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HomeMy WebLinkAboutPermit Building 1987-4-27 CITY UF SPRWGFIELD . . CDr1BIIIATlON APPLlCATION/PERMrT /3d2 I ?;, '/7 / I ~~;~GY SOURCES: Legal Description /70 33C;; 30< tJ 'J7tJe I I/ater Heater Dwner S~~('/L;u /!IJ~ I ~:~:: of l/or': ,\udress ! / 3;;:z1 ,C, I A I Phone JLJt, g;J,;). f( I I Is;. (fO I I I ,100 I I I TDTAL CHARGES I TDTAL CHARGES f/HERE STATE L,\li REOUIRES that tile Electrical wor' be done by an shall not be vali1 until the label has been signed by an Electrical IIiISPECT IOII I. WE 726-3769 . Job Address Construction Lender Address DtS 1 Gfl TEAf.1 {name} Primary Structural Electrical :1echanical COilTRACTORS (name) Genera 1 {JAJJfIP ;vi Plumbinq Electrical f.techan; ca 1 PLUI1BIIIG ',0. FFF (HARf,E Each single fixture Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (I bath) each Additional bath ~!a ter serv i ce Sewer Storm Sewer ~eND 0, fj Iv IIAIIE(please print) 1So(\)N \ E Co'FfMA~ Zone Flre Zone Tyoe/Canst. Bedrooms Star; es Flood Plain f,'{.fi ItlFORt1;1.T:.:1 u..t. I: 726-3753 ! So. Ftq. r.iain ~C1. ~tg. Access. Sa. Ftg. Dther IleloJ Add /l.lter ~eD. _Fence _Demo_Change/Use _Other Phone (address) 13uill~ina Permit Info; Describe \.Jork(i-.e.. Build Single Far.1ilv r1esidenee l'lith /I,ttachpd r,araCle' rl!!utm~ M ~ J~p~ J:u~tu;~- (lies. no. j (exnires) (ohone no.} '-1~ L..{\30Cl (address) (l ics. no.) (pxnires) (nhonp no.l -r ..( ,~, I .... ./ 'C ELECTRICAL MECHANICAL tln r!--lARf,F 1m. '" Residence of furnace/burner to BTU's SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 So~rp hp~ter ~nrl vent Temporary ConstructiQn Change in existing re-sidence- mul'ti-family. comm. or 1ndu"triill Apol iance vent C;e03,"atf> Stationary evao. cool er ~ ' Vent fan wi th sinole duct Vent system apart from " heatino or A.C. Mechanical exhaust hood Nnd duct. Of amps. CDr11.I./IND. FEEDERS IInstall/a1ter/relocate dic;trih. fpprlprc; IOf Wood stove/heater amps. ~ ISSUANCF OF PFR!HT I O<y "'0 ~ II~ l~ I I I '" I r~ARr:~ i I I I I ! ! i i i i TOTAL CHARGES Electrical Contractor. the electrical portion of this permit ~ Supervisor and returned to the Building Division Units value Val ue 1 HAVE CAREFULLY EXA1lINED the completed apn1ication for germit. and do hereby certify that all information hereon is true and correct~ and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Ore9on pertaining to the work described herein, and that IlC OCCUPArKY \~ill be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard 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 I.,.ho are in comoliance with OP.S 7'11.055 \'Iill be used on this project. SICIIATURE 6?a_~_': I Y;() ~/ Dm4-':J..7-g? FO~ OFFICE USE QillY ~ ~ Sq. Ftg. flain x So. Ftg. Access x Sq. Ftg. Other x Occy load Occy Groun Value TOTAL VALUATION syste, r:lS Development I CharQe (1.5') BUILDING PERI.IIT Charges an~ Surcharges Plan Ck. Comm/lnd 65%1B1 do Ppr Fee ------------~n Ck. Res 30%/Blda Per Fee Fence PLUllBlIlG PERI11T Charges and Surcharges . JS 00 I S ---- --~--"-- .tt,ol I . ELECTRIu'L PERf~IT Charaes and Surcharges I1ECHAN I CAL PERI1 IT Charges and Surcharges D,;mo Sidewalk Ale Paving Total Comb. Permit Curb Cut 15.100 TOTAL . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference l/ U3 43 2. examole- lot 1. Glock 3, 2nd Addition to ~prlngrield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceiling/or forced air qas 2. examole- waterheater;electrlcal/or solar E. Square footage or valuation, etc. - 1. exarnole- 1250 sq. foot house. 500 sq. foot garage 2. example- Tflnew project, check-new - if addition. check add. etc. L Building permit information: 1. examole - construct single family house with an attached gar~ge 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, DESIGN TEAr.1 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 DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES D. As noted on the CAP, the label must be delivered to the electrical contractor for sianature by his electrical supervisor. The general contractor is ~ authorized to sign the electrical label. III. Applicant to Si9n 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 appl ication, 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. V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: II I i . I . II PERMIT VALIDATION 13fo't(ft;i L(-;) 7-S1 Permit Clerk Cv ~ J Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signa ture . ~ date 1 <;r-. /-;/ /('? ~!',. . ~~-,'. .>..- ."" . ..-~~?'d Jo-=ff Cj(,-/CrI10 fYlDS ~ /O!::r(qb 7J~- ~dJc-,.. ,