ELECTR I CAL MECHAN I CAL
FFF C}IARGE Nn_FFF TIIAACF NO FFF
Each single fixture Residence of
SQ FT
furnace/burner to
BTtl' s
Relocated building
(new fix. additional)
New ci rcui ts al ts )',
or extensions ,)
Floor furnace
and vent
S.F. Residence
( 'l bath )SERV ICES
Recessed wal I
Snacp hoater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Appl iance vent
qpna ra t-e
llater service Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily, corm. or
I ndustri a I
Vent fan with
sinole duct
Storm Sewer 0f amps.
Vent systern apart front
heatinq or A.C.
COMII./IND. FEEDERS
Mechanical exhaust
hood and duct
I ns ta I I /a I ter/rel oca te
di <tri h. foeders l'rood stove/heater
0f amp s.
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES
HHERE STATE L,1ll REQUIRES that the Electrica'l work be done by
shalI not be valid until the label has been signed by an Electri
an.ilectrical Contractor, the electrical portion of this pernit
ca1 Supervisor and returned to the Building 0ivision
comp e ted appl i ca
' and all' 0regon
the Buil
t I on r pe t a nd do herc by ce f.y tha t a I n t I n hereo n I s true
a nd correc t a nd I fu rthe r cert I fy that any
State of
sion of
work nerfo rmed sha I I be done a cco rd 0rdinances of the c 'I ty
k desc r t NC 0CCUPAI.ICY wi l l be madeof Spriof any
Board i
ng t I 'I d and the Laws f the DE r ta I 'I I to the wor he
s tructu re without the permis
ll force and effect a
d ing Divis
701.055,
I on I further rt 'I fy m.y_stration rrrith the Builder's
ion is noted hereon, and thatsInfusrequrredbyORSthatIf
only subcontractors and employees who are in compliance with 0l?S 70 5 s ect
I
I'lAtlE(please pri I DATE
Zone Cons t.i ts So.Ftg
Ftg
Ftg
l{a i n Vai
Fire Zone Bedrooms.
Flood Plain Stories
Load . Access Val ue
Group Sq x Value
TOTAL VALUATION
0ther
BUILDING PERI'IIT
Clrarges and
Surcharges
Plan Ck. Conm/lndiSllBldo Ppr Fpc
Svstems Deve
Charqe (1.57'
opment
Plan Ck. Res
30%/Blde Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Domo
ELECTRICAL PERIIIT
Charges and
Surcha rges
Sl dewa l k
A/C Paving Total Comb. Permit
HECHANICAL PERHIT
Charges and
Surc harges
Curb Cut
TOTAL \4,.Ec
Sq. Ftg . 0ther
aua pcF
TOTAL CHARGES
COMBINATION APPLICATION/PERI.1IT ( CAP)
I. Applicant to furnish
A. Job AddressB. Legai Description
1. CIgrnp_]_C- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, Znd Addition toS[Fffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. example- heat/electrical cei)i1g/or forced air gas2. EIIfrETe- waterhelTiTelect-rTcTilor sdiar _-
E. Square footage or valuation, etc.l. example- 1250 sq. foot house, -5_9Q sq. foot garage
2. example- if new project, check new - if addition,cIEFadd, etc.F. Bui Iding permi t information:l. examplg - construct single fanri)y house with an
attached garage
2. Crarry-lg - rernodel existing garage into family room3. example - convert single fanrily residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeII. OESIGN TEAI4 AND CONTNACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infornration or job site
corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedu'les
are available at the Bui ldinq 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 theful I schedulesC. BUILDING DIVISION STAFT lJILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorized
to sign the electrical label.III. Applicant to sign and date
Whenever possible, the initial app)ication will be, used as
a worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to the
appl'icant 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 will be processed until these
fees are paid, AII other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
\\#
\
+
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Perm'it appf icant exempt from registration with the BuiIder's Board because:
Addit'ional Project Information :
PLANS REVIEWED BY:
name SI gn ature date
INSPECTION LINE
7?6-37 69
CITY OF SPRINGFIELD
Cr)HBI NATI ON APPL ICATION/PERMIT
INMMMTION LINE
726-3753
Legal Description
Job Address
Ranqe ^\
EIIERGY SOURCES:
Hea t
'l'N-/Value of l,lo
4N
Sq. Ftg. I'lain-
:q. Ftg. Rccess]
Sq. Ftg. 0ther__
I'lew Add Al ter Pep.
