HomeMy WebLinkAboutPermit Building 1987-11-23
'~~
1 IrISPECTIO:I L1I1E
726.3769
.
Job Address 35;),0 ~t:U-7
Legal Description 170 3. -;).;).=L V r/lJ() ~oo
i
i
I
CITY UF SPRIIIGFIELD
CDrIBJiIATlON APPLlCATlDNfPERMlT
EnERGY SOURCES:
Heat
Ha ter Hea ter
09
~
6
~
~
~
C f).' I!
Owner r~.:e. /J~.nL.l/~
Address . t)/) 'A/..w V1 C; 9 rJ
?u;~
Construction lender
Phone(p r If
i/t/3'3
IflFORt1ATION UilC
726.3753
Sq. Ftg, Hain
~CJ. ~tg. Access.
SQ. Ftg. Other
Ilel< Add Alter ~eo.
Ranqe -Fence Oemo Change/Use
Valu, of Hark: / ()/n-v Other--
BuilGinQ Pemlit Info: Describe Work(i~e., Build Single
Family ~esidence I-lith /l,qach~d (larao~)
~cI.R.f' t?AG;~
..ib? ..u , :". J _ c;.;f;;z/;:;~ '-..J-//7
(l~~ tl~ ' (-...4., 1,_ .
(lir<=;. no.) (exnires) (ohone no.-)
.
,
Address
UL~ J WI I LAll
(name)
Phone
(address)
Primary
Structural
Electrical
f1echanical
CONTRACTORS
(name)
nil fYl1) /l )
(address)
!lie<=;. no. \..
/
~
(exoi ra..",)
(ohonp no_ \
Plumbina
Cfh-Of3 z
7c(t.:- 7d94
Genera 1
,
Electrical
~1echanical
PLUI,1BI IIG
ELECTRICAL
MECHANICAL
1m.
Each single fixture
Ftt I f.HAR(;F _NO
75"& ~';lS'
~r=r=
C"8Jlii[. -1!lL....
furnace/burner to
I 4L {;Wn- BTU's
~~L..c.l:fARG.t
'3
Residence of
SQ. FT.
6.--
Relocated building
(new fix. additional)
V"
New circuits alts.
or extensions
.". "..~ _oRE;
ISERVICES
1
~4S'<r
I
Floor furnace
and vent
S.F. Residence
!l bath)
Duplex (1 bath)
Recessed wall
~On{'P hPntpr nnn vpnt
1
1
1
1.6--'
1
each
Sewer
Temporary Construction
Change in existing
rpsidf'n,p
multifamily, comm. or
TnnlJ"trial
/
Appliance vent
s.eoa ra te
Statio~1. ~~ap. I
cooler,l'f~~ e..>.",/r
Vent fan with
',iinole duct
1 Vent system apart from
heatina or A.C.
1 Mechanical exhaust
hood and du,t
Wood stove/heater
Additional bath
~Iater service
I
1
1
I
I
1
1
I I
TOTAL CHARGES '<OZ. Sb '1 TOTAL CHARGES
WHEnE STATE L,\H REQUlnES that tile Electrical work be done by an
shall not be valij until the label h~s been signed by an Electrical
Storm Sewer
Of
amps.
C0I11.1. II NO. FEEDERS
1 Install/alter/relocate
ni"t.rih fppnpr"
Of
amps.
ISSUANCF OF PFR',lT
-::?;z~ Se)
TOTAL CHARGES
M//V
/5-:"-';;'
Electrical Contractor, the electrical portion of this per~it
Supervisor and retur~ed to the Building Division
I HAVE CAREFUllY EXMlINED the completed aprlication for permit, and do hereb.v 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
of1Soringfield and the laws'of the State of Oregon pertaining to the work described herein, and that rw OCCUPAllCY ~...ill be made
of any structure without the permission of the Building Division. I further certify that my reqistration with the Builderls .
