HomeMy WebLinkAboutPermit Building 1987-5-7
Canstruct1an lender owner
Address
OESIGr< lEAl' (name) -- -...-
Prlmary
Structural
E1ectncal
'1echanlcal
CONTRACTORS (name)
General owner
P1umblno
Electncal
"echanlca1
PLUIIBIIlG
,,0 , FEE ' rHARGF NO
Each slngle flxture
Phone
(address)
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l.fORlIAT.1 L~II
726-375;
'();)
2;
~
Oescr1be llark(l e . BU1ld SIngle II
I\ttached f,araae)
Ii
I
~a Ftq lldln
~CJ r-tg Access
So Etq Other
lle\<I Add fl.1 ter neo
Fence _Demo_Change/Use
_Other
.,
IdSPECTIOl1 L!,IE
726-Vo9
-/?
Job ,\~dress 1140 north 21
Le~al D..mptlOn /7-<>3-zs:.'1'3, 0/900
,
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RanQe
Value af \lark
$60,000
BU11( lna Pernl1t Info
Farn1v l1esldence lhth
Owner Bethel
AJdres51140
Assembly
north 21
of
Goo,
746- 6432
Phone
f~~sh bu~ld~n~ gymnas~um
-~
(11C5
no
(exnlresl
(ohane no J
to"t I I
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~ 110
(address)
(Tn<=; no)
(PX01 rp<;'
(oonne nn )
ELECTRICAL
MECHAN I CAL
en: n-lllPr.~ t!O
~~r: I r~llQr.r: l
Res1dence of
SO ET
furnace/burner to
BTlI's
IRe10cated bUl1d1ng
(new flX addltlonal)
Is F Pes 1 dence
(] bath!
IDuplex (1 bath) each
IAddltl0nal bath
~Iater serV1 ce
!New Clrcu1ts alts
or extenSlOns
1 SERVICES
I
Floor furnace
and vent
Recessed wa 11
~n~cp he~tpr ~nrl vpnt
/
Sewer
~~'(torm Sewer
!TempOrary Constructlun
Channe 1n eX1stlng
rp<;ldp,nrp
mult1fam1ly, co~ cr
Tnrlu<;trl<ll
Z/--
Of
afTlps
Apollance vent
seo,arat.'"
Stat10narv evao
cooler ~
Vert fan III t'l
slnale rlllCt
Vent systerl apart from I
heatlno or A C
Mechan1cal exnaust
hood nnd durt
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TOTAL CHARGES
flHEPE STATE L \1/ REQUIRES
shall not be vallj unt1l the
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I I:..;/.~./ / "-)~/r'/...:i~ ...C:;f7?AmT
I ;v ~ ,;~, < /"2 c 2/7> <'.. V I 1- ,
I ( /-~ ';;;:,/-/'7/ ,-~t';> "c:?lc I ISSUANCE OF PFPt1IT
'2"0 .e>C>1 TOTAL CHARGES / I TOTAL CHARGES I
that the Electrlcal work be done by an E1ectncal Contractor. the e1ectncal partlon of thlS oemlt ,-
label has been slgned by an Electrlcal Supervlsor and returned to the BU11dlng Dlvlslon
CD:11' IINO EEEDERS
Install/alter/relocate
rl,~trlh fpprlpr<;
Hood stove/heater
,
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lINIE(please print)
- I HAVE CAPEFUllY EXA!'lINED t'le completed apnllcat10n for fJerm1t, and do herebv cert1fy that all lnfomatlon hereon 1S true
and correct and I further cert1fy that any and all work oerformed shall be done 1n accordance wlth the Drd1nances of the Clty
of SOllngfle1d and the laws of the State of Drenan oertalOlng to the work descnbed hereln, and that rw OCCUPArKY 1...111 be made
of any structure w1thout the perm15S10n of the BU1ld1ng DlvlSlon I further certlfy that my reqlstratlon wlth the BU11der's
Board 1S 1n full force and effect as requ1red by ors 701 055. that 1f exemot the baS1S for exemptlon 1S noted hereon, and that
only subcontractors and erlployees who are 1n comollance w1th OPS ]nl 055 \1111 be used on thlS nro]ect
_ srr,IATURF j, \;:, -_A c.~.../;~-{,I
Fon OFFIrE USE of.u - - - - 1--
UL.43? ,
Sam Seybold
om 5-7-87
Zone i.D-1 <u7"', Tyoe/Const ~/~.z::?Un1ts So Et9
FIre Zone Bedrooms Occy load ~~ SQ Ft!]
