HomeMy WebLinkAboutPermit Signage 1987-01-20INSPECTION LIIIE
726-37 69 c0r1B I I AP ICATION IT 726-37 53
Job Address
l-egal Description
EIIERGY SOURCES:
Hea t
l.later Heater
Ranqe
0wner
Va I ue of l/ork
Ftq. tiain_
Sq. Ftg. Access.--
S-q. Ftg. Other_
_l{ew_Add-A. l ter_Pep.
nce_Demo_C hange/ U se
her
Fe
_ot
l^lo r k .e., Build Singie
Farni I
n0
lle
t
s dence l'lith AttDescAddres s PhoneTf/
Construction Lender
..\dd re s s Phone
DES I GN TEAiI name addres s lics. no.exo i res )phone no
Primary
?I0,
N
St ructura I
El ectri cal
l'lec han i ca I
name addres s ( exni res )Iics- no. )( nhone no 'l
Genera l
E I ectri ca I
l lechani ca I
I
PLUI1BI NG ELECTR I CAL MEC HAN I CAL
ilo.FEE CHARGE NO FFF . HA PCF NO I FFF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New ci rcu.i ts al ts
or extensi ons
Floor furnace
and vent
S. F. Residence
( l bath)SERV I CES Recessed wal i
Soace heater and vent
Dupiex () bath) each
Additional bath Temporary Constructi on Apoi iance vent
s eDa ra te
tlater servi ce Change in existinq
res i dence
Stationary evap
cool er
Sewer Industrial
multifamjly, cormn, or Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
COI,II'I./IND. FEEDERS i'lechanical exhaust
hood and duct
Instal I /ai ter/rel ocate
d.ictrih fppdprs llood stove/heater
0f amp s.
vt"l
ISSUANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,lI.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernitshall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAIIINED the completed apnlication for oermit, and dorther certi f_v
e Laws of the
out the permi
e and effect
nd emfrloyees ,
H,g,
that any and all work performed shall be done in accordance with the 0rdinances of the City
State of orer,ton oertaining to the work described herein, and that NC oCCUPAI,ICY will be made
ssion.of the Building Division. I further certify that m-y registration vrith the Builder's
llAl,'lE (pl ease pri nt)DATE Z.(I GIiATURE
xemp
5 r',ri
herebv certif_v that alI in forrnation hereon is true
and correct, and i fuof Soringfield and thof any structure with
Board is in fuil forc as required by ORS 701.055, that if e t the basis for exemption is noted hereon, and thatonly subcontractors a who are in comcliance with 0l?S 701.05 I I be used on thi s rrro,ject.
USE
Ftg
Ftg
Ftg
Zone Uni ts
Load
TOTAL VALUATION
x I
x
X.Sq
TyDel Const Val
ValGroup
Val ue
l"la i n
Flood Plain Stories
Fire Zo Bed rooms Acces s
0ther
Plan Ck. Comm/Ind
65.%/Bldo Per Fee
Svsterxs Deveiocment
Charqe (1.5?.)'BUILDING PERNIT
Charges and
Su rcha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewal kELECTRICT.L PERI,:IT
Charges and
Surcha rges
____/5_=2_(fr A/C Paving Tota'l Comb. Permi t
Curb CutI,IECHANICAL PERMIT
Charges and
Su rc ha rge s lf €c{4tc 4!*ffi/a -zo TOTAL
,\
\)
()
o
-x.
N
ACTORS
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. elgmple- Lot 1. Block 3, 2nd Addition to
SErTndTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1. example- heat/electrical cejling/or forced air oast. exampte- waterneater/electrtcal/or solarE. Square footage or valuationiETc.-1. elq!!!ple- 1250 sq. foot house, 500 sq. foot garage2. 1.[amF]e.Jf new project, cheik-new - ir aoaition,
El'ecR--add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. examole - remodel existing garage into family room3. example - convert single family res.idence intorestaurant (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 construct.ion delays, Bu.ildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrecti ons , etc.II. Abbreviated P)umbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description -
portion of the Mechanical and Electr.ical Schedules,the applicant need fill-in only the No. Boxes aojacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedulesare 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 theful I schedul esC. BUILDING DIVISION STAFF l^IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered to theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorized
PERMIT VALIDATION
bZ b7?
-20 - r2
to sign the electrical iabelIIIApplicant to sign and date
Whenever possible, the 'initial application will be used asa_worksheet only. Where possible, Building Division Staffwili prepare a type written copy and return jt to theapplicant at the time the actuai permit is .issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no p)ans wili be processed unt.i.l thesefees are paid. AIl other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Informat'ion:
PLANS REVIEWED BY:
name S1 I na tu re da te