HomeMy WebLinkAboutPermit Building 1987-06-18IIISP
726-APPL I CAT I ERMIT riCT
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COIIB I iIAT 726-3753
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EIIERGY SOURCES
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Owner
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do' Val ue of l,lork:/q1,7oe
So. Ftq. Access.
I,l.l'iio3'n^iW
]fence_Oemo Chinge/Use
L1ther Oyei?#
So. Ftg. l.iain
Addres s 25 'e
{-J I Phone 74 , PYlll::"s lq.,it t,iI Farxr ty ties'tdence llith nttached Garaqe)
Pa>ki.o loi t>rn^t-ove,?,€t f-, /oConstruction Lender
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.\dd re s s Phone
I]ES I GN TEAI.I name addres s S ( exni res (oi
Prima
("?coStruc tura I
El ectrical
llechanical
address lics- no (phone no.exo i res )
Genera l
PLUIlB I NG ELECTRICAL
rrll-FEE CHARGF NO FFF l.HAACF tlo. I
Each single fixture Residence of
SQ. FT
furnace/burner to
-_----- BTLI' s
Relocated building
( new fi x. addi ti ona 1 )
New ci rcui ts ai tsor extensions
Floor furnace
and vent
S.F. Residence(l bath)S ERV I CES Recessed wa l 'l
Soace heater and vpnt
Duplex () bath) each
Additional bath Temporary Constructi en Apol iance vent
sepa ra te
l,later servi ce Chanoe in existinq
res i dence
Stati onar_v evap
cool er
Sewer multifamily, comrn. or
Industrial Vent fan rvith
sinole duct
lat<Storm Sevrer 2{.fo 0f amps.Vent system apart from
orA
c0Mt1./IND. FEEDERS i{echanical exhaust
hood and ductInstal I /al ter/rel ocate
di stri ir. fecdprs liood stove/heater
\0f s.
ISSUANCF OF PFRIlIT
TOTAL CHARGES O.J-E TOTAL CHARGES TOTAL CHARGES
I,IHERE STATE LAI.I REQUIRES thatshall not be vaii.l until the labe
the Electrical work be done byI has been signed by an Electri
' an Electrical Contractor, the electrical portion of this oerr,ritca1 Supervisor and returned to the Buiiding Division
llAtlE(please print)I.U S IGNATURE DAIE Z- I t- 77
and
of
of
Boa
on'l
0reoo
he Buany
rd
HAVE Y E XAIl DNI tLL c e dte tca n0mr)rfo Derm L dan doap !-)he re rt hat abvt onfr trma o hereon nfy s truecrrtecandfurthe r ertC t ha at a andf5rny rkl^rO eD r fo rme d has be done n rdco an ce t theh rd0 n an fces0 eth C tySoredndathng fi e wsLa theof Sta f rnDE ta n n to th e kwor descr b heed re nq dan hat t OCCUPrc AI,tvtCY mabe desuctrretuwlthouthetftdermpsoonfuDVIsonerrthecrttatngttranthfym.y req r the Bu der sfunsfoanrceedtffecarequred0ns070r55athtfbyehetsbaSrfoxemDtxemDte0nohetedreon tthabcutraconvantorsdwhosarecomcnoyeenceathwl7OPS0EJ05besedun0theco ro.j
USE OiI
Flood Plain Stories x
Sn
Sq
Occ.y Gro
Val
Val
its
Load
up--____Sq. Ftg. otner.%y1244
sCon t
Val ue
Fi re Zone
Zone
Bedrooms
Ftq. l'lain x
Ftg. Access x
an
P
Comm/ i ve
511
tens
rqe
opnren t 4 4.YBUILDING PERI,lIT
Charges anC
S u rc ha rges /YE /'€/7 //7
Fence ()O. ?ZPLUI4BiNG PERMIT
Charges and
Surcha rges
c6
Demo
SidewalkELECTRICAL PERI,:IT
Charqes and
Su rcha rges A/C Paving 6A Total Cornb. Permit o
Curb Cut
/877.e2-
I,IECHAI'II CAL PERI,tiT
Charges and
S urc ha rge s
.iOTAL
o
ne n0
hani al
I'4EC HAN I CAL
Job Address
t-esal pescription / 7_O z. Z<B/ OZ?<,
FFF aLt^onE
(
/
I
i S and'Iernp 1
ToTAL VALUATI0N_
P I an Ck. Res
30%/81do Per Fee
a
PERMIT VALI DATIONcoMBINATI0N AppLICATI0N/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map ReferenceT-7 03 13
2. examoie- Lot 1. Block 3, 2nd Addition to
SprjngField Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
1. examo]e- heat/electrical cei I ing/s2. example- waterheater/electricalTort. Square rootage or valuation, etc.
r forced air qas
tolaa-
II.
l. qlllrple- 1250. sq. foot house, 500 sq. foot garage2. examplEf ir new project, check-new - .if additio;,
check add, etc.F. Building permit information:i. examole - construct single family house with an;ttaaled garage2. -qlq4ple - remodel existing garage into fam.iiy room3. glq,r!lF - convert singie iaiily-resiOence intoiEETiIFant (chanse of"use)G. Value of ivork as defined jn Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, Bui)d.ingDivision Staff must be able to contact appropriitepersons regarding design informat.ion or job sitecorrections, etc.
Abbreviated Plumbing, itlechanical, & Electrical SchedulesA. Except r.rhere blank soaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appf icant need fjll-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, I'lechanical, and Electrical Schedulesare available at the Buildinq 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 theful I schedulesC. BUILDING DIVISION STAFF l^llLL 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 h.is electr.icaisupervisor. The general contractor .is not author.ized
III
IV
to sign the electrical labe.lApplicant to sign and date
llhenever oossibie, the initial application wi lI be used asa-worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual permit is issuecj for hissignature.
Fees and Charges
Plan cneck fees are due and payable at the t.ime of theapplication, and no plans will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFI ED BEFORE OCCUPAI.ICY :
ai_
Permit applicant exempt from registration t^lith the Builder's Board because:
Add'itional Project Information:
PLANS REVIEWED BY:
name da te' A -? 7-8'-,s't gna tu re
1ml*
Permi t Cl erk
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AJ e)
BACKFLOW DEVICE TEST REPORT
,t --'
SIZE
-
MODEL seRrel #-r 4 a47-LJ /
LOCATION OF DEVICE
TESTER
PASSE D: \?
F6
UIF
J
F
z
1
CE RTIFICATION
#
gATE . .'
a,;/
New Parts
and/or
Repairs
llade
lf Needed
I CERTIFY THE ABOVE TEST HAS BEEN PEBFORMED
TESTER #
NAME
DATE
1COMPANY OFFICER)BY
DOUELE CHECK VALVES
Check
#r
Check
#2
BEDUCED PRESSUFE DEVICES
Opened at
-
lbs.
Belier
Vatve
Pre:sure
Drop Across
Check
- __- tbs.
Leaked ( )
Trght ( ))
Leaked ( )
Clos€d
Tight { ,
Chock#r Check*2
Closed
Tight
l(
Re lref
Va lva
Openod at
lb3.
Clor€d
Tight
(l
Final Test
Af ter
Repairs