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HomeMy WebLinkAboutPermit Building 1989-5-8 ~, iil51'tI:T 1011 llllf. '726-3769 . . Job Address t~A l.QCl (,0 m 0 8f) \1 m ~~ . ~~~~r,y SOURCES: l.e9a1 Omription \ 'lO:\;:{ 8. \ a n~ncx) -. I/.ter lIeatcr RanrJe___ _fl (\ I.... ~,.... J ValuE" of Owner \.,,\Q \-X'?\ \\l.. 0 rtu::'-n fJ yff\ ~ ::2.."::2..1 ,.............. /A"- -, fr~ - OuiltiinQ Pe lit Info: Descrlbe Hork(1.e., Build Single Address \._J'--J\..O\.. ) ~~l. (Y19- ...-::::\r"\. TI rY'!lonc rc1r.lilv r.esidence Uith "ttached l'iaraae) ~\\ i f\C:Lj;;] QcfJ,~ - "L~)Bld\ ~D./~ I.}., \\t\.Y"Q t\., (cO) constr:~;'-lende"'J \ ' ~, Itr1 O_Il(_~-\-R J Add re s 5 Phone UDllir/ltJ\/1 {name) (address) LIlY ul SI'RlIIGf IElU CO/1BII/ATlON APPLICATION/PERMIT tlfORlIAT: .:1 Lt..:. 726-3753 So. Ftq. '-lain ~q. rtl). Access. SQ. Flq. Other Ife'" Add JI.1ter ~~eo. -Fence Demo Change/Use Other -- -- I ~ ~I , ; t I I (I ics. no.) lexolres I lohone no. I Primary Structural Electrical !1echanical CONTRACTORS Plumbino j i j J I (-lNl'\ \)(\ q. c\\\<:l\\-\-:U\0.\? 4iL('n L..:)'~~,'\t\J Po 11,' l{l\4,.lJ9 ~ ~-M~\ I PlurmlllG \J (J ELECTRICAL q MECHANICAL I , FFF I (H^Rr.F .Ef.L -.CHARGf."-!!u....... ~H ru~ I I I I '-I I I I I I I I r Res idence of (nome) (addrpss) (I ics. no. 1 (plmirpc;,\ (ohnnp fin.) General Electricdl ~lf?chaniCcll i:U,1 -----lEach sinqle fixture -----jRelocated building _--/00 (new fix. additional) IS.F. P.esidence (1 bathl -----louPlex (I bath) each IAdditional bath sq. FT. f),OC' New circuits alts. or extensions ?50 I ISERVICES 1-' Hater servlce jTemporary Construction IChanqe in existing rp~ldrnr:~ Imultifamily, (OOr.!. or Indu<;trial Sewer I Storm SC\'lcr I I 1 I I I I 10f 3/1l!'>s.1 I I -I -I I 1 ICO/~'1./INO. FEEDERS losla 11 fa 1 ter/re locate _Jti.s.1rih. fpprlpr.. Of I. amps.1 I I I r IIAVE CAl~UULLY EXN1JrI[[) t~le completed apfllication for ~ermit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of OreC)on pertaining to the work described herein. and that UD OCCUPAIlev \~ill be made of any structure without the nermission of the Ouilding Division. I further certify that my re~istration with the Ouilder's Board is In full forc~~ erfect .s re~uired by Or.S 701.055. th.t if exe:;~e b.sis for exemotion is noted hereon. and th.t :::,::::::'::::::' '~:'"9~~::;;;'" .,,, :::.::,:.:" ~ ~'~J-:1: ." ~n9 --- -- ",r FOr. OfF I C~ USE Oil!. Y " I Zone Fire lone Flood Plain Tyoe/Cons t. Oed rooms Stories Uni~s Occy load IJcc:v Group Sf!. ftn. SQ. ng_ Sq. FIg. f1ain Access Other x Value Value- Value x TOTAL VAlUATIOII BUILDinG PERHIT Charges anc Surcharges Conm/l nd Ppr Fpe R-es Per Fee Syster.Js Development CharDe (I. 5') I I I I I I & ,c9-~ ------------ Plan Ck. 65t/Bldn Plan Ck. '30%/Bldn PlUI'OING PERMIT C~Jrgcs Jnd Surcha rges Fence I Of-mo \ "5 .OU I Sidew.lk -----~75 IA/cpavin" -j<::l.:5D__' Curb Cut ,0. Il I ITotal (amb. rp.rmit 1_, Ill.'Tf\l . ELECTRIUl rERr~1T CharQcs and Surcha rlJes I1ECtlAtll CAl PErH I T Charges and Surchilrl'JeS . - COM61NATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference 1/ OJ 4J 2. examnle- lot 1. Olock J. llld Addition to Springfield (states .C~ Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ccillnq/or forced air qas 2. example- watet'heater/clectnccl~/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. exampJe- if new project. check-new _ if addition, check add. etc. F. Building permit infor/MUon: 1. examole - construct sinyle family house with an attached garage 2. examoJe. r~nodel existing garage 1nto family room 3. examole - convert single family residence into res taurant (change of use) G. Value of work as defined in Section 303 (a) of the Structu~al SpeCialty Code H. OES I GN TENI ANO COIITRACTORS To avoid deSign or conSlr'uction delays, Building Division Staff ~ust be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Plumbing, Nechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fil1.in only the Ho. Boxes adjacent to the appropriate item(s) to be installed 8. 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 Z. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 schedu I es C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES AIIO CHARGES 011 TIlE SCHEOULES O. As noted on the CAP, the label must be del1vered to the electrical contractor for signature by his electrical supervisor. The general contractor is not author'ized to sign the electrical label. Ill, 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 pJans ,,,,ill be processed unUJ these fees are paid. All other fees and charges are due and payable when the permit is issued, V. FOR OFF! CE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ~-.. --, J. . PERMIT VALIDATION QL \'5flfl 9 8-8 ~81 f PermitClerk dt/Ja ..J 1 Permit applicant exempt from registration with .the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ~ date '. .......~ . . l-4A'tdAY ;/e#.7I"/f/v '-17-07 W So?;4 fe/&~ffe/ O"'F~t7/'V q 7'Vt':2. , ""6 &IC/- ?- YC'I , C.US7CJr/lfP/P . 6t: TI/A"A~Y tu7#r-'f'4 c//v"",c// 33 ~D b.4",,-c. Fn4P/ /f'~ f:./4/""'t:,..FI"~?.e?/ (/.?f'f~t?",y 7 2c; - 73c;. 5 c::: o,.y;r AcT /r- 'f' S 0,.-<1' Je!!;s :T~TT ~hA,~ ,r4P'fM1. /ftZJ ( ;;2) s. 7,r I'r "" ", -f ~ ,;t? ~".$.5 <#f' ~ (P,l/5 P'lf>'l"1"f . .y (, // .t5 ~-:,c If' /,//G ) (i) L 10' A",J.fA,vA 13.s;DDP.t!,~L-;-"01 \ A.o.S~/"'1'I 1"".5 0...... 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