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Home My WebLink AboutPermit Plumbing 1989-09-22E COMBI ,TI APPLICATION RMIT Legai Descri ption Job Address EIIIRGY SOURCES: Hea t l,later He.rtcr Ranqe Ftg. Access.-- Sq. Ftg. 0ther_ J,lew__rAdd_AI te r-Tep . _Fence_Demo_C ha nge/ U s e 0ther Sq Sq Ftq. l.1a n-- Val ue of l.iorktrTvltlatt s tIn .€. tn e '|e Desc j At l^lo rk GaAddres s Z8 Phone Construction Lender T ?a --s SD tI\ Atlrl re s s I)honc tonP no-I i cs.' no.exD I resaddre s sDIISIGN TEAI'I nalre S truc tura I Prinra El ectri cal llechanical pxni rps )(ohone no.I ics. no.addres sNTn ame Genera I 3PB nical I5-Plunrbi El ec MECHAN I CALEL ECTR I CALPLUIlBI NG FFF CIIARGFFFFCHARGFNOFEECIiARGENON0. furnace/burner to BTLI' S1sDse2L Residence of SQ. FT -\ Each single fixture Fl oor furnace and vent New ci rcui ts al ts or extens'i ons Relocated buildinq (new fix. additional ) Recessed wal I Soace heat-er and ventSERV I CESS.F. Residence ( I bath) Duplex (l bath) each Apol iance vent seDarateTemporary Constructi onAdditional bath Stati onar,v evap. coo l er Change in existing res i dencel,later service Tndustrial multjfamily, conm. or Vent fan with si nql e ductt5P3eDSewer Vent systern apart from heatinq or A.C.0f amps.Storm Sewer Mechanical exhaust hood and ductcotltl./tND. FEEDERS lJood stove/heaterInstal I /a I ter/rel ocate di stri b. feeders 0f amp s. ISSUANCF OF PFRI,IIT TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES ? I,IHERE STATE Lllll REQUIRES that the Electrical work be done by an [lectr shall not be vali'l until the label has been signed by an Electrical Superv only subcontractors and ernployees who are in compliance with 0l?S 7n1.055 r,rill be used on this D 0o S I GTIATI.]REI,lAl'lE (pl ease pri Uni ts 5q Flood Plain Stori es ToTAL VALUATI0N-- k x x LoadBedrooms_ Occy Const Group _ Sq ical Contractor, the electrical portion of this perriit isor and returned to the Building Division forma any rd ffec n trIhaatII'I n t o'I hen reo s ruecetthedodt,l anatnocI f.yrebyetedIahetDDernlcomppp 1fchetenc'I ht 0the 'Ird ann ocesnfnd'l 1 r k for srrned Iha It^rO tycordaac1edonbendarrtecanIdfurctherLer'I ttha a a a DCvny I mad,]n nda ttha 0ccr,lc 'AI,ICYUP wl I be en1'I theto dwork s bedcrl hereofSn'i fi Ie andd th La ofws qthe tta oe on0reo rtaDE nrlprg I r5I'atr 1t n tV,l1 thh B u I sde,l I 'I on ce tr I tha t rehefurtrofsrucLuretwlOUthttheIermS0n,l o eth B I 'Id n D s m.y -qr)g and haf,r I Ion nos hereonted t ttha,lt exf t bathe Is s oI7055Boaemp exempts'I n'I Ifu foI andrce e t sa red 0Rs 0 Irequb.y ect Val ue l'la i n Fire Zone Zone Fto Ftg Ftg r value- r Val ueAcces s 0ther SYsteris Deve' Charoe (1.5r'opmentPlan Ck. Conrn/Ind 65%/8ldq Per Fee Plan Ck. Res 30%/Bldq Per Fee BUiLDING PERI'IIT Charges and Surcha rge s Fence Dgmo PLUI4BING PERMIT Charges and Surc ha rges 1 L Sidewalk Total Comb. Permit ELECTRICAL PERIIIT Charges and Surcha rges A/C Pavi ng Curb Cut 3q 33TOTAL I,IECHANICAL PERMIT Charges and Surc ha rge s )( 0wner I /M'v T I fy COMBINATION APPLICATION/PERMIT (CAP) I Applicant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 ?. example- Lot 1. Block 3, }nd Addition to I SIifnlTield Estates C, Name, etc. of owner and construction lenderD. Energy Sources 1. g4lLf_g- heat/electrical ceiling/2, example- waterheater/electrical/o E. Square footage or valuation, etc. or forced air gas r solar 1. examplg: 1250 sq. foot house, 500 sq. foot garage 2, example- if new project, check new - if addition, check add, etc.F. Bui lding permi t information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into farnily room 3. 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 TEAM AND CONTRACTORS To avoid design or construction delays, Bui lding Division Staff must be able to contact appropriate persons regardi ng design information or job si te conrections, etc. Abbreviated Plunrbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plunrbing, Mechanical, and Electrical Schedules are available at the Building Divisionl. 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 I schedules C, BUILDING DIVISION STAFF l^llLL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrical supervisor. The general contractor is not authorized II to sign the electrical label. I I I. Appl icant to sign and date Whenever possible, the initial application will be used as a worksheet only. l,lhere possible, Bui lding Division Staffwill prepare a type written copy and return it to the applicant at the Linre the actual permjt is issued for his s i gna tu re.IV. Fees and Charges Plan check fees are due and payable at. the tirrrc'of the application, and no plans will be processed urrtil these fees are paid. AII other fees and charges are due and payable when the pernrit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION *)hv (, Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because Additional Project Information : PLANS REVIEWED BY name SI gna tu re date