HomeMy WebLinkAboutPermit Building 1987-4-14
I
I ItISPECTION LIIIE
726-3769 .
-
CITY Uf SPRIIIGFIELD
COIIBItIATION APPLICATION/PERMIT
I E!IERGY SOURCES:
Heat
I t-Sater Heater
i. Ranqe
-
INFORIIATION liNe
726-3753
Sq, Ftq, l'lain
:q. Ftg. Access.
Sq, Ftg. Other
~lew__Add~lter~~ep.
Fence Demo Change/Use
Other - -
II
~
\)
f\J
I~
Jpb Address '26~C> / ;<(lv,i? AI- -::)7:"
, .
Legal Oe<<ription 1/-" "-<"-:>-/0. C; 't' <DC>
ValuE of Hork:
Owner E~k;,//-.. ~ r ?'?0 =
Add -".f'=- ~ ~. 7/ "'7:l.-nh BUll(:ina Pennit Info: Describe l.Jork(Le., Build Single
- ress:Zv:2 7'2 ~ n:a;c:;~ ./..A-'. 2'9::?~t'l-f.mily nesidence Uith ~.ttached Garaoe)
r)/~N'.::;r/.6/? C::;/7':?" q;;JY'7'~ L::.~7'/'?L.Jo:::::r /:;:>A":?~
Construction Lender ~.?J9. ~S7- 5T;!fL>~??::..s;;J(!C' p.z:? Z:PA'~___?7.dI;"
Address Phone EcpC-J/~~C-.-97'"',
UI:.~l{.iN TtN1 (name) (address) I (lies. no.) (exoiresl (chane no.l
Primary
Structural
c... OYi q~oo 0''''''
I 0 /W/ 1L..f'i '.
Electrical .:::::}::;,--:1;L-~;""" /~c.::-c-/ r .
t1echanical
CUNTRACTURS Inamel
General O!/J/N~
(i'lddress)
"ir" no.)
r p'ni=~ A
~
(nhnn,.. nn ,
PllJrnbino
, Electrical /.:::?'?~ E~
Ilechani c'al ~#f' ,.~......-? ffi..!"7"'A-...-
PLUIIBIrlG
ELECTRICAL MECHANICAL
FEF I r.H1\RGE Nn I--E.E.L J:l!AB.G.E. NO. <FE I CHARGF
I Residence of I furnace/burner to
SQ, F1. BTlI's
.,--1 New circuits alts, I Floor furnace
~g~E ~~T and vent
I SERVICES I Recessed wall
~nnr.P hp~rp~ ~nrl IIl'lnr
I I I
ITemporary Construction I I I Apol iance vent
C;F!oaratp
Change in existing I I Stationary evap.
rpc; i dpnrp cooler
multifamily, comm. or I Vent fan with
Inrlu"trial ~in91p nllet.
Of I I Vent system apart from
amps. heatino or A.c.
COI~I'1. II ND, FEEDERS I Mechanical exhaust
hood and dur:t
I Install/alter/relocate I Wood stove/heater
rlhtrih fpprlpr"
Of al1)ps.
NO,
Each single fixture
I Relocated building
(new fix. additional)
I S.F. Residence
11 bath)
IOuplex (1 bath) each
Additional oath
Hater service
Sewe r
Storm Sewer
I
I
I I ISSUANC, nF PFRIIIT
TOTAL CHARG,S TOTAL CHARGES --:::<"2-b--c, I TOTAL CHARGES M//Y . / S. &l<:>
HHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical rortion of thi,s pemit
shall not be valiJ until the label has be~n signed by an Electrical Supervisor and returne~ to the Building Division
, '. . ....' . -'" \ '. . .... . . "
I HAVE CAREFULLY EXAr1INED 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 Soringfi eld and the' Laws of the State of Orel]on pert'ai ning to the work descri bed herei n, and that' IW OCCUPAI~CY wi 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 ORS 701.055, that if exempt the basis for exemntion is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this ~roject.
,
IWIE(please print) E , /-. J{ Iv I r: 1-1 r
Zone{.j';)i2r:. /,j P
Fire Zone'
Tyoe/Const, ~~.
Bedrooms
Units
.", .._.. SIhllATURE 12.
FO~ OFFICE II~~ QiII..Y
Sq. Ftg. t1ain
SQ. Ftg. Access
, Sq,Ftg, Other
;z, f~
~~
DATE 4-14-~7
/'
Flood Plain' . S~ori~s. / .
... '" \,.
1/-5 e Ur~'6?i'?' ~:< q
BUILDING PERmr. - U?/ ~' p.ran Ck, Co","lInd
Charges an': '"'\ _ . _ _ __ _L."? ::::c2E-::::' _ 65%/Bldo PM Fj:le
Surchar.ges _ ~ I' ,__ Plan Ck, Res "
... ..... ..... .....~ . ,"' .. /" c;:> 30%/81 do .Per Fe'€,
PLU'1BING PERMIT I Fence
Charges and ------------
Surcharges I D~mo
~~~;;~~C~~/ERI:;Tl _ n:Z:;?::c2~J Sidewalk
Surcharges, , ":\ . -;?C2>:" I A/C Pavi n9
\~~;~~:~C~~/ERMIT.: _n:.f'>-:_~:-nlcurb'Cut'
\urcharges "0 . (;0 I
Occy Load
O~c.Y:Group 8-7
'.
;r '3C
,
,_/6
Value
Value
Value
~
?33t<:a.
,
" \ .
:?8.9:3 "
TOTAL VALUATION
Systems -Development
Charge (1.5!,)
" ,.' """..\ '.
:f1J:/~r.:: 4Y
\
."
'.
I
~ ,I
I
Total C~mb. rermit
~',JfE2A
II 'f~ Z/
I TOTAL
./
,-
"
-
-
,
~~--
COMBINATION APPLICATION/PERMIT (CAP)
I
L Applicant'to furnish
A, Job Address
B, Legal Oescription
1, example- Tax Lot 100, Lane County Map Reference
II 03 43 \.
2. example- Lot 1. Block 3. 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqJor forced air Qas
2. examoJe- waterheaterjelectrlcal/or solar
E. Square footage or 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
attached garage
2. example ~ 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 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
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 paid. All other fees and charges are due and
payable when the permit is issued.
PERMIT VALIDATION
.\,
"
8~roqrf
L(/(q-~ <)
g
Cc-
V, FOR OFFICE USE ONLY
I
~
Permi t Cl erk
" PROJECT CqNDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
7#/0
P6?i'T~C'E
/7'/OZ:)":_.:>L~ 7-v:P;&, C~?,
~ ~T'c.Y~c!F
-;J7.qL..>.c 7C-s~c /~
~~v
<~ /-r- ~#",.IQ
'" .;
~v-=??
Permit applicant exempt from registration with the Builder's Board because:
.#A'5 ~;:;<"~v l4/vkZ:> .;:5L-><:E
~T~~/?E e>.c ~O/L,Z;V//,--:; }V;Y/.c:::#
70 -?;>~ M~ J.-.-o=-D ~ ~ J"...- ,~7A'7/~
Additional Project Information: ,~~~
,/b, '~73';;--473~ E
//1//;;, ,.(l--U.4VV /7'
4;, ~ ',.w rt.-J 77 J}f>~
,
PLANS REVIEWED BY:
l
~:'. ~ame~/?.z> /V~
'R~~ Signaturv2~~~::-Jo date'41-/3~B7
'#- ',P'
r
\..;. <>,'"
. -