HomeMy WebLinkAboutPermit Building 1987-4-27
CITY UF SPRWGFIELD .
. CDr1BIIIATlON APPLlCATION/PERMrT
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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,
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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
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O<y
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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:
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PERMIT VALIDATION
13fo't(ft;i
L(-;) 7-S1
Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
.
~
date
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