HomeMy WebLinkAboutPermit Building 1988-4-27
I IrlSPECTIOIl LlIlE
726-3769
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8'1 '1(;0
ltIFORllATIO~-l liijt.
726-3753
Sq. Ftg. f.la;n
~CJ. ftg. Access.
So. Ftg. Other
fle\v Jl.dd Alter P.ep.
-Fence Demo Change/Use
-Other - -
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I
Legal De~cript;on
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64'300
CITY OF SPRWGFIELD
CDrmIrIATI 011 APPLI CATION/PERMIT
EIIERGY SOURCES:
Heat
\'iater Heater
Job Address
M~<;
/'1 fJ3?;,c; 3/
Owner I_~/.; /..
/vI, v.. . 1../ n .p
Address t.f"',';';h =. .~ -I-- / ';v'i' Phone, /
I~ L-. 1__ I RY'#'J4A1 t->~AL., :#"" ,... ~qi.-II1!:f'
/
?J3rf)
Ranqe
ValUE of \-Iork: /100
~
0<:)
.......:>
Address
Ul:.~ llifl fEAr.,
(name)
Phone
(address)
(1 ics. no.)
(exol res)
Build Single I ~
I
(ohone no.)
~:/.~ 0
Construction lender
r/\ 0_.
Buil(;nq Permit Info: Describe Hork(i'.e.,
far.1i1v Residence I-lith /l,ttached Garaoe)
\~-'-l~- ~
'."
Primary
Structural
<no-!
vv
L.r-OO
~/II
Electrical
!1echan; Cd 1
CONTRACTORS (namel
General (7;"'# L..JtT",k"
Plumbino
(addrpc;s)
""j, _: /jJJ 9IJh 9'4 i//v--r "r
f:':J'----- oV-.
(l ics. no.)
(pxnires)
L,/z.. ?h.f-
I /
(ohonf> M_ 1
'S'?J-I> 1
hKYI<::al
Electrical
"lechanical
PLUllBIrlG
ELECTRICAL
MECHANICAL
Im.1
lEaCh single fixture
Relocated building
(new fix. additional)
FEE (HAR(;F tlO
~H rI-lARr,1=" rlO.
~I="F rHARr,F
SQ. FT.
furnace/burner to
BTlI's
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Res; dence
(1 bathl
Duplex (1 bath) each
SERVICES
.Recessed wa 11
SnrlCP hPntpr nod VF>nt
Storm Sewer
Of
amps.
Appliance vent
seD~rate
Stationary evao.
cooler Y .
Vent fan \'li tn
sinale duct
Vent syste~ apart from
heatinQ or A.C.
Mechanical exhaust
hood and rlur.t
Additional bath
II-!ater service
I Sewer
Temporary Construction
Change ;n existing
fPc:.i riPOfF>
multifamily, camm. or
Inollc;.trii'll
I
I
VI
COMM./IND. FEEDERS
Install/alter/relocate
rlic:trih. fppdprc:
Wood stove/heater
Of
amps.
I
I
I
ISSUANCF OF PFR'1IT
TOTAL CNARGfS TOTAL CHARGES
WHERE STATE LW REQUIRES that tile Electrical work be done by an Electrical
shall not be valiJ until the label has been signed by an Electrical Supervisor
TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division
1 HAVE CAREFUllY EXmlINED the completed apr1ication for r.>ermit, 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 la...ss of the State of Oregon pertaining to the work described herein, and that rw OCCUPAIKY l.,.i11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this ~roject.
ilAl-lE (p 1 ease print) S IGII.~TURE
Far. OFFICE USE orlLY
Zone Tyoe/Const. Units St"!. ftg. f1ain x
Fire Zone Bedrooms Occy load Sq. FtlJ. Access x
Flood Plain Stories Occy Group Sq. Ftg. Other x
TOTAL
OA.TE
Value
Value
Value
BUILOIrlG PERI.IIT \ b UU Plan Ck.
Charges ane ________~__ 65%/Bldo
Surcharges "'"\ '-1. L... Plan Ck.
0- \ l J 30%/Bldo
PLU~BING PERMIT Fence
Char.ges and ------------
Surcharges DIjRlo
Comrn/l nd
Ppr Fpf>
Res
Per Fee
\~l L
_~ ~Systems Development
("'r;f<\ Cha roe (1. 51,)
\
VALUATIOil
\Jll\- ~
ELECTRICAl PERI~IT
Charges and
Surcharges
Sidewalk
I AIC Paving
I Curb Cut
I
Total Comb. rermit
/1ECHANICAL PERMIT
Charges and
Surcharges
r' /
\0'~':l
1 TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
I. ~pplicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
-j/ 03 43
2. example- lot 1.. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ce;l;nq/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -----
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examyle- TT:new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam[lle - remodel existing garage into family room
3. example - 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 TEAl.! AIID 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 Mechani~al and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
8. 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
supervi sor. The genera 1 contractor i s ~ authori zed
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
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:
.
;
.
~
PERMIT VALIDATION
(Q ~1 h 1
,
Permit Clerk
~..
~
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,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
i
PLANS REVIEWED BY:
name
signature
.
date