HomeMy WebLinkAboutPermit Mechanical 1980-04-07INSPECTION LIIIJE
726-37 59
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COHBIiIATi ON APPLICATION/PERMIT 726-375
ob Address
Legal Oescription I
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Phoae-t4A_ggr,-Nddress 37q A/ //h Quiiqing Permit Info: Describe Work(
Fami'ly Residence liith Attached Garate 'e., Build Single
Construiti on er
tcbo # l56FAddressPhone
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OEsIGN IEAI{name addres s lics. no exot res phone no.
Pri ma ry
E I ectri ca I
llec han i ca l
CONTRACTORS n ame add res s lics. no- )exD t res ohone no.
Genera l
Piumbinq
PLUIJB I NG ELECTR I CAL HECHAN I CAL
Each single fixture Residence of
SQ. FT s
furnace/burner to
BTU
Relocated bui Idino
(new fix. additiona'l )
New circuits aIts
or extensions
Floor furnace
and vent
S. F. Residence(l bath)Recessed wal l
,Slace heater and vent
Duplex (l Uath) each
Additiona'l bath Temporary Constructi on Apol iance vent
s epa ra te[.later servi ce Change in existing
res i dence
Stati ona[-Eva[-
cool er
Sewer multifamily, corrn. or
Industrial Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
c0Hl.1./iN0. FEEDERS l,tectran i cil ixhaus t-
hood and ductInstaI I /aI ter/re1 ocatedistrib. feeders liood stove/heater
0f impa
ISSUANCE OF PFRIIJT
/_l,lAl{E(please prin
IGNATURE opb +7 80
S TEREIH L.TE RE1N RESQUI ha t the EI 'Ir ac I rw0 k oobe ne EIan 'Iectr lbyac Con tra cto r ethe eI c'Isha tri Ica rt ,lInotbe 0n of 'I+hIaI'I tUN I1
p t1pern.I
a 1thebe sha been Is ed an9nby EI iec cr1 Ia S u s0rI uan fpe rv e rntu LUed t he Bu Il 1d n Di i 'Is 0n
fy
the perm
nd effect
heD e tedcomD c 'Iat no rfoap r)i0e rm and he e 'irt hat i a l ireb-y n 0 Lrma o'i nnda hereon s,Iic0 rrec an truefudrrtheertcandhaiaaIIr
"{o
kfyr oe rfo Srmed 1ha beI don nje cc0a erdanc lh the jfS0rd na ofncesfe'I dI the 'IorindthngeLawsof tyny
ofStheteta n ni0re9orta i thoe e wo kr deng scrl herebed nif a rhnd taruc 0l,tc PACCU wlHCY 1anyture
'rJ l I mabethout des'i ,l5 n0 of the u I.1 'Id 0 'I s1 onjng urt cher rte ttha re 'i tS'IsIrdBoa fy m.y tra 0'I LJln thfuIIg the uB I1 rdefoerca ssaredIrequ0Rs057015fexbytha'I em0 tt L.udhe ,i
Iss ro ItexemD 0n 5'I noon ted reohe n dans ubco trn ac tthavtorands10whe5empairec0mcniInceawlthsOP7l.t l I'I5c5 be DIth0nsedu +ecro.j
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
Un'i ts So
X Val ue0cc.y Group Sq
oel Cons t.
Load
Flood P'lain Stor.ie
Zone
alue
TOTAL VALUATI
Val u
Fire Zone Bedrooms Ftq. Access
Ftg.0ther
Ftg. l,la i n
Plan Ck. Conrn/Ind
652/Bldq Per Fee
Sys ter:rs Deve
Charqe fi.5z
opmeot
BUILDING PERI'lIT
Charges and
Su rcha rges Plan Ck. Res
30%/81dq Per Fee
FencePLUI.IEING PERMIT
Charges and
Surcha rges DEmo
Sidewal k
ELECTRICAL PERI,IIT
Charges and
Surcha rges A/C Paving Total Cornb. Permitt6.@.bo
I'IECHANICAL PERHIT
Structura l
un trrF a !.la 0/: F rtn ,FF audocr
SERV I C ES
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p
15 60
c0MEINATI0N APPLICATioN/pERr,[T (CAp)
I Applicant to furnishA. Job Address
B Leqa
l. 1-
)
rl Description
examp le- Tax Lot 100, Lane County it'lap Referenceli 03 43
example- Lot 1. Block 3, Znd Addition to-Spffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sourcds
1.
2.E. Squi.
?.
€xample- heat/electrical ce.il ing/o
examp l e- waterheater/el ectri caI /or
are footage or valuation, etc.
r lolcsg[ a1]1 gqs@
examole- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check add, etc.
II
F. Building perm'it information:1. example - construct single family house with an
attached garage2, example - remodel existing garage into family room3. examole - convert single family res'idence into
resiaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specia lty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
0ivision Staff must be able to contact appropriate
persons regarding design information or iob site
correct'ions, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the description
portion of the Mechanical and Electrical Schedules,
the app'l icant need fi I l-in
to the appropriate item(s)
Fuli Plumbing, Mechanical,
are avai lable at the Bui ldi
only the No. Boxes adiacent
to be insta1 Ied
and Electrical Schedules
ng Division1. To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be insta'lled are not covered on
the abbreviated schedules you should consult thefull schedulesC. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be delivered to the
electricai contractor for signature by his eiectrical
supervisor. The general contractor is not authorized
to sign the electrical label
Applicant to sign and date
'lhenever possible, the initial application will be used as
a worksheet only. Where possible, Building 0ivision Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
si gnature.
Fees and Charges
P'lan check fees are due and payable at the time of the
app'licaiion, and no plans wil l be processed until these
fees are paid. All other fees and charges are due and
payab'le when the permit is issued.
FOR OFFICE USE ONLY -
III.
IV.
V.
PERMIT VALIDATION
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
permit appl.icant exempt from reg'istrat'ion with the Bu'ilder's Board because:
Additi onal Proiect Information
PLANS REVIEIdED BY:
name s't gna tu re da te