HomeMy WebLinkAboutPermit Building 1983-9-8
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I nISPECTIO:l LlilE Cin UF SPRlilGFIELO
726-3769 COIIBlilATION APPLICATION/PERMIT
Job Address \ \ \ ~ ~ \4. I ~e.~\t- -, ~~;~GY SOU~Vh...
Legal Description \ "1 Cl~ '},S l...\\ (\9,N'fl :Iater Heate;\'\\\:-
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INFORl1ATIOtf l!l'it.
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq, Ftg 0lther~
--1~ew~dd~lter~~ep.
Fence Demo Change/Use
Other - -
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ValuE. of Har":
~.OOO
BUilGinq Pernlit Info: Describe Work(i.e.,
Far:lilv nesidence IHth JI..ttached Garaqe)
Owner tltc.1JLJ4,' r./H"', ,,,, "" \/
Address \'\'\~ "7::,\')'-'J....y.,!.~\ '~\'l~7"".-1'111
S('\Q..,,, l^\ ~'O'\('\.. _ C'R u,,\U,,,\,\
Construction lender
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l4 RpfL~c-~
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I TOTAL CHARGES I TOTAL CHARGES
that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
J HAVE CAREFUllY EXN1JflED t,e completed apfllication for permit, and do hereby certify that all infonnation hereon is true
and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Ore!}on pertaining to the work described herein, and that NO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify"that my registration with the Builder's
Coard is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 70~~:: US~iS project.
1lAf.IE(Pleaseprint)"Dec<'Yl '1)UYl ,<;"'..... SIGIIAT , AAL-A-/,("'~AJu... DATE~h3
FOP. OFFICE USE OIIL Y I I
Sq. Ftg. riain ,w Value
Sq, Ft~, Access 1...\\(\2--x Value'r'.\{'l'1J
Sq, Ftg, Other x Value
Address
Ut~Jlirl TEAf1
Phone
(address 1
flies. no.)
.tnamel
N":,, / '" ,.
('.JJ w. f"'-" Y
Primary
Structura 1
Electrical
!1echanical
CONTRACTORS (name)
Genera 1 .tl../.A (I..., ~ <::. .;-
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(addr~ss)
(' ,,-,V!. f~tA I. 'fib /..I
(lice;. no.)
C~M()a""7 ,~2
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Plumbino
Electrical
~'echanical
PLUIIB IIlG
ELECTRICAL
110,
FEF (!l^Rr.F-lJn
~~~ rH~ NO_
Each single fixture
Residence of
SQ, FT.
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
/SERVICES
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S.F. P.esidence
(1 bath!
Ouplex (1 bath) each
Additional bath
I ~!ater service
I Sewer
I Storm Sewer
ITemporary Construction
IChange in existing
r~s i dp'nc~. "
Imultifamily, comm. or
Tndu<;trial
10f
1 Cor~'L / I NO, FEEDERS
l'Install/alter/relocate 1
rlhtrih" fppnpr<;
10f amp,,1
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amps.l
TOTAL CHARGES
WHEP.E STATE L'W REQUIP.ES
shall not be valiJ until the
Zone~,\\ '
Fire Zone ~ \ ~
Flood Plain~\""
V,t-I
Tyoe/Const.
Bedrooms
Stories ,
Units
Occy Load
Occy Group ~-"?\
BUILOHlG PERHlT
Charges an~
Surcharges
_~~~_n___
\ ."' (p
?.. c;, , c,o
PlUt1BING PERMIT
Cha rges and
Surcharges
Plan Ck. Comm/lnd
6Sr./Bldo Ppr Fpp
Plan Ck. Res
30%/Blda Per Fee
Fence
------------
I Demo
_l;).:.~_____ Sidewalk
. Cd') A/C Pavi n9
I Curb C~t
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ELECTRIC~,L PERr~lT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Build Single
-
(exoires)
{ohane no.
(lOlxoires)
(ohnnp nn_ )
?,L/
G~9-oqot)
MECHANICAL'
furnace/burner to
BTU's
~~~ r~.IlR!iE
"/ "
" ./
I Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
.1 Appl i ance vent
seoarat~
I' Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust
hnod ~nd duct
I ~Jood stove/heater
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ISSUANCE OF PFRtllT
TOTAL VALUATION
Systems Development
Charqe (1.51,)
\'7_0.00
ITotal Comb. rermit
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I TOTAL
Co\. ~
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A.O~:.
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Co.~BIrIATlO~ APPLICATlO:lIPER.~IT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II OJ 43
2. examole- lot 1. Block 3. 2nd Addition to
5prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air aas
2. eXilecle- waterheater/electrical/ar solar
E. Square footage Or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition.
cneck. add, etc.
F. . Building pemit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage fnto 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 CO~TRACTORS
10 avoid design or construction delays, Building
Oivision Staff must be able to contact appropriate
persons regarding design infonmation 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 f.ill-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 Oivision
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. aUILDl1iG OIVISIO~ STAFF WIll FIll OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
nam~b.>..I\\) ~ ~ \e\,~
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Signatur~c\ ~~~\- da~e C\ -'Q;-~ ;