HomeMy WebLinkAboutPermit Building 1989-7-10
IrISPECT I Oil LIilE
7Zq-3~69 .
[ NFORrlAT: _':1 L, ;.~
726-3753
So. F t q. '.la i n
~q. !'tg. Access.
Sq. Ftq. Other
New Add Alter ~eD.
--Fence Demo Change/Use
--Other -- --
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I
I /Temporary Constructio.n I
I /Change in existing "
residence
,. , I /multifamily, comm. or ./ I
Industrlal
I Storm Sewer '~J 10f amps,j / I
S ~C>>~7,r;;.n-t.>;~ IU?~ncor1r'1.IIND. FEEDERS I I
I'. 'R I I~stall/al ter/relocate " I ,I
" dl rl b feders
I . Of amps,l I I /
I I II
'I I I
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TOTAL CHARGES b 7--50 TOTAL CHARGES ~-yC) TOTAL CHARGES ~~. /> -S>
\./HERE STATE L\11 REQUIRES that tile Electrical \~ork be done by an Electrical Contractor, the electrical [lortion of this permit
shall not be valiJ until the label has been signed by an Electricaq Supervisor and returned to the Building Division
CITY UF SPRIIlGFIELD
C0/1BITlATION APPLICATION/PERMIT
E!lERGY SOURCES:
Hea't-'
Hater Heater
\.
JOb Address
(' f".,u +e..JV~'.cJ
l.SI
Legal Description
Ranqe
o cl..(
wner ,(2.. _ -::s eX F1~(.....
Acldrcss (,q I Cp.t0-t.e~;Q..1 Phone
frn"#..-77 4...&:>44<::~/.0 h-?s"77~~'''f~~'.
. Construction Lender
ValuE of Hork: D
tt LJ s CD":-
IJuih;ino Permit Info:
Family Residence Hith
Address
DE I N TEAll
~
name
Primary
L c.'-t r'1 1+\[<::10
}
Structural
Electrical
<2,nO
t?i -r )
~1echanica 1
CONTRACTORS (name)
General LJ(l;'\)td S, \VI."-':1.,,:11-"<-- -'R1'(l.",
Plumbinq Aluk- 'PI<>>-b; ^J . .
ElectricallCe'-\l'\.ol.,(!s b(~(J..,-
/lechanical &r-.c.<<'''''''-...... .J.Ic.,,",J,:,iv1...)
v /
PLUl1BING
(address)
'i<~.~P:",",<:" 01~
(1 i cs, no,)
(exoiresl
~6Sb
13{3,
2o-(S~<:..
S/"'? l~f, "l
"7lq{Cfc
7/<&1
)2l26 ,~
L e, .1'<.....""'<- t-I. "" I
27'6Z e.e...+~ 'G/vc.(
Lc,-'w-uL. I-l u.-:.-,
I
L{C]U'1
ELECTRICAL
MECHANICAL
no,
l...li.LJ CHARGE ~I
Residence of
furnace/burner 'to
BTU's
-.E.E.L1-.C.1:iMG.Ll ~I
/
Each single fixture
~~~~.
Relocated bui dlng
(new fix. additional)
Floor furnace'
and vent
7 --5P
SQ. FT,
---
, ~'New circuits alts.
t:..--" or extenslOns
~ e:>-;:;:;: ~~r-3'G
ISERVICES'
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7:.?~ .
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IS.F. Residence
(I bath 1
I Duplex (1 bath)
jAdditional bath
I Recessed wa 11
Soace heater ilnd
,
vent
each
/ Apo 1 i ance vent
seOil t"il te
I Stationary evap.
cooler .
I Vent fan \~ith
sinole duct
I Ven t sys ter.l apa rt from /'
heating or A,C.
, r1echanical exhaust
hood and duct
I \10od stove/heater i
Id:~~ E'X/:5T. "
#V.hl= ;:5Y~rE"'~
I I
I I
Hater service
Sewer
ISSUANcr OF PFRrlIT
(ohone no, )
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3'{s~ - S~::;- I
~
~,(3~ 7C7.? J
4~1.f -2 sOi I
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.E.EL1..GHM.GE...
(ohone no. )
~ol-Z'84J
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I
r HAVE CAREFULLY EXAmNED the comnleted apnlication 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 Laws of the State of Orenon oertaininq to the work de~cribed herein, and that NO OCCUPANCY will be made
of any structure without the nermission of the IJuilding Division. I further certify that my reqistration with the Builder's
IJoard 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 employees who are in comDliance with ORS 70r.055 will be used on this project.
IIArlE(please print) U/i'/~ ~ /H:Z:4~,";
- "
SIr;rJ^TURF;2;/~.
FOr; OFF I rE USE orJL Y
So. Ftq,
Sq. Ftc).
Sq. Ftg.
~z~~_-=
DATE_ '7/le.J<a'7
l,(~.-:::s-_~' ...;,
Zone ..-::::.:.c::::.
Fire lone
Flood Plain
TYDe/Cons t.
Bedrooms
Stori es
Units
Occy Load
Occy Group
75'-<.
r1ain x Value
Access x Value
Other ~r...&-~,n_-C- Value
TOTAL VALUATION
I
BUILDING PERI.11T
Charges anG
S u rc ha rge s
CD
Comm!I nd
Per Fee 3Z.~:;
Res
Per Fee
~ Plan Ck.
---~t:2...~Q__ 65%!BldQ
").. ''":::> Plan Ck.
~. ~~ 30%/IJldq
PLUr1BING PERMIT /'''7 :5""0 I Fence
Charges and r ---_CI2L-=___,__
Surcha_r~es_ 0 y_ 38 I D~mo
ELECTRIUL PERr~1T ~,..( ...?~S-O Sidewalk
~~~~~:~g:~d If -----j-_/y-- A/C Paving
11[(IIANI m P'RI<IT /5 ~ I C",b Cot
~~~~~:~g:~d 6 V - - - ~; ~-/
Systems Development
Charge (1.5?:)
-[
I
!Total Comb, Permit
I TOTAL
16-:5. 2 <7
,"
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition td
Springfield Estates
C, Name, etc, of owner.and construction lender
D. Energy Sources
1. example- heat/electrical 'ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1, example- 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
attached garage
2. example - 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 I GN TEAr'1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job si te
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
D. 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 .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 pa~d, 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
J..
r pernitclerd;l/J~)
Permit applicant exempt from registration with .the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
I
name~/f?HF n~~
signature ,~~'7-J? date /-;/0-89
/ ' / , ,<.'",,.,, .:::::.
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