HomeMy WebLinkAboutPermit Building 1986-12-9
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Address
-LJt~llirl I tJ\fi
(name)
Phone
(address)
lNFORt1ATI'J:/ lli'le,
726-3753
Sq. Ftq. I.lain I
:q. !='tg. Access. . \
Sa. Ftg. Other ~
Hew Add JI.1ter P.eD. ~
--Fence Demo Change/Use ~'-
"t'lSBbr ~ Other- - ~
Built;lnQ Permit Info: Describe ~Jork(;-.e.. Build Single ~
Familv nesidence Hith I\.ttached haraae)
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(lies. no.) (exnires) (ohane no.)
.
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I IrISPECTIQff LIllE
726-3769.
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CITY UF SPRIrIGFIELD
COt1BIIIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
(-later Heater
Job Address J ').::J 0 S o.u-~ A
Legal Description l7-rtJ~"'~~--3 /f"~/'z~
"'
RaMe
-,
Owner J, 'YY)
Address j 7 ;;l 0
Per S I
.5 0 "'- Th
ri
A
Phone
'1Q~'n~~
Construction Lender
Primary
Structural
Electrical-
:1echani ca 1
CONTRACTORS I name)
General Rn YyY) "'''"' J Rr-.-l:k
Plumbina
(address) (li~s. nn.)
p,q ~)~ M.....G" let ~L/-a.6;(
(exoi rpo:;)
(ohnnp nn.)
O/-:1S-??7 9c<3J..b(Q
- .
El ectri ca 1
t.lechanical
PLUIIBIIIG
ELECTRICAL
MECHAN I CAL
110.
I FEF CHAR!;F Nn
~!="~ fl-l.ll.Rh~ t!O_
I .c~F fHAR(;!="
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Res i dence
(l bath)
Duplex (1 bath) each
SERVICES
Recessed wa 11
SnAre heatpr ann vpnt
Additional bath
Temporary Construction
Chanoe in_existing+_
res,idf!:nl:'e
multifamily. comm. or
Tnrllto:;tri<:ll
_ _ _1_ _._u
Appliance vent
seaa ra te
Stationarv_evao.
cooler W ,
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
rlechan i ca 1 exhaus t
hood and duct
'dood stove/heater
Hater service
Sewer
Storm Sewer
Of
amps.
COI~I.1. II ND. FEEDERS
Install/alter/relocate
dio:;trin. feprlprs
Of
amps.
ISSUANCf OF PFRtHT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l.JHERE STATEl:~\'J REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valii until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAmNED the completed aprlication for permit. 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 Sari ngfi e 1 d and the laws of the Sta te of Ore(]on perta i n i ng to the work descri bed herei n. and that IlO OCCUPArlCY \...i 11 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 ons 701.055. that if~~xempt the basis for exemntion is noted hereon. and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this nroject.
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-- ---. .-
FO~
SIr,HATURE~.
OFFICE USE GillY
Sq. Ftg. r1ain
Sq. Ftn. Access
Sq. Ftg. Other
8 r/151 q I ;<-q-~b
/.". ~_ ..syste. ms Development
~I:). ~~ Charqe (1.5%)
.Q Jl.4,
Dmld. _'Hf b
IIAI-IE(please print) f(C;.,V'rYl.... "'. rf
,~;i/..:
BUILDING PERI.IIT
Charges an~
Surcharges
/
V5€ U-z:?E ~<'~
, -:z <"'."...". . Plan Ck.
____~..._____ 65'X/Rldt:1
/ _ Plan Ck.
. 30t/Bldo
Tyoe/Const.~~.
Bedrooms
Stori es
llnits
x
Value
Value
Value
I~-=>
Zone C':G
Fi re Zone
Occy Load
Occy Group
x
Flood Plain
x
TOTAL VALUATION
COlTlll/lnd
Ppr Fpp
Res
Per Fefl
/-1.;1/
.
PLU'1BING PERMIT
Charges and
Surcharges
Fence
D,;mo
..ELECTRICP.L PERr~1T
Charges and
Surcharges
IIECHANICAL PERI11T
Charges and
Surcharges
Sidewalk
------------
I A/C Paving
.t' Curb Cut
------------,
Total Comb. Permit
TOTAL
~-=-
026,0{1 ~,-;
-.f-
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot lOa. Lane County Map Reference
17 03 43
2. examp)e- lot 1. Block 3. 2nd Addition to
Springtie,ld Estates
C. Name, etc. of owner and 'construction lender
D. Energy Sources .
1. exarnf?le- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, chec'k new - if addition,
check. add. etc.
F. Building permit information':
1. example - construct single family house with an
attachea gar'age
2. examole - remodel existing garage into family room
3. example - convert single famlly residence into
restaurant (change of use)
G. value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM 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, Mechanical, & 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
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 S;,0r! the el.<::>ct!"ici.:!.l labe1..____ _ - _--:::-:.
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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11/{S-'%b
I Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
UB.;t/~'7l~E7?
Signatur~___
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date/:< ;;' €&".
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