Board is in full force and effect as required by ORS 701.055, that if exempt the ba' for~' . tion is noted hereon. and that
~~~~~m~~ee~-:;~~D~~n~t~~0~~11 b se on ~s p j~~'Wea.~~~~€
IIAIlE(pleaseprint) RUbY jO:)OIJ)J;;Jl., SIGIIATVRE /.-j:( 'Ar?//' om If-23-%}
-~. I
FO~ OfFICE USE - ,
Sq. Ftg. Hain x Value
Sq. Ftg. Access.LtDJ? ::?~t::> ~ __Value--3_~_ _.
8- ~ Sq. Ftg. Other~~E2 '.. _'_ Value_ Z::;i:=.:..-=:'
TOTAL VALUATION /~.~..eo
Zone G C
Tyoe/Const.
Bedrooms
<5"-1V
Units
Occy load
Occ'y Group
Fi re Zone
PLU'1BING PERMIT
Char.,ges and
Surcharges
/
V~ ~~ 2':?7
BUILDING PERfllT . \\d.86 SO 'Plan Ck.
Charges an': B~"" ---- 65%/Bldo
Surcharges t!) '=" Plan Ck.
~ . ~ 30%/BldQ
I \0, ~-..:> 0 Fence
Q.~~ /;7:3 - D~mo
~~ Sidewalk Zd~/
2'-z0~/-~-1 AIC Paving
__ _ .I.22~"'::-,'J Curb Cut
. 7'1> I
Stories
Flood Plain
CorrrnlI nd
Pp" ~..~
Res--I
Per Fee
q.:;l.-V1IO(3S
I 5.... ~ Syste, ms Development
0<._>3 'CharQe (1.5~)
,
4'-z.~
I
I
I
I
~O. '70 I
ELECTRICAL PERI~lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
?-.?(). 2.0
/..&-g-c:rtJ"
~(::,r2.. '2.0
-? '"?'-:->. ~I '/-
Total Comb. Permit
--
.
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100. Lane County Map Reference
11 03 43
2. example. Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilinq/or forced air QdS
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
1. examDle. 1250 sq. foot house. 500 sq. foot garage
2. exam~le- 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 (a) of the
Structural Specialty Code
H. DES I GN TEAl,! AIIO CONTRACTORS
. I,To avoid,design or construction delays, Building
Divislon Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces Occur in the description
portion of the Mechani~al 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. I f the i tem{ s) to be ins ta,ll ed a re 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
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. -
ApPl.icant..to.: s.ign'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.
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.
." ..
II.
.'. l.
, .,' IJ I.
IV.
V. FOR OFFICE USE ONLY
1/
"1
.
~
.
PERMIT VALIDATION
/ {J S fG
11-~3-'{1
"
Permit Clerk
Cu
',~. \
PROJECT CONDITIONS TO BE SATISFIED BEFORE ~':"" (....'7/77/.7"' />:Se>#-'/C.IF.'
: ... . . . ....' . . .... ~~'.
!
I
,
Z;>FV~cC>;P~E/Tr ..kA"F~/.;77~;l7:r ~T::> /9H~
i
~ =-'i"~h'.A?./E i
,
/Vc:-~Z> ~4#FZ>
<; Fe .71:.rt'Y
0.......P/E
,
'-1.I?//779
! -,
!
.~ :-.-,;- 7?->
~,,</'7.
,~
"7>
/-- L7'7 ~/ ..r-
.
,~'_. ~~'"~
'",f" 'f',
,;
/55~,1!!Y"Cc.
,
~-J J z:?",#//,-"./' c:..r--r-,
.,
Permit applicant exempt from registration with the Bujlder's Board because:
'J,'
.:..:
. .. -, . - r
"-:-'-Ad'd'i'ti,o,na 1 project::I nfonnat ion:
,
,}
1
PLANS REVIEWED BY:
'\, \name
. '.
. .
/~#tE/l~~Signa~Ure~$_~
'.,' < . .....
, t- . '
..
"
" .
.," -~
-
."
"
.... '.-'"
"
.\
"
'-;;;-.,:'- ,..' , ,
" ,.,c~_~~'date
/" .' ."\
'7- .:? /"-8 ?
'..