HomeMy WebLinkAboutPermit Plumbing 1982-12-281?6-3L 1NE ERMITCOMBIiIATICATI
Job Address
Lega1 Descri ption U )Ranqe-
Hea
EIIERGY SOURCES:
lJater Heater
n Val ue of llork
Owner Ks.*
Sq. Ftg. Access.---
Sq. Ftg. 0ther_
J{ ew_Ad d_A 1 te r_Re p .
_Fence_Demo_C han gel U se
0ther
Sq. Fto.n
AddrG s s PhoneC Builriinq Pernrit Info: Describe Work(
Farnily llesidence l,lith Attached Garaqd
ng e
T
Cons tructi r
Addre s s Phone
DES I GN TEAI.I name addres s l ics. no.exoi res ohone no.
Pri ma ry
Structura l
i"'lec ha n i ca l
CONTRACTORS n ame add res s I ics. no. )exDI res (ohone no-'
era I
PLUI,lB i NG ELECTR I CAL MECHAN I CAL
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' S
Rel ocated bui l d
(new fix. addit
ng
onal )
New ci rcui ts al ts.
on extensions Floor furnace
and vent
i dence
SERV I C ES Recessed wal I
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
[^later servi ce Cha in existing tati onar-v eva p
Sewer multifam i1y, comm. or Vent fan wit
Storm r 0f rt fromVent systernti
COI,lI.l, / IND. FEEDERS han i ca exhau s t
Install/al ter/re'l ocate
tr'lood stove/heater
0f
ISSUANCF OF NgB1111TOTAL CHARGES
TOTAL CHARGES TOTAL CHARGESREQU
nti 1
r/H EER TESTA LAL,J RES th a t the ecE'I tri a berkwohas do ne LI ecnaotn t crt abea,j ntraCou ttocrthea he e ecbeha tr L abeen rtp0 0n ofgnedan th SbyEIec t
bytri ac c permis0rupeandreturnedttoheudiDisvlonng
I'lAl,lE(please print
IGiIA
fyoermi t
rfo rmedof any
Boa rd that m.y regis tor exemDtexemp
55 vri
E FULL D the e tedcomp ca ontindaapp rfocomectand an dodfu herther rtcecertreb.y thatLha tfyand nanya forma L 0nkl^/Or h ereonto 'I +spe ruesprfieadshabengdtdonenheWSLaacc0theofrda nce w1Sta th tteof he 0rd n a nces0reqonn 0 fDe rta n toSrut the LgthurectkwordethouI^l l sc r bedtthe hereerm n a ndpssn0 th taof Ctt 0cctheBud UPANCYD lrllsnngson be mafufu
ty
deforcert herand cer tieffectas fyredu1 sreqORS tra t nby701 thy/ton055 Buthesubcovthatf derntrac t storsdanthebasesefirp0yeawhonrennheotedcomDNCawlreonhtnda7070r?s ttha0beused0thnectproj
Zone
Fire Zone Ftg
Ftg
Ftg,
0c cy Load
Bedro oms Val u e
xFlood plain Stories Group
Iue
Value
Type/Cons t
llain
TOTAL VALUATION
-
. Access
. 0ther
an nd
terns DeVe
5%
BUILDING PERI,IIT
Charges and
Su rcha rges opmen tanP5
B F
Fence
PLUI4BING PERMIT
Charges and
Surcha rges
Dgmo
Sidewalk
ELECTRICAL PERI|ITunarqes and
Su rcha rges
Total Cornb fermi t
A/C Paving
Curb Cut
IOTAL
o0
to
El ectri cal
I,IECHAN ICAL PERIIITs and
rges
\1()s,2.lst.St-
-l
U
FFF .HA PNF NN FFF .HA DNF Irn FEF CHAPNF
lr
I L-\0f'r\-Xh t,,r 0
1
s
PERMIT VALIDATION
Permit Clerk
d&
?
htotM
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descr.iption1. example- Tax Lot 100, Lane County l"lap Reference]7TTT32. ggru]e; Lot_l. Btock 3,Znd Addition tosprrngfieid EstatesC. Name, etc. of owner and constructjon lenderD. Energy Sources1. exampl e-2. exarnple-
E. Square footag
hea t/e i trica i
wat ea e ec
r forced air gas
or solar
e or vaiuat O[,
l. examp'le- 1250 sq. foot house, 500 sq. foot garage2. examp'le- if new project, check new - if addition,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction de'lays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.IL Abbrevjated PIumbing, l4echanical, & Electrical SchedulesA. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Div'ision
L To conserve space on the perm'it form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful'l schedul es
C. BUILDING DIVISION STAFF l^llLL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. 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.
IIL Applicant to sign and date
Whenever possible, the 'initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gnatu re .
IV. Fees and Charges
Plan check feis are due and payable at the time of the
application, and no plans will be processed unt'il these
fles are paid. All other fees and charges are due and
payab1e when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECTC0NDiTIONST0BESATISFIEDBEFoRE0CCUPANCY
Su ebecaaBordI.I erd sButthheon1WS1rattfromreg'iI anc exempttarmPetpp
Addi t'io nal Proiect Information:
PLANS REVIEI^IED BY:
s i gnature
name
date