HomeMy WebLinkAboutPermit Building 1989-6-14
'-
.
li!SPEC! 1011 l HIE
721'-)7';9
LIlY "I' SPHIin;FIElU
COIIBIiIATlON APPlICATfON/PERM/T
E!IERr,y SOURCES:
Ileat
tlater Heater
Job Addr... \D W 8- \'{\~"f\ "I--\}-, .--
l.e9al Demiption \( \D-:::)~~'SA-\ rA.G\D()
.,
ImORI1Al:.:1 ll..:;'
726-3753
Sa. Ftq. '.lain
~q. f'tl). Access.
SQ. Fl9. Other
lie,., Add /J.I ter ~eo.
--Fence Demo Change/Use
Other - -
RaMe
(I ics. no.)
(exnires I
Primary
~L
f\r
Structural
Electrical
Bui Id Single
J]i
.-01
I :
J I
I I
fohone no. I
i
,
i
i
I
J
J
,
i
General
SIr.rlATURCa M ~ DATE d -,.J.f/-S7
FO~ OFFIC,.lIlil: O:II.Y
r
S~. Ft!]. f1ain x Value
SQ. Ft!]. Access x Value
SIl. Hg. Other x Value
TOTAL VAlUATlOII
,. ~
Plumbin" - t\ .\ (\ ')
Electrical f\ r (\ ./
P'p-chanical
PlUIIR IiIG
ELECTRICAL
MECIlANICAl
i:U. t
~IEach 'in91e fixture
IRelocated building
(new fix. additional)
Is,F. Residence
_(1 brlthl
Duplex (1 bath) each
-.Ef.L J:JUIllGE. II
Residence of
furnace/burner to
BW' ,
SQ. F1.
!New circu!ts alts.
0'" extenSIons
ISERVICES
-,
I Floor furnace
and vent
I I Recessed wa 11
_ ~f}u'P hP;ttpr ~Il{l
I I
Additional bath
I Temporary Construct ion
IChanrye in existing
rps;d~nr~
Imultifamily,
[ndll<;.triill
I ApolTance vent
<;.POil.l'atp
I Stationary evap.
cooler
I Vent (an l'lith
sinale duet
I Vent system apart
heatilltl or A.c.
I ~leehanieal exhaust
_~ood .lnd durt.
".
Wood stove/heater
I SSIJANCr OF prR!1I T
11A:IE(plea,e print) ~J;,tI ,if. ~,Il-P/'Yd'4/'
Zone
Fi re lone
FlOOd P1.1in
Tyoe/Cons t.
Bedrooms
Stories
llnits
Oeey load
OCC,Y Group
BUIlDlllG PERI-liT
Charl]es an~
SurCharges
_ ull.~~i ') _
<.~. /.';)."
Plan Ck. Comm/lnd
65!/Bldo Ppr Fpe
Plan 0. lies
JO%/Bldo Per Fer
PlU'1BING PERMIT
C:'arges and
SurCharges
I Fence
-------- / Demo
____________1 Sidewalk
,.1 AIC Pavin9
I Curb Cut
ITotal (amb. rermit
IIOTAL
&;5. U3 ,
,CLECTR'Cf.l rERI:1T
CharQes and
Surcharges
IIECIIANICAl PEP-lilT
Charges and
Surcharf}CS
------------
~-rlARGl.
I
vpn' I I
-,
I
I
I
from I I
LI
I I
I I
, I
I I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl iCdnt to furnish
.A. Job Address
8. legal Description
1. example- Tax lot 100. lane County Map Reference
II O"j 43
2. eXolnlple- lot 1. Olock 3. 2nd Addition to
~prlngfield [stales
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examn.le- heal/electrical ceilinq/or forced air QdS
2. eXclmole- waterheater/electrical/or solar
L Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- Tf'"""'new project, checknew _ if addition,
cneck add. etc.
F. Building pennit information:
1. examole - construct single family house with an
attdched garage
2. examoJe - remodel existing garage into family room
3. examole - convert single family residence into
. restaurant (change of use).
G. Value of ''lark as defined in Section 303 (a) of the
Structural SpeCialty Code
H. OES'IGN TENI AND COIITRACTORS
To avoid design or construction "delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonnation or jOb site
corrections, etc.
II. Abbreviated Plumbing. f-lechanical, & Electrical Schedules
A. Except ,",here blank spaces Occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need filJ.in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Fun Plumbing. Nechanical, and Electrical Schedules
are avaj1abl~ at the Building Division
1. To Conserve space on the permit form the schedules
have been abbreviated
Z. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUilDING DIVISION STAFF Will FILL OUT ALL FEES AIID
CHARGES 011 TIlE SCHEOULES
O. As noted on the CAP, the label IllUSt be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is ~ authorized
to sign the electrical label.
11[. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wi 11 prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees i1nd Chilrges
Plan check fees are due and pilyable at the time of the
application, and no plans ''IiI I be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
.,
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
.e
,.
I
:I
I
i
,
I
i
I
Pe rm i t
.
PERMIT VALIDATION
~- \+-81
+~0S
v&~
clerofm)
-I
.
]
J
Permit appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
da te