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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 . _ .' II PERMIT VALIDATION ~(\ ~\o~ ,,:\~ ~/J I '&J Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ ifJ" ~.-'~~L...::>c./ <-..0 5<?//71" / At77/C- ~.z:;>..6' PA'.??~~ {;~~ , .~~~~ 5/&:A./~2> jP,4- ~~ 'T"'r I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . I PLANS REVIEWED BY: name L.oh'#G ?.c c-----~ y ~. signature . '/ . ,~~ date ;0tS'-:?)