HomeMy WebLinkAboutPermit Fence 1989-2-27
IiISI'ECfIUIl L!ilE LilY uf SI'RIIlGflEtU. tlfORllAT:,:1 L'",
726-3769 ~ COIIBIIIATION APPLICATION/PERMIT '. 726,3753
Job Address ""2... ~ J""'... c=.....', ~ ' '~:<o.' -, E!IERr,y SOURCES: " ,;0.. ftQ. ',;ain
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l.e9al oei,'cf)riPtOioc1n'~/\',31')\ Ontonn' . Ilaterlleater SQ. ftg..Other . I
~ Ue,:" Ai:!d' ,1'1.1 ter :l.eo. C)
RaMe -rence Demo Change/Use i
J Valu, ('JI~" I Other- - I
Owner ~ :L. . l:r'~~~.I-......\\\.\ ~ n......J.. J - I
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,',I"rc50(') ~~~: . ,,~:\., Pia !'llr 4.fiulltdno j1ernllt Info: Oescnbe Hork(i.e.. Build Sing e
U - \-J (.>.-J'\.") '\. ~"""- __ I ..."'\ '\ \ ne Ii tar.lilv nesidence !lith fittached r.araoe)
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..\JJrcss Phone
Ul~ILrj rl:.l\f1 (name' {address} (lies. nn.) lexn;resl (nhone no. )
Primary
~1echan i ca 1
CONTRACTORS
{name)
(address)
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Structural
Electrical
(1 if'o;. nO.l
(pxnirps) (ohonp nn.)
Genera 1
Plumninn
Electrical
t1~(h~nic~1
PLur1fiIllG
EtECTRICAL
MEClIAN I CAL
nu.
Sel'/er
i'-L-I CIIARGE JIO
Ii
I I ISERVICES
I I ,-
I I ., Temporary Construction
I I I IChanf"Je 1n existing
rp<;id'i'Jlt':{>
I I I Imultifamily, conl!l. or
InrllJ<:;tri~ 1
I 1 IOf
Ii ,- -ICOf.n'1./INO. FEEOERS
H- Install/alter/relocate
_ .futrih_ fpprlprc;,
Of amps.j
,
I
I
I
Residence of
-ITL .J:JIARGE ""
'"
r IlJ1RGL
Each single fixture
sq. fT.
furnace/burner to
BTlI's
-I Relocated bui Iding--
(new fix. additional)
IS.F. Residence
(I bath)
-----jouPlex (1 bath) each
Additional bath
New circuits alts.
or extensions
Sewer
I Storm
-,
I
-I
I
I
I
amps.1
I Floor furnace
and vent
1_____ I ~ecessed wall
I-----r-n~rp hp~tpr ~nrl vpnt
I' Apoliance vent
"pottl'atp
I Statlonary evap.
cooler
I Vent fan \'11ttl
sinole duct
I Vent system apart from I
hf"atjn~ or A.C
I Nechanical exhaust
hood .lnd duct
11'/ood stove/heater
I
I
I
I
I I
1-/
I I
~!ater service
I
I
I I
I TOTAL
ISSUANCF OF PfRl1IT
I IIIWE C^I~UULLY EXNlIr/[I) t~le completed apnlication for r>errnit,
and correct, and I further eerti fy that any and all \'1ork oerforrnr.d
_ \,i.. (9I.:s/?J().R.J
only subcontractors and
Zone
n re lone
Flood Plain
Tyoe/Cons t.
Bedrooms
Stories
Units
Oecy Load
Ocey Group
Sf!. .
SQ.
S~.
om 7_ Z7 Yf
/IA:1E(please print)
FO~
x
Value
Value
Value
x
x
TOTAt VALUATlDrI
;'!\
I1ECtlMIICAI. PErl11T
Chil r9t's and
SurchJrf}es
lrota1
t'T!'
Ill' \L
Syster.\s Development I
CharQe (1.5')
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COl'lb. rp.rmi t '~I.
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BUILDIIIG PERIIIT
Cllar'1es 3ne
Surcharges
Plan Ck. Comm/lnd
65!/Bldo Ppr Fpe
------------~n Ck. Res
30t/Bldo Per Fee
,/
PLU'1fiING PERMIT
C~ilrges ilnd
Surcha rges
I Fence
------------
j Demo
I Sidewalk
------------jA/c Pavinq
I Curb (ut
I
)
,[L[CTRICt,L PUU:IT
Charqes and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
J
.
I. Applicant to furnish
A. Job Address
B'. legal Description
1. example- Tax lot lOa, lane County Map Reference
II UJ 4J
2. eXilRlple- lot 1. Olock 3. 2nd Ad~ition to
~prln9field [states
:',C. Name, etc. of Owner and construction lender
. O. Energy Sources
1. exam!?le- heat/electrical cciJin']/or forced air QdS
2. e.,<amoJe- water'heater/elecl,'ical/or solar
E. Square footage or valuation, etc. -
1. examDle~ ]250 sq. foot house. 500 sq. foot garage
2. example,- T7new project, check---new _ 1f addition,
check add, etc.
F. Building permH information:
]. examole - construct sjnyle famj1y house with an
attached garage
2. examole - r~nodel existing garage into family room
3. examole - convert single family residence into
restaurant (Change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SpeCialty Code -
H. DESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, Building
Division, Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbrevidted Plumbing, Mechanical. & Electrical Schedules
A. Except ,,,here blank spaces OCCur in the description
portion of the Mechdnical and Electrical Schedules,
the appljcant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
8'. Full Plumbing. Nechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit fonm the schedules
have been abbreviated
2. If the item(s) to be installed are not covered'on
the abbreviated schedules you should consult the
full schedules
C. BUItDING DIVISION STAFF WILt FILL OUT ALL FEES AND
CHARGES ON THE SCHEDUtES
O. 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
Lo ~;gn lheeledrical label. --
III. 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
signature.
IV. Fees and Charges
Plan check rees are due and payable at the time of the
application, and no plans ,...ill be processed until these
fees are paid, All other fees and charges are due and
payable when the permit is issued.
PERMIT VALIDATION
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V. FOR OFFICE USE ONtY
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PermitClerk t1/"1J)-,
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVI EWED
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