HomeMy WebLinkAboutPermit Building 1987-6-23
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726-3769 '
Owner
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- - lITY U, SPRHIGFIELD
CO/lBHIATION APPLICATION/PERMIT
\ EIIERr,y SOURCES;
Heat
,!-later Heater
RaMe
of I-IOrk#~)iiJ
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726-3753
So. Ftq. t.iain
~q. ~tg. Access.
So. Ftg. Other tJtJ8 f'
__llew~Add-.!,lter__~eD.
Fence Demo Change/Use
Other - -
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Legal Oescription r'70335 3~ () 1lJdlJ
ValuE
Address
Phone
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!luil{iina Penuit Info: Describe I-Jork(i..e.. Build Single
Far.lilv nes;dence IHth /I_ttached llaraoe)
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(lies. no.l (exn~res)
(ohane no. I
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Construction lender
,\dd re 5 5
Ut~Hjrl fEAr'
Phone
(address)
Primary
Structural
C 1)8 ,5?Joc>
Electrical
~1echanical
CONTRACTORS
(na~l
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(address)
(lies. no.)
(exoires) (ohnnp nn.
Genera 1
Plumbino
Electrical
,-- , _J ,
~ 'VI?S
r.1echanical
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'1=':~ CH ~_..1:ill....J Residence of .~ tin furnace/burner -to
SO. FT. BTU's
Relocated building - ./:w c~'rcuits alts-:--- ~- Floor furnace
(new fix. additional) v or extenSlons ...,.. and vent
-- "7 ~~ t'?rR.J?e.
Recessed wall
SERVICES SO<lrp hp~tpr ~nrl
PLUIIBIIIG
ELECTRICAL
MECHANICAL
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".nt~:L
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Wood stove/heater I I J
~~:':~7f~:'16~-:J
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/;5: &5&0> I
A,
Each Single fixture
-----IS.F, Residence
II bath!
I Duplex (I bath)
jAdditional bath
I~!ater service
~~1 Sewer
r Storm Se\<ler
each
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I I COHI'I./lND. FEEDERS
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IT-
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::;;'.:::Q -... J TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ITemporary ConstructiQn
IChange in existing
rp',' i dJ'nrp
Imultifamily, COIrel. or
lnrl1lc;tr;al
IOf
amps. I
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=<':? .5'''''''1 TOTAL CHARGES J'?#N'.
Apoliance vent
c;",Oilriltp
Stationary evao,
r:ooler W .
Vent fan \<li th
sinole ('tllct
Vent system apart from I'
he<ltina or A.C.
j'lechanical exhaust
hnod and curt
amps.
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Install/alter/relocate
rlic;trih. fPPrlprc;
TOTAL CH~.RGFS
I-IHERE STATE L,I-I REOUIRES
shall not be vali~ until the
ISSIIMlCF nF PFRlIIT
I HAVE CAREFULLY EXArlINED the completed application for r,lermit, 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 Ore~on pertaining to the work described herein, and that rw OCCUPAHCY l<li11 be made
of any structure without the permission of the Guilding Division. I further certify that my re9istration 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 employees \Vho are in comoliance with OP.S 71)1.055 ,'lill be used on this project.
Electrical Contractor, the electrical rortion of this permit
Supervisor and returned to the Building Division
IIAIIE(ple"e print)
\j eX' tv
Ko~>
SIr,II^TVRE ~
FO~ OfrfCE USE DilLY
Units .So. Ftg. Ilain
Occy Load~~Z.~~~~ Ftg.
Occy Group 4-5 Sq. Ftg.
t/4?o--VJ.
D~TE...€/;I 3/1' 7
Zone
':::::c
Tyoe/Const.
Bedrooms
Stories
"'5""-/";/ .
Fire Zone
Flood Plain
x
Value
Value
/
Access
Other.ho
x
PLUI1BHlG PERHIT
Charges and
Surcharges
Vs= Ci?Otf '. 772
BUILDIIIG PERI.IIT /-:<&, S?O ; Plan Ck.
Charges an~ ~ _______.:.____ 65%/81110
Surcharges "'" ~/u Plan Ck.
;;;:>. I' 30%/Bl do
___~~~-,"_'":::_I Fence
S Demo
t.JtPR P
Value /R.oces. o>-,b.
,
TOT^L VALUATION
COrml/lnO
Ppr FflP
Res
Per Fee
to -q-~l']
\)L--&.40 I f~,S3
Syste~s Oevelo~
Cha roe (1. 5') ~ _ _ II
(jPI
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-:z '/0.
~
. ELECTR IU,L rERI~IT
Charges and
Surcharges
~
. fS=
-;:?<~ So
------------
. 7'0
. /5: C>~ I Curb Cut
--------6;'-;;-1 '
Sidewa 1 k
I A/e Paving
Total (omb. rermit
IIECHAN I CAL PERIiIT
Charges and
Surcharges
l.o
TOTAL
_J?? W
tf63. <7Y
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- 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
O. Energy Sources .
1. examyle- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/eJectrlcal/or solar
E. Square footage or valuation, etc. -
I. 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. DES I GN TEAl.! 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-1n 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 far signature by his electrical
sUDervisor. The general contractor is not authorized
to sign the electrical label. -
111. 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
applicatiofl, 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.
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V. FOR OFFICE USE ONLY
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Infonnation:
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PLANS REVIEWED BY:
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name / C5iP38E. .?~~ignature
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date ~-2 3'-~?