HomeMy WebLinkAboutPermit Building 1987-4-28
I HISPECTJOII LHlE . un uf SPR111GflELD .
' 726-3769 . _ COIlBUIATlON APPLICATION/PERMrT
I,
Job Addr~' 7 p;., If- 1FT b!)5' A In f?TH- /t~~~~G1 SOURCES:
Legal Descnptlon T~II/III~ ~ N''LL ()/VI'... ,~later Heater
Ranqe
) 7-0~'3<:;-, 3/. o~oo .Y.alu~Of Hork:
Owner tf1. l It't! k:vp ~L L 11 "'2' CO lJ -
~ ~ ' 13ullt:inQ Permit Info: Descnbe Hork( l.e..
Au'""7hs , 7<; t'JPJt<." ~ 1: .!?(jIiEI.J~hone, fam,ly ReSIdence tilth Mtach~o r,ar,opl
II
A-MluJ.1RJ; (l.1J. 6,5'7-U"'!'( Jlew
Construction Lender J
J, t. 11/ ~
'fA tIll
~"'/,
Sf DF'"
,\ddress
Ot~I(jFI n:Arl
Phone
(address 1
-;:>? oj /? q;;(
{nameJ
(1 ics. no.)
Primary
t8' N. to
Yd4-rl.,JCldU
""
< ,
hl ,,_k,vt5-
Structura 1
"
E1 ectri ca 1
!1echanical
CONTRACTORS (name)
General fJA-u ;It. r iViJ:/e";
Plumbil'lQ
(address) flits. no.)
g~~olP. AJe' h""~(lr' 7c;".,<o
Electrical
.A
'-
r,lechan; ca 1
PLUlIBUIG
ELECTRICAL
110,
ffF
r.HARr,F ~Jn
c~~
n-lnIH::~ rm
Each single fixture
Residence of
sq. FT.
IRelocated building
(new fix. additional)
IS.F. Residence
II bath I
Ouplex (I bath) each
P.dditional bath
,I
I
I
Temporary Construction \
Chanqe in existinq I
rP?;dpnrp W
multifamily. camm. or
Tnrlllc::tritll
INew circu~ts a1ts.
or extenslons
/SERVICES
I
~!ater' service
Sewer
Storm Sel'Jer
I
I..:
I
amps,
Of
COI11'1. II NO. FEEDERS
Instal1/alter/relocate
rlic:;trih_ fpprlprc:;
Of
amps.
I
I
I TOTAL
!tiFORJ1AI: .:1 l.....
726-3753
So. Ftq. I'iain
:q. ~tg. Access.
SQ. Ftq. Other
Hew Add fl..1 tel" ~eD.
--Fence Demo Change/Use
Other- -
1...9
'100
.N
./;2
Iv<>
I
Bui Jd Single
]) ;e 'T A-Il. .4t i..
fl .f' R'Z>... ..p
(exni res)
(ahone no.)
~-~ I 3.
(pxnin>sl
{I)hnne nO_ 1
LH?- "L-Yt.l,l
. c:: -i>-fj' 7
6"0. ~OO I~~"),("'"
MECHAN I CAL
I ~l="l="
I rl-.D.Qr,~
I
I
furnace/burner 'to
BTU's
Floor furnace.
and vent
Recessed wa 11
Sntlrp hptltpr ~nrl vpnt
Apo1 iance vent
SeOill"atp
I Stationary evao.
cooler
Vent fan \'Ii th
sinale duct
Vent system apart from I.
heating or A.C
Mechanical exhaust
hood ami dlJr.t
Wood stove/heater
ISSUANcr OF PfRIIIT
I
Electrical Contractor. the electrical portion of this permit "
Supervisor and returned to the Building Division
I HA.VE CAREFULLY EXNHNED the completed apnlication for fJermit. and do hereby certi.f~ that al1 l"nformatian hereon is true
and correct.. and I further certifv that any and all' work oerformed shall be done in accor'dance with the Ordinances of the City
of Soringfield a.nd the laws of the State of Ore~on gertaining to the work described herein, and that tlO OCCUPArKY \",i11 be made
of any structure without the permission of the 8uilding Division. I.further certify that my re9istration'with the Builder's
Board is in full force and effect _as required by Or.S 701.055. that if exemot the basis for exemotion is noted hereon. and that
only subcontractors and employees who are in comoliance wlth ORS 71')1.055 \"I.ill be used on this .nroject.
SICIIATURE4 ~ ~
. ~ FO~ OFFlCE USE .0illY
Uni ts Sl'1. Ftg. rlain
Occy Load Sq. Ft~. Access
Occy Group~~ -"2- '1. Ftg. Otherr~ /A
IIAilE(please print)_I"J JII.N ~e:-
Zone L L
Fi re Zone
Tyoe/Const. ,<;-/V
Bedrooms
Flood Plain
Stories
-?
(/.::7& cb~-#8'.2.5/
BUILOIIIG PERI.lIT ~ 5"
~~~~~;~g:~: J- -- --:;/.-?'f;--
PLU'1BING PERMIT
Cha rges and
Surchar-ges
TOTAL CHARGES
t...~.,.., ~'7
om!/~2?-?L
v
x
ValuE'
Value
x
x
Value
~c=e>-;>
. Plan Ck.
6St/Bldo
Plan Ck.
30%/Bldq
Fence
m
Co"",1I nd
Ppr Fpe
Res
Per Fee
fJ, TOTAL VALUATION
1:,&V:20i
II/e/' 5'2 5 ' "1 Syste, ~s Development / / ..r/
I <, a -(-, CharQe (L5~) /'/-/'r ,
De"'"
,ELECTRICfl.L PER::IT
Cha rges and
Surcharges
Sidewalk
A/C Paving
Total Comb. rermit
IIECHANICAL PERI1IT
Charges and
Surcharges
Curb Cut
TOTAL
, 7/.'27/
I
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. examole- Tax Lot 100. Lane County Map Reference
17 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air OdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- 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. 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. DES IGN TEAr,j ANO COIITRACTORS
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 I,there blank SDaces 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, ~lechanical, 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 AIID
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for sionature by his electrical
suoervisor. The general contractor is ~ 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
payabl€: 'ilhen the permH 'is 'issued.
V. FOR OFFICE USE ONLY
.
_
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II
PERMIT VALIDATION
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ ifJ" ~.-'~~L...::>c./ <-..0
5<?//71"
/ At77/C-
~.z:;>..6' PA'.??~~ {;~~
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.~~~~ 5/&:A./~2>
jP,4- ~~ 'T"'r
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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I
PLANS REVIEWED BY:
name L.oh'#G ?.c c-----~ y
~.
signature
.
'/
.
,~~
date
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