HomeMy WebLinkAboutPermit Building 1989-10-20
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HNSPECTioN LINE
1726-3769
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CITY Uf SPRINGflElO
COMBINATION APPliCATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
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INFOR/1ATION LINt
726-3753
Sq. Ftg. 14ain
~q. Ftg. Aceess.
Sq. Ft9. Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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Job Address J<I86 ~7FW/-1-1 C;V
Legal Oescription \ I(l~~ ~d{)
.z: -S"'
O\;::}(D
Phone
Range
ValUE of Hark:
.5'Doo
BuiloinQ Permit Info: Oeser be Work(i.e.. Build Single
Familv Residence Hith Attached Garaoel
1k77l..C Sro/i!AC(e. Ac..t. k
thAI#- CodE-~
;neu;
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Owner', Atecu jJfC.arJIJ ok
Address "'P 0 '6 6x. Sl"> II
.-SA^" /1?,;m;o (]A. :9r,k./6z-,' ,
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'(<hS-IS7/-Z,",OCJ eloX!JOS(;
Construction lender
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Address
UESIGN TEAl4
,
{namell I I
Phone
(address)
.:J,3</-S-N RD'.>S
flies. no.l
(exnires)
(ohane no.,
Primary '/;?A.., F h~Pf c,.
?or+I4NO ,OfZ. 'i7ZZ,?
Structura 1
Electrical
Mechanical
CUNTRACTORS I name I
General ;?'J&J(;.. - iLk,'h./A.J
(address) flies. no.) (pxoirp~l
79:3/ ~ e k/',./q ;7)//~kIC, (JfZ.
(Dhon~ no. l
777-d.8'7
Plumbino
Electrical
~1echanical
PLUI,lBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARr.F .~
~-.CliARliE. NO.
FFF rHMJiE.
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~r.p hp~tpr ~nd vpnt
Storm Sewer
Of
amps.
Appliance vent
spoaratp.
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood nod duct
Sewer
Temporary Construction
Change in existing
r@s 1 qp~nr.p
multifamily, conm. or
lndudrial
Water service
CO~4./INO. FEEDERS
Install/alter/relocate
rii c; tri b. fppdprs
Wood stove/heater
Of
amps.
ISSUANCF OF PFR!HT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\l~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall no~ be valiJ until the lab~l has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all ;"fonmation hereon is true
and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the \ Sta te of Dreoon oerta i ni ng to the work descri bed herei n t and that UO' OCCUPAI~CY wi 11 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 701~055f that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
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Units
Occy Load
Occy Group JIJ~":2.
SIG!IATURF. ~ ~.: ..
FOr. OFF I CE USE DIlLY
Sq. Ftg. l1ain
Sq. Ft~. Access :03"'/ zP
Sq. Ftg. Other
DATE /o.'l.a-ST
IlAl,IE(please pri~ML ojt(., IhtYIJ
Zone CL:..
Fire Zone
Fl Dad Pla i n
Type/Canst.
Bedrooms
Stories
-:2-#
x
x
Value
Value
Value
~~......
x
BUILDING PER/lIT
Charges and
Surcharges
, ~ c'" Plan Ck. Conm/lnd
___,"e._<:2~_ ..Ql!/Bldo P!'r Fpp
.., er-3 Plan Ck. Res
~ ~~ ' 30t/Bldo Per Fee
Fence
TOTAL VALUATION
7p.QP-''4f>. u;
Systems Development ,~
~.$:f 15'/'7/ Charqe (!.5~) -?? . --
PLUI1BING PERMIT
Charges and
Surcharges
Demo
Sidewalk
A/C Paving
Jotal Comb..Permit
ELECTRICAL PERIHT
Cha rges and
Surcharges
TOTAL
~tY3
/28~8
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources
I. exam~le- heat/eleetrical ceili~Q/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- 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. example - remodel existing garage into family room
3. examyle - 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 TE~I 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
2. 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
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 ,not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will b~ used as
a worksheet only. Where possible, Building ~ivision 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 OFFICE USE ONLY
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pERMIT VALIDATION
\-~c0 81
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Permi t
Clerk~~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
#0 ./ .1.ri.r...-?/T ,/75~A'-.--c.~6A<".?"'7-c. 0/~-- ~T€ P~h--
.~A(T.' _2)&V~LLP~'~,E;// ~~~k~,,,G.7T.T &~./y~"Z).
\ ~ ~t )~ \\ - 12-- %~ 1'ifl
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name'/Ao~';c ~~G/f'signature~~""'~~.J)date //~"2/-$9
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