HomeMy WebLinkAboutPermit Building 1984-08-17I NSPE
725-3
CITY
COMBI',{ATI0N TI
53 ZaD 5r,Job Address
l_esa1 Description /2€7.8J_?3 . OO S-CO
EIIERGY SOURCES
Heat
liater Heater
Ranqe
WyHW:gssscOwner(a
Pernlit Info: Des ;e., Build SingieAddress /?O Se ZzD fV.'w*gv6t1'7 &srzoeT 2 Sz*rtce 3qq>rcs
Construction Lender furzr Zr><. /s - /?'x €,r/
,/or?rA 7cr4' ,/S - /€ k 52'
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Addre s s Phone
DES I GN TEAI'{name address 'rcs. no exDl res ohone no.
Primary ?ax O7? he{ttrkz.
Struc tura'l
EI ectri cal
Mechanical
ACTORS n ame addres s l ics. no-(exnirps)nhnnp no
Pl umbi nq
EI ectri cal
Itlechanical
PLUt4B I NG ELECTR I CAL MECHAN I CAL
N0.FEE CHARGF NO FFF . HA RCF NO FFF CHARGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTLI' s
Relocated buildinq
(new fix. additional)
New circuits alts
or extensions
FIoor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wal l
Snaap hpatpr and vant
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seDa rate
["later servi ce Change in existing
resi dence
Stationar.v evap.
cool er
Sewer
I ndu stri a I
multifamily, comm. or Vent fan with
sinole duct
Storm Sewer 0f amps.apart from
.c.
Vent systern
heatinq or A
COMI.I./IND. FEEDERS
Mechani cal exhaust
hnod and drrcl
I n stal I /a I ter/ rel ocate
di stri h fcpdprc l'Jood stove/heater
0f
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE
and correctof Soringfi
of any stru
Board is in
only subcon
cture without the permission of the Building Division. I further certify that my registration vrith the Builder'sful'l force and effect as required by ORS 701.055, that if exempt the baiis for lxemption is noted hereon, and thattractors and employees who are in comcliance with 0l?S 701.055 will be used on this project.
tlAtlE(please print SIGN2,
a c ta 0 fon r t a dond here cert tha at n onrmatcomppl")Derm hereo n truesb.y fy
a nd rtfu rhe cert t tha a wo DErk sharformed dobe ne an ccndaf"v ordance thwl t 0rdhe n 0ances f t Che ty
d
any
ofeathendoLawstheftaSte DC rta n n theto kwor rdesc bed h nOregonsere and atth 0ccNC ,ANCYUP wl madebe
: USE Oi,ILY 7
zone_1p/l_Jyoe/const. S-ft
Stori pq
Fire Zone Bed rooms
Ftg l'la i n
Valcroup E-? sq. Ftg.
Val ueUni ts
Flood Plain
Load 5q. Ftg. Acces
TOTAL VALUATI
Value ?@,oo
ue /P.GoN/v/.@,a.
Plan Ck. Conrn/Ind
65%/B1do Per Fee 17:iZ ?Pt.>Svsterns Deve
charqe (1.57 opment /vso'BUILDING PERI'IIT
Charges and
Surcharges -7<
ao_GA
Plan Ck. {=rp e3wEuA ffio1317;4<.
Fence rl/are: SD<y'ppcv€D 76PLUI4BING PERMIT
Charges and
Su rc ha rges D6mo 5,rg Z Yar:-
Si dewa I k
.r-v dF */sU.ELECTRICAL PERIIIT
Charges and
S u.rcha rges Total Cornb. Permit 7e.72A/C Paving
Curb CutNECHANICAL PERMIT
Charges and
Surc ha rge s 7 /9.7eTOTAL
?Lt sz sq.
cd
5a"a /a?22. -1/zz/ar 29?.?szg
ryfT-?*-e,KEZTza)>rFa,
PERMIT VALIDATION
Permit Clerk
[sUYot
)u
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 432. ela4ple- Lot 1. Block 3, 2nd Addition toSIiTfr['fteta EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. examp_le- heat/electricil ceiling/or forced air gasZ. exampie- waterheater/electrical/or soTarE. SquareTootage or valuationl-etc.-
l. example- 1250 sq. foot house, 500 sq. foot garage2. exampie- if new project, check new - if add.ition,
check add, etc.F. Building permit information:1. example - construct singie family house with an
attached garage
?. exampie - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
0ivision 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 Buiiding 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 shou)d consult the
fu l'l schedul esC. 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 theelectricai 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 wilI be, used asa worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for hissignature.
IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. AII other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
Permit applicant exempt from registration with the Builder's Board because:
a ,O,
Additional Project Information:
I
name / n&lr h/724a? sisnatur
PLANS REVIEWED BY:
date 8. ZO-A /
Phoae: 2i3-152g
PRE.CUT EUILOINGS
V. R. REYNOLDS
ROSE CITY PRE.C
",***;;,,t')o.Pfrl*)!ilf;i,Nr.
9400 N.E. Halsey Sueet
Portlaad, Oregon91220
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