HomeMy WebLinkAboutPermit Building 1989-2-8
1,'ISPECTIOIl LliIE , CITY UF SPRJlMIElD. NFORllAT:,:1 L'", I
726-3769 , \~. ~BIIIATJON APPllCATl,ON/PERMIT _ 726-3753 _fl i
Job Address?? S- \--\ ~ ^-- ~ \. ' I ~~;~GY SOURCES: ;~: ~~~: ~:~;ss. ~ I
Legal De'cription\...... a~ ~S 7:l) ()'SS{)f) I I-Iater Heater SQ. Ftg. Other ':J \,
l Ilel... Add ,d.1ter :l,eo.
I -Fence Demo Change/Use
~ - Ranoe of I-Iork: -Other- - ~ I
Owner ~_\r=;O ~ ~ / I
,\ddrcss\ C-.::... G---~, ~ ~ Phone ~~~J\;~n~e~;~~~~e '~f~~ ^~g~~~~er,~~~~~; .e.. BUIld Single II () i
(-t.. )Q-.-p A ~p \ ('~ <:'oy.~ - ') thS I 'v--.., _ _ _ -0_ ...'_ _ V'~ i
Construction Lend;;r !rz. '\J~~"y\ \Jf,l,. .~ ~"" :U~
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. (Iics.no,) (exnlreS) (ohoneno,)
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I TOTAL CHMGES
that the Electrical work be done by an
label has been signed by an Electrical
I.HAVE CAREFULLY EXNlINED the completed ap["llication for r:Jermit, 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
o f Sari "gfi e 1 d and the laws of the S ta te of OreCJon pe rta i n i n9 to the work descri bed here in, and tha t IIC OCCUPAIlCY lii 11 be made
of any structure without the permission of the Ouilding Division. I further certify that my reqistration 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 \oJho are in comnliance with OP.S 7t"J1.055 \oJi11 be used on this rroject.
Address
Ul:.~llirl I tAl-'
I name'
Pri ma ry
Structural
111 ;),
<'5wO
Electrical
!1echani ca 1
CONTRACTORS
_ ._.f name I
General
PlumbinQ
Electrical
t.1echani ~~, 1
iiO.
, F
Each single fixture
-----IRelocafed.building----
(new fix. additional)
Is.F. Residence
(I hath I
IDuplex (1 bath) each
IAdditional bath
~!a ter servi ce
Sewer
J Storm
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Se~If'r
TOTAL CHARGES
I./HEP.E STATE LW REQUIRES
shall not be vali1 until the
IlM1E(please print)
Pc Le r
-){". '::1./
,;;
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
BUIlDlllG PERI.IIT
Charges an~
Surcharges
Phone
(address)
(address)
I fi{UI-
'I ___ ?i~. lID. (,h"ireS'
0"
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ELECTRICAL
\.L.CL ~. L...
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~;.JllL
furnace/burner .to
BTlI's
Floor furnace
and vent
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.ffL.l:!lAllliE..
(l1hn'le no, 1
~ ::=0
.~
MECHANICAL
Residence of
SQ. FT.
/New circu~ts--~'lts,
or extenSlons
ISERVICES
I
Recessed wa 11
~n~rp hPntpr nnrl vpnt
Temporary Construction
Change in existing
rp~ j ct~l1re
multifamily, comm, or
IndlJo;,triill
I Apol iance vent
<;eOilratp
I Stationary evap.
cooler
I Vent fan with
sinole c1uct
I Vent system apart from I
heatino or A.C
I i'lechanical exhaust
hond ilnd dud.
II'load \tove/heater "I
YI\\~' ~H\.\I
I I
ISSIJANCE nF PFRlHl 00
CHARGES \. t>, I
electrical portion of tnis pergit
the Building Division
Of
I COt1I.1./1 ND. FEEDERS
Install/alter/relocate
rlio;,trih. fppdpr~
amps.1
Of
amps.1
Electrical
SU[1ervi sor
L::OTAL
Contractor, the
and returned to
Un; ts
Occy load
Occy Group
SIr,iIATURE ~?-~ c;::7
FQ~ 1}t r- I Lt U~t OiJl Y ,;.- ~ /7 .
.Sq. Flg. r1ain x
SQ. Ft~. Access x
Value
Value
Value
OATE
J -f--gt
Sq. Ftg. Other
x
" \I~
TOTAL VALUATION
\J ~ Plan Ck. Comm/lnd
- - - - - _ _ _ 65X1Rl do Ppr f:"p~
Plan Ck, R-es
-- 30'.t/Blda Per Fee
PLU11BIIIG PERMIT
Charges and
Surcharges
I Fence
--"\:Jt~ Oemo
20/
I=< ,I
Syste~s Development
Charoe (1. 5')
, [LECTR lCf..l rERl~1T
Charqes and ___________
Surcharges G A/C Pavinq
11ECHANICAL.PEiii1'rrl () 0 -+ '
Charges and __J~_~______ curD Cut
Surcharges ~ J \.') r
Sidewa 1 k
\5.,5
Total Comb. rermit
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
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I. Applicant to furnish
A. Job Address
B. legal Description
1, example- Tax lot lOa, lane County Map Reference
1/ OJ 4J
2. example. lot 1, Block 3, 2nd Addition to
Spnngfield Estates'
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. examl?le. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/eJectrical/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. examole. construct single family house with an
attached garage
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. DESIGN TEAI-I 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 DIVISION 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 cneck 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
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V. FOR OFFICE USE ONLY
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Permit Cl erk
LV
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Buiider's Board because:
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Additional Project Information:
PLANS
REVIEWED~ .--- \
,R'ASJ "l..)eA,)\ signatt.!.re~,--
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