HomeMy WebLinkAboutPermit Building 1989-10-30INSPECTION LINE
726-37 69
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CC)MBI NATI ON APPL ICATION/PERMI T
lNFoRtitATl0N LrNL
726-37s3
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Owner L
l-ega1 Description /
&
-oe
Job Address 2
Ranqe
l,later lleater
EIIERGY SOURCES:
Hea t
Sq. Fto. l'lain-..-
Sq. Ftg. Access._
Sq. Ftg. Other_
t{ew Add Al ter-Aep. -
_fence-Oenro Cha-nge/Use
-other-_-_--*!W:t"2;e*>-c
Ga ra
ila:;-Euitd SinsleDescr
nce l,li th
n
Farn i5-7aqr.Address .<= , ,r4 Phone
C
Constructi on Lender '/
$
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m
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a.??I'honeAddres s exDt resh!!rei_:-DESIGN TEAI.I name
Pri ma
St ruc tura I
E l ectri ca l
l,lec ha n i ca l
I'1ec ha
El ect
MICHAN I CALELECTR I CALPLUHB i NG
furnace/burner to
BTLI' s
Floor furnace
and ventNew ci rcui ts al ts
or extensions
Relocated building
(new fix. additional )
Recessed wal I
Snacp heater and ventSERV I CE SFs
I
Duplex (l bath) each
Apol iance vent
ceDa ra teTemporary Construct i onAdditional bath
Stati onary evap
coo l erl.later serv'i ce
Vent fan with
sinole duct
Chanqe in existing
res i dence
Indrrstria l
multifanrily, comm. or
Sewer
Venf systern apart fronr
heatinq or A-C.0f a mps.
Storm Sewer Mechanical exhaust
hood and duct
-
COMI,I./IND. FEEDERS
l'Jood s tove/ hea terInsta l I /a l ter/reI ocate
distrib. feeders-
amp s.0f
S IGiIATUREl,lAl.1E ( pl ease pri nt)
StorieFlood Plain
TOTAL VALUATION
-/6P-"'=f.-../--_
9zY-----,ltn:t ssq
Occ.y Group
Load Sq x
r!q
x
lo ,>o'trfo
-x
,l
Con se/
C HARGEAL STOTAESCHARGTOTLTCHARGESOTAL
'Ih s trm'rfcrlIar'It oon tetheecIt pectrartol:ECI r1t ac ponCoIIbebdonekant:ecI rlt ca wor r.yRESIhattlretL,1UEl,lilEn TS TEA REQU ,l oI nsD'IBuI'I 'Id nrretdu rne theto gdIaSuroIsantecIrtIcan'I peIIsnedsbeenhaabegbythetvabeI,)'I tUN 'IIhaSIIno
n 'I t ruesI'I forman 'It no hereoIrttthaacehedodIanf.yrebvermtIctaforonpe tedINIXAIltDcomp ap pheilAE C 'Iheft ty0Irdannocesnctw'l thehIhabeIonednIa ccordaIIkl.ror rDC o srmed.I hat at a andandcfu rther ert nyfydan I I madeUPAI,ICY 1 benndaathilt0ccrkdsercbeIhereidartn1
'I theto t^/OfStatefonfrlIfIeanddLawstheo0re1toenqtheoSpng sv|l tth Bu I'I derhesIatr1tonrhtaVIIs0nregm.yfurtherIiofnhet'IBu dI 'I Di tyfrutuwlrehottUthesrm1snqoastcpeny Lonherethaando tedsn'IItr0ntba'IS foShefe exempatht'I055 xemptfturedORS701fuIIaforceefeactreqsbyndrdBoas'I ni
n sth.i ec7n055ll/l I used projbe'I n I1 cean th 0r?swldan1esawhorenolbcsunt0torsoyecomDracvemp
Value
Fire Zone
Zone
Bedrooms
ISSIJANCF OF PFRIIiT
Ftq
Ftg
Ftg
r Value
r Val ue
l'la i n
Acce
0the
Deve
7.57Plan Ck. Cornn/lnd
657,/Bldq Per Fee
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERI.IIT
Charges and r-/'
Su rc ha rges
Xa--E-
Fence
Demo
PLUI4BING PERMIT
Charges and
Surcha rges
Sidewal k
Total Comb. Permit/b tW
TLICTR]CP.L PERIIIT
Charges and
Surcha rges
Curb Cut
A/C Paving "'/
//a /€-€Ztrf
TOTAL -7,Anaq
I{ECHANICAL PERMIT
Charges and
Surc ha rge s
Residence of
SQ. FT.Each single fixture
Icorrect,
certi
l
opment
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition to
SpiTnlTield EstaresC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
2
exampl e- heat/
examp I e- y,/a ter
re footage or
air gas
E. Squa
F
i examp-le- 1?50 sq. foot house, 500 sq. foot garagez. example- if new project, check new - if addit.ion,
check add, etc.
Bui 1din9 permi t inforrnation:1. example - construct single farnily house with an
attached garage2. example - remodel existing garage into family room3. example - convert single family residence intorelTiuFant (change of-use)
Value of work as defined in Section 303 (a) of the
lD 30 a1
G \baADStructural S
H . DES ] GN TEAI4
pec ia I ty Code
AND CONTRACTORS
To avoid design or corrstruction delays, Bu.ildingDivision Staff must be able to contact appropriatepersons regarding design information or job siLe
correcti ons , etc.II Abbreviated P lumbing, MechanA. [xcept vrhere blank spaceportion of the Mechanica
the appl i cant need fi I I -to the appropriate item(B. Ful I Plumbing, Mechanica
'lc:al, & Electrical Schedules
occur in the description
and Electrjcal Schedules,
n only the No. Boxes adjacent
) to be instal led
, and E)ectrical Schedules
are available at the Building D.ivision1. To conserve space on the permit forrn the schedules
have been abbreviated2. If the itenr(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedul esC. BUILDING DlVISION STAFF I^JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorized
III to sign the electrical label.Applicant to sign and date
IV.
Whenever possible, the initial application wi ll be used asa worksheet only. l,lhere possible, Bu.i lding Division Staffwill prepare a type written copy and return.it to theapplicant at the time the actual permit is issuecl for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the tirne of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USI ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit appf icant exempt from registratjon with the Builder's Board because:
Additional Project Informat'ion
PLANS REVIEWED BY:
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