HomeMy WebLinkAboutPermit Building 1987-9-28
Job Address
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726,37;;)
Sa. Ftq. I.iain
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SQ. Ftq. Other
rje\~ Add ft.l ter .r1.eo.
--Fence Demo Change/Use
Other- --
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726-3769 '
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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
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Construction Le~r / ~/.fJ ~:J Q ~tJ~
Address Phone -- tI
l)'t.';)iu1~ ItAl' lflame) IClddress)
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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-~
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(lit":o::.
no. )
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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
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V. FOR OFFICE USE ONLY
Permit Clerk~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMKY:
:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
1....c97?#~ -;:2~~Signature .4~~~
date
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9~ 'Z8-2?7
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