HomeMy WebLinkAboutPermit Building 1983-09-147
I NSP726-
NE T 725-37COMB I APPL I
q,
ooLega1 Description
Job Address
Val ue of (5()
Hea
EIIERGY SOURCES:
llater Heater
Owner
@
Sq. Ftg. Access.-
llew
Sq. Fto 0ther
'I ter_Rep
Use
PhoneAddress - \ U Descri
GaraFdence
ng e
)n^tP-o-Dld,o-o - t
Construction Lender
Address Phone
Hec han i ca I
Electrical
Struc tura I
Pri
exp i res )(
I
PLUIIB I NG ELECTRICAL
I'{ECHAN i CAL
Each single fixture Residence of
SQ. FT
frurnace/burner to......-.".- BTU,sRetedoca'Ibu dI 'I ng
new(fi x.add t 'I1 ona l )
Duplex (l bath) each
Res
New circuits altsor extensions
SERV I CES
FIoor furnace
and vent
Rec essed wal I
Additional bath
llater service Change in
res i dence
existing
Temporary Constructi on App I iance vent
seDarat
Sta onary evap
Sewer orImutfamiIcommv Vent fan th
Storm ewer 0f
tlood stove/heater
sys tet"l rt from
ca stc0Mt1./IND. FEEDERS
0f
Insta I l,/a I terlrel ocate
ISSUANCE OF PFRI.lJT
IOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
by an
ri cal
I.JHER E STA TE 1l'/L.REQu thaRES tt EIhe triec c a wo rk be donsha e E ecbenot ctri aVAI ntraCoUNtth rctoea ectheEbehas ctribesen'I rtp0 on fgnedaEn th sbyECt fpermisorSupe rv a nd re rnedtu to t he Bu di VIDing on
l{Al.lE(please pri
IGiJATURE
qon
Bui
any
rd
Ci ty
madePermiffect
het ecomp 0ntiappdanco rrec t DC t andaf dou he recerher ertctb.y atth athataty forma ontifyndaa henyw0r re0n s tofkfo rueefiperrmedsn9ddanSprr'hathe dobe neLat,is fo nsthe accorda ncteta e twl h0reof the 0rd nf a nces ofoDe rta n thestongworktheturetruccrldesthwtbedtouthehenrelssoofnandthathetNCOCCUPAHCYdwtBoaDsnbengsonfufo rce cfurthereand rte tthaafyrequred my rat t on0Rsregi l,J l thon055by701 the Busubconftha derlytractantorsdLheexemptbasernrJforoyeewhoexarenonsnotedcomcwlancehthereonS0r?thaand055701 tw'l be thon ect
Ind___la (1.5i
Res
1
ValFtg. Acces s
an
an
Iue
Load
lue
t
opment
BUILDING PERI'IIT
Charges anC
Su rcha rges
Group sq. Ftg. other
ToTAL VALUATTON_
Fire Zone Bcdrooms
Flood Plain Stories
ts SQ. Ftq. t,tain
PLUI4BING PERMIT
Charges and
Surc ha rges
Fence
Dgmo
Sidewalk
ELECTRICAL PERI'IT
Charges and
Surcha rges
Tota'l Comb. permit
A/C Paving
Curb Cut
I{ECHANICAL PERMIT
Charges and
Surcha rges
TOTAL ,fl1 o40
\(addrpsirame )Dhnne nn
L
amps.
s '|
Uni
PERMIT VALIDATION
* 6l k8&
Perm'it Cl erk
(
v,hq-l
COI4BINATION APPLICATION/PERMIT ( CAP)
Applicant to furnishA, Job AddressB. Legal 0escriPtionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. examDle- Lot l. Block 3' Znd Addition to
SpTii'gTi et o Estates
C. Name, etc. of owner and construction lender
D. Energy Sources cal cei l i or forced air gasexampl e-
examp I e-
re footag
heat/el ec r s6TIF-2 wa ea ter o
E. Squa e or valuation,
example- 1250 s,
example- if new
EI-eEI-Ed, etc.
q.foot house, 500 sq.foot garage
2.proj ect, check new -if addition,
II
F. Building Permit information:
1. exatpie - construct single family house with an
aTGiTEa sarase?. ;i;;pia --rer6del existing garage into familv room
3. exam6']e - convert single famity residence into
EiTilurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SPecialtY Code
H. DESIGN TEAM AND CONTRACTORS
io-iroia design or construction delays' Building
iirition Stafi must be able to contact appropriate
;;;;;;; "A;raing-Jesign
information or iob site
corrections' etc.
Abbr;;iaa;d Plumbing, Mechanical, & Electrical Schedules
i:-' E;;;;i-.n.i.-utint spaces occur-in the description
;;;;;;. ;i ine uectranical and Electrica'l schedules'
[it.-ippri.r.i n..a iirl-in only the No' Boxes adiacent
to the approprlate item(s) to.be-installed
B. irri Frrinbinb' m.cniriiil, and Electrical schedules
aie availabt6 at the Building Division
1. To conserve'tptit-on the-permit form the schedules
have been abbreviated
?. i?'in-.'ii.ris)-io-ue installed are not covered on
the abbreviaila-icneautes you should consult the
fulI schedules
C. BUILDiNG OiViSTOII-STNFF t,lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on tne'i[p,-i[" tuutl must be delivered to the
electrical .ontt]tiit-ior iignature bv his electrical
suoervisor. Th;";;;;t;i' t'niiiitot ii not authorized
to sign the electrical label'
. Applicant to sign and date
blhenever possible' ii"-initiut gPPlication wil'l be used as
a worksheet onlv. lr'il!.i"piiiiuiL' a'itaing Division Staff
will prepare u typ. *"itten copy and return it to the
applicant at the t.l,"'int-itiuil permit is issued for his
s i gna ture.. Fees and Charges
Ptan check fees are due and Pqyable at the time of the
aoolication, and no piini niil-be processed unti'l these
?[5l';;;';;;0."-nii 6in" i".' and charses are due and
piiiui. wiren the permit is issued'
. FOR OFFICE USE ONLY
III
IV
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PROJECT CONDITIONS TO BE SATiSFIED BEFORE OC CUPAIICY :
useadrbecoaSB1BuderIthehtwirat'lt ons1r0mfregext.II an emptc'irm atPe pp
Add 'iti onal Proiect Informat'ion :
PLANS REVIEITIED BY:
date
name s'l gnature