HomeMy WebLinkAboutPermit Miscellaneous 1989-2-17
II IrlSPECTI011 llilE
'1716-3769 '
Job Address ~ MkC( ;'Y$O 2R.4J~1
I.egal Oe<cription ((J () Jdn-!7c/ Jay
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Owner C; rj OF
,'Jdrcss 225- AI, 5"lb f) r:
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Construction lender
"__ or
C ;iy'i)TsPRlHGF I ElO
C0/1B iliA TI ON APPlI CAT ION/PERMIT
E~IERGY SOORCE3;
Heat
I'later Heater
Ranoe
Valur of I.Jark:
l );0"" M )6 F/l<?Q
,
Phone
Address
OESIGrl I!:AH
(nam",l
- .-'--
Primary
5 t ructura 1
Electrical
me ~'I':;4,'K. elcc-T:
!1echanical
CONTRACTORS
(name)
General
Pl umbi nQ
Electrical
~"echanical
PlUIIBlIlG
i:O.
Phone
(address)
(1 ics. no.
Z? 77(;, ryh JVI,) IV,,;.
(address)
( 1 ics. no. 1
r- ,....,
/") / /J--'fY
oL- I I I
ELECTRICAL
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.
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Each single fixture
I....ITL I CHARGE '.J!IL'
Residence of
sq. FT.
-/ Relocated buiiding
(new fix. additional)
Is.F. Residence
(I bathl
Duplex (1 bath) each
Additional bath
Hater service
.. Sewer
IStorm
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Sel'ler
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TOTAL CHARGES
1'/I1EnE STATE l,\I/ REQUIRES
shall not be val H until the
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jNew circu~ts-alts.
or extenslons
ISERVICES
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NFORIIAT:." L'",
716-3753
Sq. Ftq. I-iain
~Q. F"tg. Access.
So. Ftq. Other
flel'i Add /1.1 ter ~eD.
--Fence Demo Change/Use
Other -- --
L11~~
1/"0'0
---
72.(;;-7/-,4Q
-- - , ,
(exoires)
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-- ~
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ITemporary Construction
IChange in existing
rp~_idJ'nr:p
Imultifamily, comm. or
lnrlllc;.trial
IOf
Icor1I'1./INO. FEEDERS
I Install/alter/relocate
r1ic;.trih_ fPPdprc;.
Of amps. I
amps.1
(ohane no.)
MECHAN I CAl
,.
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I 'I-
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furnace/burner -to
BTlJ's
Floor furnace
and vent
Recessed wa 11
Sn~~p hPntpr nnd vpnt
I Apol iance vent
c;.~oaratp
I Stationary evap.
cooler
I Vent fan vdth
sinale duct
I Vent system apart from "
heatinq or A,C.
Mechanical exhlust
hood ilnd durt
Vood stove/heater
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perrili t
TOTAL CHARGES
ISSUANcr or prRillT
j5<>P. TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor, the electrical l1ortion of this
label has been signed by an Electrical SUl1ervisor and returned to the Building Division
r HAVE CARE FULL Y EXMlINED the coml1l e ted aPr 1 i ca t i on for .lJermit, and do hereby cert i fy tha tall in forma t i on hereon is true
and cprrect. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Sari n9 fi e 1 d and the Laws of the S ta te of Ore<:1on pe rta i n i ng to the work descri bed here in, and tha t 1m OCCUPAIKY \'Ii 11 be made
of any structure without the permission of the Ouilding Division. I further certify that my re9istration with the Builder's
Ooard is in full force and effect as required by ons 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees who are in comoliance with Or.S ]01.055 l'Iill be used on this rro.ject.
IWIElp!ease print) CI1<f t'?;::):-~~;=;-~_SIr.IIATURE ,<~/~ ~~
FOr! OfFICE USE Ui,LY .
Zone
Fire lone
Flood Plain
Type/Cons t.
Bedrooms
Stories
om o/~9.
Units
9ccy Load
Occ'y Group
s~. Ftg. 11a'in
SQ. Ft~. Access
Sq. rtg. Other
BUILDIIIG PERI.IIT
Charges anc
SUrCharges
------------
I Plan Ck. Corrrn/lnd
65t/Blda Per Fee
Plan Ck. Res
30%/BldQ Per Fee
I Fence
I Demo
Sidewalk
I A/e Pavin9
Curb Cut
PlUI1BING PERMIT
Charges and
Surcharges
------------
. ElECTRICP.l rER1~IT
Charqes and
Surcha rges
IS- d{)
------------
.75
flECHAN I CAl PERf1 IT
Charges and
Surcharges
------------
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
CharQe 11.5')
1_,
Total (omb. rermit
I~WAl.v~ ~a 7y
t?.I77( 1.V..d~ 7"
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
11 oj 43
2. example- Lot I. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air QdS
2. examole- waterheater/electrica~lor solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- rr-new project, check-nfw _ if addition,
check add, etc.
F. Building permit information';
1. example - construct single family house with an
attached garage
2. examole - remodel 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. DES I GN 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. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. 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 installed
B. Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form 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. BUILDING OIVISION STAFF WILL FilL OUT ALL FEES ANO
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. -
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 fees are due and payable at the time of the
application, and no plans will 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
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Permi t Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
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name
signature
date