_Fe nc e_l-@o_C h a n g e/ U s e
0ther
0wner [.lf,Ken!i " Ent""pr.ises , Inc.:e., Build Singlenh
Re
Builriir
1,f ami I y
Perr
sid
scr
nce lli th At
nAddressPhonZ45eBt?20 tlo. 5t-h Street ;5
I \
\. lll,Construction Lender
f]\-it \d'ffr
00
-O
E--I
Address Phone t
hone no-DL5I GN I LAI4 name addre s s I ics, no
Pri ma ry \
Structura I
El ectri ca l
Mechani ca l
ohone no-name add res s ( l ics. no. ) (exoires
ran anton,ugene,regona,ne, Jr
Electrical
l,'lechanical
ELTCTRICAL MECHAN I CALPLUI.IB I NG
FFFFFFCHARGFNOFFFCHARGFNON0.
Residence of
SQ. FT
furnace/burner to
BTLI' sEach single fixture
New circuits alts
or extensions
Floor furnace
and vent
Relocated bui Iding
(new fix. additional)
SERV I C ES
Recessed wal I
SDace heatpr and vent-
S.F. Residence(1 bath)
Duplex (1 bath) each
Temporary Constructi on Apol iance vent
seDa ra teAdditional bath
Change in existing
res i dence
Stationar.v evap
cool erI^later servi ce
ormultifamily, conm
Tndrrstrial
Vent fan with
sinole ductSewer
0f s.Vent systern apart from
heatinq or A.C.Storm Sewer
+I
c0Mr.r./IND. FEEDERS
Mechan ical exhaust
hood and ducthamn] i'Finn nanm
InstaI I /a l ter/reI ocate
d'i stri h- fpedprs trlood stove/heater
r -' "'
amp s.0f
Demol itt'on pernr i t or ly u0t',tE
ISSUANCF OF PFRtlIT
TOTAL CHARGESTOTAL CHARGES (TOTAL CHARGES
l.lHERE STATE LAI'I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali,J until the label has been signed by an Electrica'l Supervisor and returned to the Building Division
D^IE?-ZllAl.lE ( pl ease pri nt S IGNATURE
Valuex
x.0ther
Ftg l'la i n
Access
its
Load Ftg
Group Sq. FtS
Zone___Tyoe/Const. _ Un
EXAtlINED the completed appl o hereb.y certif,y that all information hereon is truecatt, anon!'re
fy ny
of 0regon
,he Bu iof any
Board
permi'fect xempt
5 vri'l
nIIworDerkofrsrmedIhabeInedoIndadanfu rtherI ertc I tha atdanrrecc0t
art n'I ,l theto rwo dk sce 1rSrlefidIdanLatheofwsStatheteofpen9png
v'lDi IS 0n fu rtherIsIdirutcttwluthothesson1tofure fytsbaathtIfe055InI'Ifu I a I ORSa
ng
701sforcendefredsrequby
u'Ion I 1 7 0 05 IsutracbcontorandIawhorenIceanthwl011svempoyeescomp
Val ue
ValueStori esFlood Pl ai n
BedroomsFire Zone
nce with the 0rdinances of the City
PAI'ICY wiII be madein, and
vrith the Builder's
noted hereon, and thatfortiat m.y
Plan Ck. Corun/Ind
651"/91tlo Ppr Fpe
Svsterns Develooment
Charse (1.5U)'BUILDING PERNIT
Charges and
Su rc ha rges Plan Ck. Res
30%/Bldq Per Fee
FencePLUI,IBING PERMIT
Charges and
Surcha rges Dgmo
SJdewal k
Total Comb. Permit
ELECTRICAL PERI,IIT
Charges and
Surcha rges A/C Paving
Curb Cut tE,10TOTAL
I,IECHANICAL PERMIT
Charges and
Surc ha rge s
{
[,later l{eater
TPlrt
{)l
Ynr rpq
:TORS
ToTAL VALUATIoN_
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43?. example- Lot 1. BIock 3, 2nd Addition toS[iffiTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat,/electrical ce.iling/or forced air gas2. EiEmEl-e- waterfiEETEiTeTEE[fitl-l7or soTli---E. Square footage or valuation, etc.1. example- 1250 sq. foot house, 500 sq. foot garage
2, example- if new project, check new - if addition,
EIec[--add , etc.F. Building permit information:1. example - construct single family house with an
attached garage
?. example - remodel existing garage into family room3. example - convert single family residence into
reitaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid des'ign or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.IL 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 adjacent
III
to the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedules
are available at the Building 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 the
ful I schedulesC. BUILDING DIVISION STAFF t.JILL 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 electrical
supervisor. The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Whenever possibie, the initial application will be used as
a worksheet oniy. Where possible, Bui)ding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
signature.
Fees and Charges
Plan check fees are due and payable 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.
FOR OFFICE USE ONLY
IV.
PERMIT VALIDATION
ID'&'tq
Permit Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY
name Si gnature date