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HomeMy WebLinkAboutPermit Building 1986-11-20 I rHARGF JJJl....1 I furnace/burner to BTU's I' Floor furnace and vent I Recessed wall ~n~rp hp~tpr ~nrl vpnt I \ i , (' . .,,' .prISPECTlOrl LItlE l!26-3769 Job Address 3350h(l-1e.Ulli J Legal Dmription l1-ll~-;:):l-~~ - \ nnffO -, . . CITY OF SPRWGFIELD COMB IllATION APPLICATION/PERMIT E!lERGY SOURCES: Heat l~ater Heater Ranqe Owner LUJI\;\\pr>:~ .l\'\'\eV"l'\fthl\i,\[t () 31'y' Address3~~t) ArUou:a.L.\ 'Phone 7z(,-IZ(" I va~() OOD Buii6;nQ1Permit Info: Familv nesidence With Construction lender l\ Q \\\. l\Al 1) Address Ut~Jl.iU TE-Ar' (i \ \~e~ 1_. \1in-O r- Phone (address) flies. no.) \~14 ~D\\\U)\~ ~ I Primary Structural Electrical. Mechanical CDNTRACTORS (name) (address 1 11 its. no.) Genera 1 Plumbina .. ..... C'l O"'-~ [ , Electrical f.lechanical PLU1IBI t1G ELECTRICAL NO. I HF I rHARGF yo <<< / Each single fixture Residence of 7. S-o SQ. FT. IRelocated building (new fix. additional) Is.F. Residence (1 bath) IDuPIex (1 bath) each IAdditional bath New circuits alts. or extensions c- '2 c> T-l. J'r; c>r'1 ..,. SERVICES c.-/ ?2.~. !Temporary Construction IChange in existing rps- j d_pJ1r:p Imultifamily, camm. or Tnrlll"trii'll \>!a ter servi ce Sewer Istorm Sewer jt: kAp Ex tS )'" I I I I I amps.1 Of COMfI./IND. FEEDERS l I I I I I I I 2:;>-~ I 7.~ I Install/alter/relocate !'1ic:.trih fpprlprc 10f amps. TOTAL CHARGES WHEP.E STATE LAW REQUIRES shall not be valiJ until the 15:- TOTAL CHARGES INFORlIATlDN LINE 726-3753 Sq. Ftgo I.lain ~q. Ftg. Access. Sq. Ftg. Other new Add Alter Rep. Fence_Demo _Change/Use _Other lCX) E;'- o I~ I~ Describe Work(i.e" Build Single ,tl,ttached Garaae) - ~~ llh(\fJ rexn;~esl ~ohone no.\ 4R~- S3Cf (,., (pxoires' (ohnnp nn. ) 1/4. 00 /~ MECHANICAL "-EL J:JiABGE. I App 1 fanee vent Sfloaratp I Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I hea t i no or A. C. 1 Mechanical exhaust hood and dur:t I Uood stove/heater I I I ISSUANCE OF PFR'1IT TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE ~AREFUllY EXAtlINEO the completed application for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of OreC]on pertaining to the work described herein, and that UO OCCUPArKY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project. /:::7 -/ L ~ATE (1-2()-~b . ~ _ 7 - - -"r ~ -- FOP OfFJ'r.F rlC;;J;....orlt.y......,......-. ~ ./ /' . .~t~. r1ain x Value Sq. Ft9. Access x Value Sq. Ftg. Other/~tft::1R...;IJ...j. ~..RValue ~ """'lP {i;Vi3lo1, eJl//lD/tt TOTAL VALUATIOII VII -2. ~ ~ Syste~s Development / I A.. . I .;,; Charoe (1.5~) N r . IIArlE(please print) ~orl SIGrlATURF lee.- Zone~tC. Tyoe/Const.~/~SI'. Units Bedrooms Occy load Stories Occy Group A,- ~ Fi re Zone Flood Plain (/5c:c::::..oPc-. //--'&28 BUILDING PERMIT f'L.(~ ~~ Plan Ck. Charges and "'\ __ Zt_~_____ 65%/Bldt'1 Surcharges tr ,.. /02 Plan Ck. ~ -t:>. 30%lB1 do -LS3 .e> I Fence --- .-6~--1 DfilIIO ~~;~~~;C;~/ERr~lT",- ____~~_:.S_~J Sidewalk Surcharges. ." _ ~O lAIC Pavi ng MECHAIIICAL PERMIT -I Curb Cut Charges ,and ____________ Surcharges I CorrrnlInd Ppr Fpp Res Per Fee I I I 1 I I PLU'~BlNG PERMIT t' Charges an.d ":> Surcharges ITotal Comb. I I TOTAL Permit /.85: I< i!-!!.po 7!( . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference II OJ 43 2. example- Lot I. Block J, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exarnole- ~eat/electrical ceilinq/or forced air OdS 2. example. waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examDle- 1250 sq. foot house. 500 sq. foot garage 2. examyle- if new project. check-new - if addition, check add. etc. F.' Building pennit information: 1. example - construct single family house with an attached garage 2. exam21e - 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 TEM4 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-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 . Z.' 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 Do 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 wi.] 1 prepa re a type wri t ten 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. Vo FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ,. , .. , ------1' . PERMIT VALIDATION rB011~1 (/r- 2f) /~G J JJ<o~ Permit Clerk e--o) \ l Permit applicant exempt from registration with the Builder's.Board because: Additional Project Information: PLANS REVI EWED BY: name L~/YE h~~ Signatur~ - . H~:..? d~~e //-/"?-B"G