HomeMy WebLinkAboutPermit Building 1987-8-7 (2)
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II1l~PECT 1011 L1I1E
}l726-3769
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CITY OF SPRlilGFIELO . IIlFORlIATION Ui," 1'1
CDrIBIiIATION APPLlCATION/PERHlT 726-3753
E!lERGY SOURCES: So. Ftq. I.iain
Heat ~q. nl]. Access.
Hater Heater Sq. Ftq. Other ()\)
R Uel<l Add Alter P.eD. )
anqe --Fence Demo ChangeiUse ~
( Val UE of Hof Lj 0; (JOG Other - - ~
BUlh:inQ Permit Info: Describe ~Jork.(Le.. Build Single \J1
FBr.lil! ne~lden:e I-lith /l..ttached (1araoe) "~
UfWADJrr. .tY! /J.//' AJ'dAJA. ~
/l.Mm. };-!/!'! ch./. a-nd .
I-ji{/f) , f't'lfi- (J ZhALLt~
(lies. no. f (exM/~~) f (ohone no.)
i Job Address - r/~ f (j C:; II (,; tl Ii? ~;; /) -' ,.
tegal Oe'criPtion'-j''7'~r3~ Q .;;2'0 l7:::z.t()O
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Owner - /imfiM /! ~ j -l- {! .<L4.tJr ,
Address ;;;'.0, 2?..x /0 &
f?':>I,s,c,. In'"
Construction lender
Address
Ul:.~I(ifl TENl
(name)
Primary
Structura 1
Electrical
!1echanical
CONTRACTORS
(name)
\ 1'7/DAP
Genera 1
Plumbina
Electrical
~'echan;cal.
PLUllBlIlG
UO.I
/6 I Each sin91e fixture
/Relocated building
(new fix. additional)
S.F. Residence
(1 bath!
Ouplex (1 bath) each
IAdditional bath
~/ater service< -:5"0'
I
I
I
Sewer ~.o .
Storm Sewer -< ,5'" '
TOTAL CHARGES
WHEnE STATE L~W REOUlnES
shall not be va1iJ until the
/. \ Phone
. ?~O; 7)/7-~~-?~-
: '_"..8:5';>0/
Phone
(address)
t".o.tlU
tI
Vi -tv Cl
I
/~oS
,.
tU~~
(address)
(~xoirpc;\
/"
/1;1-Ob.15Y' :
I~ ./
\.
'-
(1 ic:.c; no. \
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ELECTRICAL
MECHANICAL
FFF I rHARr,F
7.:>~/:7t:1.-
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~ r:n'
Res i dence of
I
I furnace/burner to
/ BTlI's
I Floor furnace
and vent
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
6.-
~ln
fI-lAOr.!:"
rm.
I!:"r:r:
I rl-lllor.r:
sq. FT.
New circuits alts.
or extensions
SERVICES
ITempOrary Construction
IChange in existing
rp'i i dJ>n~p
Imultifamily, comm. or
Tnrlll<:.trial
/5:""'"
I Apol lance vent
c;poaratp
I Stationary evap.
cooler
I Vent fan with
sinolp duct
I Vent system apart
heatino or A.C.
Mechanical exhaust
hood and du~t.
G
~
/8--
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17. :>.01
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I' 1
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/ ?5: - TOTAL CHARGES ?;?:>6 I TOTAL CHARGES 7 S co-or
that the Electrical work be done by an Electrical Contractor. the electrical rortion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
5:- "'07>
~t''',.
7~.- J
"2 a-:::>
from
Of
amps.
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COMM./INO. FEEOERS
Install/alter/relocate
rlic;;trih fpI"rlpl"C;
Wood stove/heater
IOf
I
~ ~jP~c:-.,
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";;!.-
amps.
ISSUANCF OF PFR'llT
I HAVE CAREFUllY EXMlINED the comnleted application for permit. and do hereby certify that all information hereon is true
and correct, and 1 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 Orel]on oertaining to the work described herein, and that tW OCCUPAIlCY ,.,.ill be made
of any structure without the nermission of the Building Division. 'I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors. and employees \...ho are in compliance with QP.S 7tH.OSS \'Iill h:! used on this project.
SIGUATURE \5- \. uk :
FO~ OfFICE USE Q;lLY
Uni ts So. Ftg. 11ain lfFc. ~
Occy Load Sq. Ft~. Access~;>';~
Occy GroupH#~/Sq. Ft9. Other
. /i\ r2,I.,K1t.s
-e> Plan Ck. Conm/lnVl, C, / 1'-1( C? 7 (,/)
__:;?_"Ss:.._____ 6S%/Bldo Pp. Fpp '..Y7. '/ 0- -d I
Plan Ck. Res
/ / - ~ 30%/Bl do Per Fee
__1.1..5: ~C>
$.7S
____~? .5"0
/&B I A/CPavin9
~-u?1\~n: Curb cut.
IIAHE(please print) S-fCU e.
Zone
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
BU I LO IrlG PERf.11T
Charges anc
Surcharges
~
PLUllBING PERMIT
Charges and _-'
Surcharges ~
ElECTR I C~.l PERr~1T
Cha rges and
Surcharges
11
MECHANICAL PERMIT
Charges and
Surcharges
v
OI'l vel
4[t
~ om€;h lu
~-N
x/3S'~Value
x S"'?6 Value
x Va 1 ue
/
TOTAL VALUATlOII Ya~-
i""2'
'Syster.Js Developme~' ./.......-. c-e:>
Charoe (T.S~) ~.
Fence
I Demo
I Sidewalk
Total Comb. rermit
5'6"7: ;>.8-
I TOTAL
//~'1. 78
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COMBINATION APPLICATIONIPERMIT (CAP)
PERMIT VALIDATIDN
Y. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. Lane County Map Reference
i I 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilina/or forced air oas
2. examole- waterheater/electrical/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 pennH information:
1. examole - 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)
~. 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.
II. Abpreviated 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 abbrevi a ted
2. If the item(s) to be instailed 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 for signature by his electrical
supervisor. The general contractor is.nat authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will be used as
..., a worksheet only. t~here 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
signa ture.
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.
'2ae f?i #= /01"" 8'
V. FOR OFFICE USE ONLY
Permi t Cl erk
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." PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
",
PLANS REVIEWED BY:
name /_/::'R#tF ~~~
signature ~~.......,_~~ -,
,/ .";
date 9-/-x-?