HomeMy WebLinkAboutPermit Building 1987-8-7
I IrISPlCTlOIHIIIE
,726:3769
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CITY OF SPRlilGFIElO . lflF0R11ATION Uiit.
CmlBliIATlON APPlICATlON/PERMIT 726-3753
E,IERGY SOURCES: So. Ftq. /.Ia i n
Heat :q. ~t9. Access.
I-later Heater Sa. Ftg. Other ()\)
!leI'!' Add Alter P.ep.
Ranqe_ -Fence Demo Change/Use ~
(Va.lu, of \0/01 L( 0; 000 Other - - I~
BulldnQ Pennit Info: Describe l,Jork(Le., Build Single \J'
Famil1 nesidence With Attached GaraGe) ~
Odp./ffLffn fJ/1 /lUA/~ ~
/Mm. f//A//1 rIA.J} ~d
!-IW jJ 1';;; -() Zh (1LU~
flies. no.) (exM/~~l t (ohane no.)
i Job Address
Legal Description
-:2;!()S (; C;Z?.u)/).L.->/
/'7() 3;;) Q .;:20 I)::;'t,{)()
Owner -J~M./JAv1) -l-U~,
Address -DO -z::? //> L::> .) Phone
r..., , V.oX /t./Z> /7~O :'l:--~~~~
7J:.;v-$c.' 1z:Jcp~8::f?O/
Construction Lender
Address
UI:.~I(jrl TENl
Primary
Structural
Electrical
r1echanical
CONTRACTORS
(name)
Phone
(address)
!JJ.LJNJ~
(address)
/" ...........
/;;;i-Ob.~f' )
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\
(namel
, f.7DAP
t/cJb!-=<;
Genera 1
Plumbino
Electrical
~\echanical'
110.
(l ics. no.
(exo;r~s'
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PLUIIBI riG
ELECTRICAL
MECHAN I CAL
FFF rHARr.E tIn
~~~ fl-lARr.r flO
I ~~~ rUAtu:r
Residence of
furnace/burner to
BTlI's
Each single fixture
I Relocated building
(new fix. additional)
IS.F. Residence
fl bath)
Duplex (1 bath) each
16
Additional bath
/
7.~c 17tJ.-
SQ. FT.
6.-
INew circuits alts.
or extensions .
Floor furnace
and vent
SERVICES
I
1
16
I
13'
117. ~"
so: -0 ".07>
Recessed wall I
Sn~rp hp~tpr ~nrl vpnt
Of 7~
I cor~'1. 11 lID . FEEOERS
Install/alter/relocate
rli~trih^ fppdpr~
Appliance vent
Sf'oar.ltp
Stationary evao.
cooler ~ ,
Vent fan with
sinolp duct
I Vent system apart from I
heatino or A.C.
I ~lechanical exhaust
hood .lnd duct
I \.Jood stove/heater
~ ;7?r-_?-..
I
I
";?-
~
/8....
IS: c,&>
Temporary Construction
Change in existing
rp"irlpn('~
multifamily. comm. or
InrllJ<;trii'll
I ~Jater service<5o'
I Sewer 5C '
I Storm Sewer < .5"" '
:::1'c...."
'2t!). - J
amps.
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali'J until the
/ ?s: -- TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
I
I
I ISSUMICF OF PFR'11T
33 7- $6 I TOTAL CHARGES 7 57 ~
Electrical Contractor, the electrical portion of this per~it
Sunervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the completed apn1ication 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 Soringfield and the laws of the State of Oregon pertaining to the work described herein. and that 1m OCCUPAHCV will 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 exemption is noted hereon, and that
only subcontractors and emflloyees loJho'are in compliance with OP.S 701.055 l"Iill r used on this oro,Ject.
IWIE(please print) 5.fcue.. OI'l vel SIr,IIATURE~uk O~.TE~h ~~
FO~ OfFICE USE O;IL Y
Units Sq. Ftg.
Occy Load Sq. Ftg.
Occ,V Groupil#h-/Sq. Ft9.
Zone
Fire Zone
Flood Plain
BUILDING PERI-HT
Charges an~
Surcharges
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICP.L PERr:1T
Charges' and
Surcharge~
11ECHANICAL PERMIT
Charges and
Surcharges
Tyoe/Const.
Bedrooms
Stories
~-N
11ain1fFc ~
Access~~
Other l
x
x 13S'~
x S""/6
ValuE'
Value
Value
I
';;::: _0' Plan Ck.
____~~._____ 65%/Bldo
Plan Ck.
30%/Blda
I Fence
1~/..,K1&'5
rsJ../. '71 g-7fl
TOTAL VALUATIOII Sl'a~-
COIMl/l nd
PPY' Fee
Res
Per Fee
Systems Development
Charoe (1.5%)
~._e>
/1- ~
__LZS: .-.>f>
:3-7S
_n_?$7- 5'=
/&8
~s. esp
------------
/,75
Demo
Sidewalk
A/C Paving
Total Comb. re~mit
l-oT"
II f\L
SC>9: ?8>
I
! /1t?9. 78
Curb Cut
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COMBINATION APPLICATIONIPERMIT (CAP)
PERMIT VALIDATION
II.
I. Applicant to furnish
A. Job Address
8. legal Description
1. example- Tax lot 100, lane County Map Reference
11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilina/or forced air Qas
2. example- waterheater/electricalfor 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 garllge
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 TEM1 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.
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 instafled 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 fo~ signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
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 r.eturn it to the
applicant at the time the actual permit is issued for his
signature.
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' I'lhen' the:permi t' is issued.
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IV.
~E&J flr -11= 101 G:> 1r
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V. FOR OFFICE USE ONLY
Permit Clerk
rhR-
. PROJECT CONDITIONS TO BE SATISFlED.BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
nameX;;R#c:E A:~6'<"
v
signature ~.?~~~ '
,/ . /
date '9-/-j!f'?
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