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HomeMy WebLinkAboutPermit Building 1987-9-28 Job Address /5CJ .. tl/~C; j- t:; 36a:::> . 1 NfORI1A r: _:/ LI..:,. " 726,37;;) Sa. Ftq. I.iain ~q. !=t9' Access. SQ. Ftq. Other rje\~ Add ft.l ter .r1.eo. --Fence Demo Change/Use Other- -- C><y ~ li~ I\s\ i IflSPECTIOII LHIE 726-3769 ' - - -I ( I Owner ~/L m{Ll1..u-pv~ I.Valu, of "lofj1)1 rzJ1) ~// _/ // '. /J.4- ,nO /17 Ouill;ino Penllit Info: Descnbe I.Jork(l.e., Build Single AJdrcss (/ /l/r1 CY 1;:;;..-v(KCi-~ Ph&- r.r - Family rlesidence Hith /lttached r.araqel _ t2UWri fJP ---.) } f)oLtldnl/Z/Or. n ~~ . Construction Le~r / ~/.fJ ~:J Q ~tJ~ Address Phone -- tI l)'t.';)iu1~ ItAl' lflame) IClddress) IJ Legal De<eription 17-03-:77--;32.. (1 ics. no.) lexnires) (ahonl:' no. I Pnmary ~~R ~~ ~0';'- /3_~ :)~ -:::?"/P/,~/'J7LA'fq p~ '77<~Y _ "227-0383 Structural rA-/Y Lkc-IC!A /~,/JJ~ ~ 11 ~ h' 6/1 ~i'tAv'D Electrical (1la.c/Ar-,/ <,n~ ,-O::?R r;lofh'7 !1echanical (J CONTRACTORS ! name) (address) ~t;~-r~ - P I JJ}(" 13:nL-~ o (lit":o::. no. ) (pxl1,,.,,d (l1hr'\np nn I f..../Df'3'7c5f) ,Z-/-';:') . Plumbino Electrical t,lechanical PLUIIBWG ELECTRICAL MECHANICAL i;O. FFE CHARGF NO I. f Resldence 0 furnace/burner to BTlI's 7 Each single fixture /,-:>0 -SZ~ SQ. n. <rr CHIl.Qf..r !In b.s-o I I I <<< ICHIl.QCLI jRelocated building (new fix. additional) Is.F. Residence (j hath) IDuplex (I bath) each )Addi.tional bath l~!ater service I Sewer I Storm Sel'ler ~ New circuits alts. or extensions '::::? &<i! MoP r-s ,5 ISERVICES I Floor furnace and vent Recessed wa 11 SOil,P hp~tp,. nnrl vpnt "PM-#"'<, 11t=e+::l,/~9;) jTempOrary Construction jChange in existing rps i dJ"JllP jmultifamily, Camm. or Tnduc;.tri<ll IOf amps. ICOM~.IINO. FEEOERS Install/alter/relocate rlio::.trih_ fppdprc;. Of amps. Apoliance vent seOi1ratp Sta.tionarv evao. cooler' . Vent fan l'll th sino1e duct Vent syste~ apart from heatina or A_C. Mechanical exhaust hood <'Ind du,t, l'lood sto'le/hNter I I Ph'!-HS 7?E~:.>/A~ i I I I I I TOTAL CHARGES I-IHEnE STATE L,\I~ REQUIRES shall not be val i-J until the ~~.~~ TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANcr nF PFR!1IT ;;:'Z- Se:. TOTAL CHARGES Electrical Contractor, the electrical portion of this per~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXArHNED the completed apfJ1ication for oermit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all Nark oerformed shall be done in accordance with the Ordinances of the City of Soringfie1d and the Laws of the State of OreC)on pertaining to the work described herein, and that 110 OCCUPAHCY will be made of any structure without the permission of the nuilding Division. 1 further certify that my rC9istration 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 "" ,""co,,,,,,,,, '"' _''''0 ,. '" " ,_H,.,. ,no 00' ,"Lffii&i'Jt " "" ""j,,' IIMIE(please print) J) c.r.. WEST. SIhtIATURE. DATE 1-;)9-f 1 Fan orFlrE USE billY .~- Sf'!. rtg. f1ain x Value Sq. Ft!J. Ac:ee3:; ~""::::-A?_......~",-"1':""':: Value ~~2. Sq. Ftg. Other~.D/7/~A7X-gij4"f' Value TOTAL VALUATIDr' TYDe/Const. Bedrooms 'S-N Units Occy load Occ.y Group Zone Fi re Zone BUILDlIiG PERI,lIT Charges an~ Surcharges / <7 Z 5e> ~~~~B~~~ ----- 7-gsh ~~~~B~~~ _ _ _ _:2..'Z.-2?,'_ _ Fence 2.,{,3 ____~~.::;?~_ Sidewalk If3 COlT1Tl/lnd Ppr Fpp Res Per Fee tf-Zf-S'1 /Zg,3 t !{)2-if'Z.l~h~~~~s (~e5Wpment "'2a/~.. -.. II_~~ _.-> - .- ?'y""'=' Flood Plain Stories "2 /65". """" PLU11BItlG PERMIT Charges and Surcharges D~mo ,[LECTRIC~,L PERr',IT Cna rqes and Surcharges Ale Pa'lil1~ Total (omb. rermi t IIECHANICAL PERI1IT Charges and Surcharges -:z s:? c:, J 'f ~ Curb Cut I TOTAL t;S/. If! . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. examp.le- Tax lot 100. lane County Map Reference 17 OJ 43 2. example- lot 1. Block 3, 2nd Addition to Springtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qa5 2. examp]e- waterneater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250'sq.. foot house." 500 sq. foot garage 2. example- rr-new project, check-new - 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. OESIGN 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 DIVISION STAFF WILL FILL OUT ALL FEES AND 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 Oivision 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. .. PERMIT VALIDATIDN IV;) 11 q~)-9~f J V. FOR OFFICE USE ONLY Permit Clerk~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMKY: : " - ~ J Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name 1....c97?#~ -;:2~~Signature .4~~~ date ! , 9~ 'Z8-2?7 ~,