HomeMy WebLinkAboutPermit Building 1986-12-3
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(j SP 0 lIlE ,. CITY OF SPRWGFIELD
\" 'P~'6-1'M II, L CD/IBIiIATlON APPLICATION/PERMIT
, , r .0 E!IERGY SOURCES:
. Job-Address "3\90 \oA-\G\r--lftl{ Lr, Sftl-fQ, Heat
Legal De,cription /7-()3 -'22-2<'. 0,5'00 \"ater Heater
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LNFORtI,H: ~ 1 U'It..., I'!
726-3753
Sq, Fto. '.iain
~q. ~tg. Access.
So' Fto, Other
flew Add P.1ter ~.ep,
--Fence Demo Change/Use
Other - --
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Address
'<ValUE of I'/ork.:
f'!\, :)ACc0S F-\l\~N\,~;{..( iO)o--rrO
~ 32 BUllcllnQ Pernllt Info Describe \4ork(i..eq Build Single'
7::r c;-- ~ L \ U '<.. S)', Phone,Jl{2_ >/1 '(F.oi;~ P.esidence l'lit~ ~ttached r,araael
& 0-..<<> G-- ""E. 1 612 , FflC>ltICR"1f- -l. \ ~Sl'~L\.. f/-Nr->\Nt'-
Owner
Construction lender
Address
DES lorl flAil
lname)
Phone
(address)
o ~ ~ A l.. L . \ N.s1I9-L'- ~\)l;T"'rzu
I, N F'ht~t-"to'\a *- H-~~)"- .",..p <;:,'" V\ ,
(lies. no.l {exl1iresl (ohone nO.l
I Primary
Structural
Electrical
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t1echanical
CONTRACTORS lnamel
Genera I C. >R \'':In' II! \0.
(address)
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n ies. no. \
(pxoi r'ps \
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Plumbina
Electrical
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PLUIIBIrlG
ELECTRICAL
MECHANICAL
no.
I FFF I OIARr,F rm I
t~~ I nlJ1RG~ tJO.
, e E..L. . ..GllARGE
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTU's
I Relocated building
(new fix. additional)
IS.F. Residence
(1 bath\
IDuplex (1 bath) each
jAdditional bath
New circuits alts.
~~or extensions
ISERVICES
I
Floor furnace
and vent
Recessed wall
~n~~p hp~tp~ ~nrl vpnt
~!ater service
ITemporary Construction
IChange in existing
rp~ i rlJ'_or'" .
multifamily. comm. or
Tnrl1J<;fri~l
Storm Sewer
I
I
I
I
Of
amps,
Apoliance vent
Sfll')aratp
Statlonarv evao,
cooler ~ .
Vent fan with
sint11e r1lJr:t
Vent syste~ apart from
heatino or A_c.
I rlechanica 1 exhaust
_ hood and dur:t
Vood stove/heater
Sewer
yom.\. II ND, FEEDERS
~10 ~'install/alter/relocate
\- r1i<;trih f"",r1pr-<;
Of amps.!
'I
TOTAL CHARGES TOTAL CHARGES
WHEnE STATE L.'II REQUIRES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I SSUANCF OF PFRllI T
TOTAL CHARGES
Electrical Contractor. the electrical rortion of this permit
Sunerv;sor and returned to the Building Division
I HAVE CAREFULLY EXN1INEO the completed aprlication 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 Ore,:!on pertaining to the work described herein. and that rm OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my re9istration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemntion is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S ]t11.055 I'/ill be used on this project.
IlAI-IE(please print),nDm"-.S - ~, ~_~,~.~~.f" L, . SIr.lfATURE~_ (! ,~, Q-,
FOr. OFFICF. USE OiH Y
DATE/z-hJ~r..
Zone ~.c.
Fire Zone
Flood Plain
Type/Const.~~ ~ Units
Bedrooms / -. Occy load
Stories / Occ.y Group 71'-2,
'Sq.
So,
Sq,
Ftg. f1ain x Value
Ft~. Access ,x Va 1 ue
Ftg, Other~I.'-;XJ",~ Value ~~....-
TOTAL VALUATIGrI
7' 1 0., (),) '.)
BUILDING PERl,lIT
Charges an~
Surcharges
__~.so
-;;;',<~
Plan Ck, Comm/Ind
65I/Bldo Ppr Fpp
Res
Ppr Fpp
, -q' "'I
i
\
~2Y:;>
Systems Development
Charoe (1. 5~)
PLU11BING PERMIT
Charges and
Surcharges
Plan Ck,
10%/B10n
I ~~nce
------------, Demo
I Sidewalk
"ELECTRICP.L PERI~IT
Cha rges and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharl)es
"- ,
AI..C Paving
Curb Cut
~ Total (omb, rermit
1
[ TOTAL
$5=5. ?2
/3t66l
.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A, ,Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
17 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. example. heat/electrical ceilin~/or forced air qas
2. examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. ------
1, example- 1250 sq, foot house, 500 sq, foot garage
2. examole- if new project. check-new - if addition,
check add, etc,
F. Building permit information':
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. example - convert single family residence into
restaurant (Change of use)
G, Value of work as defined in Section 303 la) of the
Structural Specialty Code
H, DESIGN TEM1 ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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 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.
V, ' FOR OFF! CE USE ONLY
. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
.
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Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
. Additional Project Infonnation:
PLANS REVIEWED BY:
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date /2-5~