HomeMy WebLinkAboutPermit Building 1986-8-20
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Job Address
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CITY Uf SPRlflGFIELD
CO/IBIIIATION APPLICATION/PERMrr
E!lERGY SOURCES:
Heat
Hater Heater
Ranqe
INF0R11ATlON l!1'jt.
726-3753
Sa. Ftq. I.lain
~q. ftn. Access.
Sq. Ftg. Other
flew Add Alter ~ep.
Fence_Demo _Change/Use
_Other
~
a
(ohane no.)
j H1SPECTIOIl LIIIE
726-3769 .
Legal Description
Owner ~J /!f1~; i4~A./l4;fi/YJ
Address {c 7.5 I rYUlJ/t"th{/ &-...L! Phone ifW-
construc::::/,f: ~ 0 () q~ rf
Val~f l'lark:
-".~g5
Burl{:lno Permit Info: Descrlbe Hark( 1.e..
Far:lilv l1es;dence Hith (Ittached Garaae)
1t~ InaA-i~/
Address
lJ!;,~Jtirl ftNl
(name)
Phone
(address)
(lies. no. \
(exn; res)
Primary
Structural
Electrical
r1echan; ca 1
CONTRACTORS~(nameJ
____ I
Genera 1
(J
f.(/,.. /677t
(addr~<; )
/7JL/i:U Q.
~
(lire; no.)
(p)(n;rp,; )
fohnnp nn_)
P\umblno
Electrical
, ~,lechan;cal
PLUIIBIIIG
ELECTRICAL
MECHANICAL
Each single fixture
sq. FT.
I m I r"AOr.'
nn I
I 1="1="1=" I rl..IlI.Rr.1="
:~o. I
I FEF I rHAR(;F
110
I
Residence of
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.f. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11 I
Snn,P hPntpr nnrl vpnt
Sewer
Temporary Construction
Change in existing
rp}; rlJ'n,p
Imultifamily, comm. or
lnrlustr;al
10f amps.1
COIII.\.1l NO. FEEDERS
Install/alter/relocate
di~tr;h. fpprlpr~
Apol iance vent
<:;poaratf'
Stationary evao.
cooler ~ .
Vent fan with
sinale duct
Vent system apart from
heatinq or A.C.
MeChanical exhaust
hoorl nnd duct
Wood stove/heater
Ha ter servi ce
Storm Sewer
Of
amps.
ISSUANCF OF PFRlIlT
TOTAL CHARGES TOTAL CHARGES
WHEP,E STATE L\\~ REQUIRES that the Electrical work be done bv an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAt1INED t~e camp 1 eted ap!" 1 i ca t i on for lJermit. and do hereby cert ify tha t a 11 in forma t i on 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 Orel]on ~ertaining to the work described herein. and that rlC DCCUPAUCY will be made
of any structure without the permission of the Ouilding Division. I further certify that my registration with the Builder's
Board is in full force and effect as reouired by ORS 701.055, that if exempt the basis for exemotion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IIAI.IE(please print)
-r:r IJIlflrrflcwS
FOr.
SIr"IATURE -r-1"711carfJ;.
OFFICE USE DriLY I
Sa. Ftg. Ilain
Sq. Ft~. Access'
Sq. Ftg. Other
.
Dft.TE
~. Zo-<tb
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Occ.y Group
x
x
Value
Value
Value
x
TOTAL V ALUA TI ON
BUILOIllG PERfllT
Charges an':
Surcharges
I Jiirr2V I Plan Ck. COI11T1/Ind
6S%/Bldo Per Fee
------ ?---
I Plan Ck. Res
a 30%/61 do Per Fee
Fence
ISystems Development I
Charoe (1.S!-j
PLU'1BING PERMIT
Charges and
Surcl1a rges
Demo
ELECTRIC~.L PERI~IT
Cha rges and
SUr"charges
Sidewalk
AIC Paving
Total Comb. Permit
IIECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.------------1
TOTAL
~f,SV
J
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
6. legal Description
1. examole- Tax lot -100. Lane County Map Reference
11 03 43
2. examole- Lot 1. Block 3. 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
~. Energy Sources
1. examole- heat/electrical ceiling/or forced air qas
2. examole- waterheater/electrlca\/or 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.
check add. etc.
F. Building permit information:
1. examole - 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. DESIGN TEA\.l 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, ~lechanical, & 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 ~ authorized
to sign the electrlcal 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 i$ issued.
(j~~1~1
'6' ~D <7)&
v. FOR OFFICE USE DilLY
Permi t Cl erk (t!./'
j
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board.because:
Additional Project Information:
I
PLANS REVIEWED BY:
name
signature
date
.