HomeMy WebLinkAboutPermit Building 1986-12-9 (2)
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CITY UF SPRIilGFIELO
CQrIBHIATlON APPLICATION/PERMIT
, E!lERG~ SOURCES:
Heat
Hater Heater
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Job Address J r"),1 0 So ~ A
Legal Oescription l7~~"~:--3 A~~60
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Ranoe
tNfORtlA'!"" .:, ll.l,- 1,1.
726-37;:
Sq. Ftq. I'lain
~q. !='tg. Access.
So' Ftg. Other
Uew Add Alter ~eD.
Fence_Demo _Change/Use
_Other
Phone
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1h~-mL' ~ ~ f(~p~ ~
~:;J69~~;; /-~ . EF/~77~ h/~ I
. ~ ~~ p.....~/J ;J"'/~ .. \,
<lies. 1'\0. \ (exolres\ (onone no. \
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Bui16inQ Pernlit Info:
F.lr.lily nesidence IH th
Oescr,be Wor~\i.e.. BUlld Slng\e
Attached r.araoe)
Owner J ,- m
Addrc" 17;;10
K>J S I
So ""TI,-- A
rj
7(;). (P-17H
Construction Lender
Address
OESIGI, TEIIII
(name)
Phone
(address\
Primary
Electrical
1} 7 \
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II.""
Structural
.....
.. JJ,.M\ ,
IpO,P
~1echan;cal
CONTRACTORS (name)
General Rt"l }/~ f"'\"" J
Plumbina
)?f"\"Ih
(address 1
P.o. ~)~ M'\((''J-1Cl
f1 ir<:; no_ \
(p'inirp<:;\
(n!,nnp nn
4lfd...6~
0/ - :) :')-/r L9,. <.3~ b ((
Electrical
t.1echanical
I;
PLUllBIrIG
ELECTRICAL
MECHANICAL
'.~!;;
..,,'.
'!;,;'
-',;
.'.1.
flO. I I FEF"
Each single fixture
NO
I Residence of
SO. FT.
New circuits alts.
or extensions
i !="H" I rl-l.o.or.~
f'IO
Relocated building
(new fix. additional)
I rHARhE
I
I
furnace/burner to
BTlI's
I "c 'rNAQr
Floor furnace
and vent
Is.F. Residence
(1 bathl
IDuplex (1 bath) each
Additional bath
SERVICES c'
Recessed wa 11
~n~rp hp~TPr ~nn vpnt
Sewer
I Storm Sewer
IOf
~mps.
Apoliance vent
seo:lr~t~
Stationary evao.
cooler ~ '
Vent fan with
sinale duct
I Vent system apart from I'
heatino or A.C.
Mechanical exhaust
hood ?. od due t_
Wood stove/heater
Hater service
Temporary Construction
Chanoe in existing
rp~id~nrp
multifamily, comm. or
Innl/<:;tr;al
COMM./IND. FEEDERS
Install/alter/relocate
ni<:;t.rih fpprlpr<:;
I
I
I
, I
Of
amps.
TOTAL CHARGES
WHERE STATE L1W REOUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRmT
TOTAL CHARGES
Electrical Contractor, the electrical rortion of this permit
Surervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED t~e completed application for ~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 laws of the State of OreC]on oertaining to the work described herein, and that flC OCCUPAIKY \'Ii11 be made
of any structure without the permission of the Building Division; I further certify that my re9istration with the Builder's
Goard is in full force and effect as required by ORS 701.055. that if-exempt the basis for exemntion is noted hereon. and that
only subcontractors and emrloyees who are in compliance with OP.S,701.055 will be used on this ~roject.
BUILDING PERMIT
Charges an~
Surcharges
SIGilATUREPA .x
FO~ OFFICE USE DillY
Sq. Ftg. riain
Sq. Ft~. Access
Sq. Ftg, Other
t/5e u.z?~ ~<<; (jr/15/q j;).q.fb
--., <" __ ' Plan Ck. Corrm/!nd \ // ~_ "Systems Development
___~c;.,..!.._____ 65UBldo P"'r ~pp __~b. ~~ CharQe (1.5:',)
/ ~ Plan Ck. Res .
. ' 10%/Bldn Per Fep
I Fence
1::( i)f l.:
.9 l&:i
Dm/02 ~ 'YIC b
Ij~please print) f? CA. V Y"'y) ,.-.-~. c{
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Zone
c:c:
TYOe/Const.~;-~.
Bedrooms
x
Flood Plain
Stories
/
Unlts
Occy Load
Occy Group
x
Value
Value
Value
1:5~ coo
Fire Zone.
x
TOTAL VALUATION
/-1./1
L
PLU'iBING PERMIT
Charges and
Surcharges
Demo
I
I
I
ITotal Comb. rermi t -I
CJt, ,of.
~,~
..ELECTRICAL PERr:IT
Cha rges and
Surcharges
11ECHAN I CAL PERriIT
Charges and
Surcharges
Sidewalk
I A/e Paving
~_.:.::..________: Curb Cut
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
]7 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 ceilinq/or forced air Qas
2. examole- waterheater!electrlcaJ/or solar
E. Square footage Qr 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. example - construct single family house with an
attacileo gar'i1ge
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. OESIGN TEM4 ANO 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, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
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,19" th.e elt'ctdcal.labeLn.___....._-:=._u..-.-____._,.
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 CONDITIDNS TO BE SATISFIED BEFORE OCCUPArJCY:
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'PERMIT VALIDATION
~0755/}
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
. Additional Project Information:
PLANS REVIEWED BY:
name UJ5"h/c(Zicc:;"E/3' Signatur~___
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