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HomeMy WebLinkAboutPermit Building 1987-8-7 I IrISPlCTlOIHIIIE ,726:3769 -.-----~ . 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' ) I , ~~ \ (namel , f.7DAP t/cJb!-=<; Genera 1 Plumbino Electrical ~\echanical' 110. (l ics. no. (exo;r~s' --- 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 ----.~=-~ . . ',' ,.. ,- \. 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. , , " .\ - .' Ill. \ -'.;. ..' ...... '" .... .~ IV. ~E&J flr -11= 101 G:> 1r i" ~ V. FOR OFFICE USE ONLY Permit Clerk rhR- . PROJECT CONDITIONS TO BE SATISFlED.BEFORE OCCUPANCY: . ' .. ..- Permit applicant exempt from registration with the Builder's Board because: '. . - . , :....... t,- . Additional Project Information: . , ~ ~.. .... . . . -, ) ........ PLANS REVIEWED BY: nameX;;R#c:E A:~6'<" v signature ~.?~~~ ' ,/ . / date '9-/-j!f'? , .