Flood Pla1n Stones / Occy Group ~-- ""3' Sq Ftg Other
;::;CE 1/t:J?/-79~.5:::>7 ,.-r-<--n ~/~ 1~~/;7';
BUILOIlIG PERilIT ' -62;:;? <=> . Plan Ck c1_<Ml<Ml;;II~n:d [1./ -:......, Sysfens Development
Charges an': ___-.:.:::_~.._____ 65<V/BldCl Per Fp€! .IX:::?"" ~.....~CIt>Charqe (1 5"')
Surcharges:Z ....., =-.-, Plan Ck Res "IiI ')
/....- -' "'" 30%/Bldo Per Fee It
.--:7.-. ~ Fence
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~-
? ~D
r1aln
Access
,
Va1ue~d'~~
Value ,/
x
Value
TOTAL VALUATlOr,
PLU'~B IrlG PERM IT
C'larges and
Surcharges
Demo
ELECTRIUL PERI'IT
CharQes and
Surcharges
r1ECHArllCAL PEPHlT
'\ Charges and
\ Surcharl1es
Sldewa 1 k
I A/C Pav1ng
Total romb Perm1t
~ "If? :s 2..
I Curb
r-----------
Cut
i TOT,L
Lf -::?b. 3'':;
V5E
G=-pc=- 66- "7//" '
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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Appllcant to furnlsh
A Job Address
B legal Descrlptlon
1 example~ Tax Lot 100. Lane County Map Reference
11 OJ 43 _
2 examole- lot 1 Block 3. 2nd Addltlon to
~prlngtleld Estates
C Name. ete of owner and constructlon lender
o Energy Sources
1 examole- heat/electflcal cell1nq/or forced dlf qas
2 examole- waterheater/electrlcal/or solar
E Square rootage or valuatlOn, ete -
1 examole- 1250 sq foot house. 500 sq foot garage
2 examoJe- If new proJect. check new - If addltlon,
check add. ete
F BU11dlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garaQe \
2 examole - remodel eXlstlng garage loto famlly room
3 examole - convert slngle faml1y resldence lnto
restaurant (change of use)
G Value of work as def1ned 1n Sect10n 303 (a) of the
Structural Speclalty Code
H DESIGN TEAll ANO CD:ITRACTORS
To aVOld deslgn or construct1on delays. BU1ld1ng
D1vls1on Staff must be able to contact appropr1ate
persons regard1ng des1gn 1nformat10n or Job slte
correct1ons. etc
II Abbrev1ated Plumb1ng. ~lechanlcal. & Electrlcal Schedules
A Except \Ihere blank spaces occur 1n the deSCrlpt10n
port1on of the Mechanlcal and Electr1cal Schedules.
the app11cant need f111-1n only the No Boxes adJacent
to the aoproprlate ltem(s) to be 1nsta11ed
B Full Plumb1ng. Mechan1cal. and Electrlcal Schedules
are aval1ab1e at the BUlld1ng D1v1s1on
1 To conserve space on the perm1t form the schedules
have been abbrev1ated
2 If the 1tem(s) to be 1nstalled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 0,; THE SCHEOULES
o As noted on the CAP. the label must be del1vered to the
electr1ca1 contractor for SlQnature by h1S electr1cal
superv1sor The general contractor lS not authorlzed
to slqn the electrlcrl label
lIT Appl1cant to slgn and date
Whenever Posslble. the 1n1t1al appllcatlon w1l1 be used as
a worksheet only Wnere Posslble. BU1ldlng D1vls10n Staff
w1l1 preoare a type wr1tten copy and return 1t to the
app11cant at the tlme the actual permlt lS lssuea for h1S
51 gna ture
IV Fees and Charges
Plan cneck fees are due and payable at the t1me of the
appllcat1on. and no plans w1l1 be processed untl1 these
fees are pa1d All other fees and cnarges are due and
payable when the permlt 1$ lssued
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/306 &5 C(9
1<-- (0 -r1
--
V FOR OFFICE USE ONLY
I Perffilt Clerk ~ ~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
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Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
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Addltlonal ProJect Informatlon
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PLANS REVIEWED BY
name L6?j>y E
7t~~ Slgnature~~----?~
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dateC~:?7"~
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