HomeMy WebLinkAboutPermit Building 1987-01-20/q..>,7Job Address 2.0 /5
Legal Description
Sq. Ftg. Access.=--
Sq. Fto. 0ther.-_
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_Fence_Demo Change/Use
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EIIERGY SOURCES
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l,Jater Heater
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Descri beidence l,lith Attach ;e. , Bui 1d Single
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Constructi on Lender 7Z-Fe^a-i.
Address Phone
DES I GN TEAI.I , name address I ics. no.( exn i res ohone no.
Pri mary
St ructura I
El ectrical
llechani ca I
CONTRACTORS n ame address l i cs. no. ) ( expi res (ohone no. )
6<-Generai /)t )t 1
PI
ectr i ca I
l.lecha n i
PLUI1B I NG EL ECTR I CAL MEC HAN I CA L
ri0 FEE C HARGE NN FFF I^HAPCF NO FFF CHARGF
Each single fixture Res i dence of
SQ. FT
furnace/burner to
BTLI. s
Relocated buildinq
(new fix. additional )/
New c i rcui ts al ts.or extensi ons
.krlen= ;7)*t )11,,;a
Fioor furnace
and vent
S . F. Res i dence(l bath)SERV I C ES Recessed wa l I
Soace heater and vent
Duplex (1 bath) each ,@l//fr dftTaru.<N0fr'=
Additional bath Temporary Construction Apol iance vent
s epa ra te
l,later servi ce e in existino
ence
Chang
resid Stat i onary evap
cool er
Sewer multifamily, comrn. or
Tndrrqtrial
Vent fan with
sinole duct
Storm Sewer 0f am ps.Vent systern apart from
heatino or A.C.
c0t1t1./IND. FEEDERS i'lechanical exhaust
hood and duct
Instal I /al ter/rel ocatedistrih- feedprc tJood stove/heater
0f s.
ISSUAIJCE OF PFRIIJT
TOTAL CHARGES TOTAL CHARGES
I,JHERE STAshall not be
TE LAN REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permitvali'l until the label has been signed by an Electricai Supervisor and returned to the Bu'i1din! Division
IlAllE(please print S I GIIATURE DATE
DC
fo
I HAVE CAREFULLY EXAI1INED the completeO ap1-rticatlon for and do hereb.y certify that all inforrnation hereon is trueandcorrect, and I further certif_v that anyoringfield and the Laws of the State of
and all work oer rmed shall be done in accordance with the 0rdinances of the CityofS0relton oertaining
the Buil dinq Divi s
to the work described herein, and that NC 0CCUPAI,ICY will be madeission of ion. I further certil"y that m.y reqistration vrith the Builder,sof any structure without the perm
Board is in full force and effect as rectuired by oRS 701.055,that if exempt the basis for exemotion is noted hereon, and thatonly subcontractors and ernployees who are in comcliance with 0l?S 701.055 vri I I be used on thi s oro,ject
FOI? OF
Val
Fire Zone Bed rooms
Flood Plain Storie
Zone x
x Val ueFtgAcces s0ccy Load
0c c.y Group Sq Ftg.0ther Val ue
/Const. Units So. Ftq. l,lain
Plan Ck. Comm/Ind
65%/81de Per Fee 1. 51
opments terxs
rqe
BUILDING PERI,.liT
Charges anC
Surcharges
re_,')'do
Plan Ck. Res
31%/Bldq Per Fee
FencePLUI4BING PERMIT
Charges and
Surc ha rges Demo
Total Comb. Permit
Sidewal k
Curb Cut
A/C Paving
- ELECTRICAL PERtlIT
Charges and
Su rc ha rges
I,IECHAI.IICAL PERMIT
Charges and
Surc ha rqe s
Cr4'-ldB
,oo reTOTAL
PECTION LIIIE
-37 69 COIlBI iIATIOII APPLICATIONIPERMIT 726-375:
s
owner ()77s n/= 5
I
(
TOTAL CHARGES
T0TAL VALUATI0N_
,Ap-ft;-----
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
?. example- Lot 1. Block 3, 2nd Addition to
Spilngfield Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example-2. exampl e-E. Square foota
hea t/air gas O,ry
wa ter
ge or1. example- 1250 sq. foot house, 500 sq. foot garage?. example- if new project, check new - if addition,
check add, etc.F. Building permit jnformation:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert singie family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction delays, Bui)ding
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II. 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. Full 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 onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISiON STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the ]abel must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date
i.lhenever possible, the initial application will be used asa worksheet only. I^Jhere possible, Building D.ivis.ion Staffwill prepare a type written copy and return it to theappiicant at the time the actual permit is issued for his
si gnature.iV. Fees and Charges
Plan check fees are due and payable at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
pD re
V. FOR OFFICE USE ONLY Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY:
Permit applicant exempt from reg'istration with the Builder's Board because:
Addjtional Project Information :
PLANS REVIEWED BY
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