HomeMy WebLinkAboutPermit Building 1986-11-20
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I furnace/burner to
BTU's
I' Floor furnace
and vent
I Recessed wall
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l!26-3769
Job Address 3350h(l-1e.Ulli J
Legal Dmription l1-ll~-;:):l-~~ - \ nnffO
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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
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Address
Ut~Jl.iU TE-Ar'
(i \ \~e~ 1_. \1in-O r-
Phone
(address) flies. no.)
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Primary
Structural
Electrical.
Mechanical
CDNTRACTORS
(name)
(address 1
11 its. no.)
Genera 1
Plumbina
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O"'-~
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Electrical
f.lechanical
PLU1IBI t1G
ELECTRICAL
NO.
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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 )'"
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I
amps.1
Of
COMfI./IND. FEEDERS
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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;'-
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Describe Work(i.e" Build Single
,tl,ttached Garaae)
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rexn;~esl ~ohone no.\
4R~- S3Cf (,.,
(pxoires'
(ohnnp nn. )
1/4. 00
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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
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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
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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
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1
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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:
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PERMIT VALIDATION
rB011~1
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Permit Clerk
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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
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