HomeMy WebLinkAboutPermit Building 1989-03-15Oil L I t'lE
c0rlB I APPL I CATI ERMIT
S?t/, 37rr*gFtel/Job Address IOO N
I Descriptionl-e
Ran!le-
l,later llea ter
EIIERGY SOURCES
Hea t
Sg. Ftq. llain fA2O'7:q. Ftg. Access.-__
Val ue of l,lork
Atlen
/a
o"
C>
ingle
Farn i l n o
GaAddressrH
Constructi on Lende
Phone238 //, /
l'honeAddress
res ohone no.exD'addressDES I GN TEAI'!n ailte
Pri mary
l''lec ha n i ca I
addres s (lics. no.CONTRACTORS na}n z>-
MIC HAN I CALELICTR I CALPLUIIB I IIG
FFF CIIARGFFFF(.HARGF NONNCHARGENO furnace/burner to
BTU' s
Residence of
FTSQ
FEE
Each si ng1 e fi xture
Floor furnace
and vent
New ci rcui ts al ts
or extensions
Relocated building
(new f.i x. addjtjonal)
Recessed wal I
SDace heater and ventSERV I CT SS. F, Res i dence(l bath)
Duplex (l bath) each
Apol iance vent
sepa rateTemporary Constructi onAddi tional bath
Stationar.v evap.
cool erres i dence
Change i n exi sti ngllater service
Vent fan with
sinole duct
multifamjly, conm. or
I ndustri a lSewe r
?a4t apart from
.c.
Vent systern
heatino or A0fS.<P Storm Sewer
I
Mechanical exhaust
hood and ductc0M'.'!./tND. FEEDERS')c
l'lood stove/heaterI nsta I I /a I ter/ rel oc ate
dist-r'i b. feeders
of =--_=.==-_-amPS.)(
q
ISSUANCF OF PFRTIIT
TOTAL CHARGESTOTAI. CHARGESTOTAL CHARGFS 70-a
WHERE STATE LtN REQUIRTS that the Electrical work be done by an Electrical
shall not be valil until the label has been siqned by an Electrical Supervisor
DA.TE 7 -/r^876enT w. AllAttE(please print)I GiIAT
0reoon
he Bui
0ns
he rtCE I hat at II I onf,trma onI nhereo SI uetrYIXIteed'II tca ol fon r tI an\etDCARULEFLEI Derm rebv f.yappconrp
I acn w1cordance t theh I0rd ancesn fo cthe I tybedonetndafuIhertcrterf,|t tha a n<l Ia l.rOI DErk ha IIrformedsndrrecanycoa.v
nI th ta OCCUPAHCYt,tc IWI be1 demaandtarn1n1toworkthecrtdesherebednefidIndatheofhetSatteffoeIIJoqDTtrSoivllnhtButheIedrIidniSioInftheurtcerr1thattIt,afw'i t tL he I s s on1 tof nq my re('loaSrutucthouermrenyp
nda thahattIfextI055tbaIssrot0nIs'I hereonnotedthIuforceIdanefecatsred701nIrdBoa'I s exemprequb,y
I beI ed thon s'|tUS0
enlp
'., i ro.l ecnlStracubconantorsdIr"rhoS rea ni Icomc an,|wlce 0nrh 7niS 55 penlr)oyee,v
Contractor, the electrical portion of this perrilit
and returned to the Building Division
Ftg
Ftg
Fts
tluin/*o_-* /O/a)utue ,/7 9 -a
Flood Plain
TOTAL VALUATION
lue
Val ItF
xrVa
D 3:Lq:39
Stori es Occy Grou
zone LMI .Tyoe/const. _152//_-_un;ts
Access
0ther
-_--Sq
p--t-:Z-sq
Fi re Zone__-Bedrooms ,Occy Load
opment /fl%Plan Ck. Comm/Ind
65%/B1do Per Fee ln Svsterns Deve
clrarqe (1.5i
Plan Ck. Res
30%/B1dq Per Fee
Charges anC
Su rcha rge s
_/g_2._?___7 ?
BUILDING PERNIT
Fence
lZ 2v-12
Sidewalk
Demo
Tota'l Comb. Fermit
PLUI,IBING PERMIT
Charges and
Surcha rqes
ELICTRICAL PERI,IIT
Charges and
Surcha rges
4#
A,Dt
A/C Pavinq
Curb Cut 757.ttNECHANICAL PERMIT
Charges and
Su rc ha rges TOTAL
fu.,
ri a'l
4o(
;€.,
Sq. Ftg. Other__
_l'leq)!Add_Al ter_Pep .
Fence Demo Change/Use
-0ther-
Iics- no.
El ectri cal
nhnnp nnwe"nrrl ffi
Laws
I fy
,4ibroozZ Vuudoze
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal DescriptionI, example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition to
S[FTngTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
]. example- heat,/electrical ceiIing/o2. exarnpl e- waterhEITerZeTEctijtI7or
Square footage or valuationl etc. -
r forced air gas
ul
d,
7E
@-
0lc
n
-yl. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
d6ecfi-add, etc.F. Bui lding permi t information:l. example - construct single family house with an
attached garage2. example - remodei existing garage into family room3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building0ivision Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Eiectricai Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electricai Schedules
are available at the Building 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 theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theeiectrical contractor for signature by his electricalsupervisor. The general contractor is not authorized
)p
II.
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to sign the electrical labelIIIApplicant to sign and date
Whenever possible, the initial application will be used asa worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. AII other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV.
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registratjon with the Builder's Board because
Additional Project Information:
PLANS REVIEWED BY:
name s'l g na tu re date