HomeMy WebLinkAboutPermit Building 1984-04-24I NSPECT I 1
726-37 69
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COMBI LICr
b .ERGY SOURCESr rt
Ranqn
Value
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Job Address
Legal Description
. Ftq . I'la i n_
Sq. Ftg. Access._
Sq. Ftg. 0ther_
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_Fe nce_Demo_C ha n gel U se
0ther
0wner lmrnb,tl &,u..e., Build SingieBuilciir
Fami I y
nq Pernri t I nfo: Pg5,:r'i be Work (
llesidence l,li th Attached GaraqeAddressPhone
Construction Lender
6.La
trtoa
Addres s Phone
exn I res ohone no-DES IGN TEAI{name addres s i ics, no
Pri ma ry
Structura I
name
E l ectri cal
Mechan i ca I
Genera I
Pl umbi nq
-
---_-
PLUI{BI NG ELECTR I CAL MECHAN I CAL
NO FEE CHARGF NN FFF CHARGF NO FFF CHARGF
Each single fixture Res'idence of
FTsQ
furnace,/burner to
BTU' s
Relocated buildino
(new fix. additioial)\
New circuits alts.or extensions \S \SP
Floor furnace
and vent
S. F. P.es i dence(l bath)SERV I CES Recessed wal I
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
reparate
l^later servi ce Change in existing
res i dence
Stationary evap
coo I er
Sewer \multifamily, cornm. or
I ndustri a I
Vent fan with
sinqle duct
Storm Sewer oft&S.trl: 2.OO amps.\SaD \s90 Vent systern apart fromheatinq or A.C.
c0Mr'1./IND. FEEDERS Mechanica l iihault-
hood and ductInstal I /al terlrel ocatredistrib. feeders l,lood stove/heater
0f
ISSUANCE OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES 5:"TOTAL CHARGES
ST,l"JHERE T E L.1l,l REREQU I tha tS Fthe ec rlt ca work be done E'Ianby tec carl ctra torConhanotbeVA.l the entU ec catri 0nbeatheport tof Shihasnbee fsnedpermiIanEbytreccasrv't rupe and ret tourned Buthe S 0ng
l,lAt''lE(p l ease pri nt 'r5o NL IGiIA
TE
ng
st 0regon
the Bui
Ci ty
made
of any
Boa rd f exempt
.055 rvil
LL INED cc0mp tia 0napl-)rmlrDE t and dondacorrec+a nd certfurthe r atcertffy n rmatthata onvanda hereon snykw0r t rueormedD€ rfr has dbe 0ner n accedndaSp da0r encthe thwlLawstof 0rdthe nshetate ofancesof t heDe rta ni to t workheng esd crlru bedrectuwt nhereitthouth and ath te NCs5permi0n UPAI{CY0cc WIof bedDsngsnhefL rt rfufor rtacend t thaeffefyctsa my stra t nUIredreg t14l hreq0Rs the Buiby701055 der stthaonstheacubcontrtovbasforsrsndaonsernpwhoaxemptnotedoyeesrennhereoandc0mcancewltha fth70t?s 0 be us ed 0 thn trLproj t
Fl ood pl a i n__
-__Stor.i
es
x
x
Load q
c.y
/Const
TOTAL VALUA TION
lue
its Ftg. l4a i nre Zo
q. Ftg. Access
Sq. Ftg.0ther
I Val ue--
Value
Zo
Fi
P an . Comrn/n
BUILDING PERNIT
Charges and
5u rcha rges 0pmenan Ck Res
3
Fence
PLUI4BING PERMII
Charges and
Surcha rges
Demo
S idera ? k
EL ECTRICAL
Charges andourcnd rgeS
PERI'IT
A/C paving
fota l Comb Permi tCurb Cut
TOTAL 3z
CHANI CAL PERHITarges and
rc ha rges
I
tdi Divi
N.._
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l,la..r Heater__
COMBINATION APPLICATION/PERMI'I (CAP) :.
I. Applicant to furnishA. Job AddressB. Legal Description1. glaTplg: Tax Lot 100, Lane County t4dp Reference
17 03 43?. example- Lot l. Block 3, Znd Addition toSffiffiield EstaresC. Name, etc. of owner and construction lenderD. Energy Sources
l. example- heat,/electrical ceilino/ot. exampte- waterheater/ejectrical/or
Square foot.:ge or vaiuat.ionlGll--E
1. examplr: 1?50 sq. foot house, 500 sq. foot garaget. exampie- if new project, check new _ if addit.ion,
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodel existing garage into family room3. example - convert sinEie family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
r forced air gas@
'igr
ff n or construction delays, BuildingTo avoid des
Division Sta must be able to contact
persons regarding design information orcorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description
appropri ate' job site
,ion of the Mechanical and Electrical Schedules,
applicant need fill-in only the No. Boxes adjacent
II
III.
port
the
to the appropriate item(s) to be installedB. Ful I Plumbing, Mechan'ical, and Eiectrical Schedules
are availab'le 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 should consult the
ful l schedulesC. BUiLDING DIVISION STAFF HILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical label.
Applicant to sign and date
Hhenever possibie, the initial application will be used as
a worksheet only. Where possr'b1e, Building Division Staff
will prepare a type written copy and return it to the
app
si9
'licant at the time the actual permit is issued for his
na ture .
IV. Fees and Charges
PIan check fees are due and payable at the time of the
app'lication, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
4-N&
s^07489
PERMIT VALIDATION
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
ua serdabecI1erdBoSButw'l th herat1tonfromSt.I anc ext regatempePrmipp
Add'itional Proiect Information:
PLANS REVIEI^IED BY:
te
s'ignature
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