HomeMy WebLinkAboutPermit Building 1989-4-25
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C;;A-~rlY .::;. / .
1f1~I'ECT WII L1i1l.
726.3709' '
Job Address
3520
I.eqdl Description
INFORlIAT: .:1 Ll..:' I
726.3753 If\ :
So. Ftq. Hain ~ I
~q. rtf). Access. () .
So. Fto. Other ->' .
lie" 'Add P.1 ter ~eo. -ir1r-.. I
Ranl'1e
ValgS",';?W._ L 6~~~~_Oemo_Change/Use Ie;' i
Ouih;ina Permit Info: LJescrlbe Hork(i.e.. BU11d Single C"\ I'
fclr.Jilv nesldence Hith fI.ttached r.araQe\ J !
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(ohane no. I
LIlY uf SI'RlflGFlELU
COflBlf/ATION APPlICATlONfPERMlT
EIIERr,y SOURCES:
lIeat
Hater Ileater
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/7 t:J3. zz.. zoO. 300
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Owner,l?Ac:::t' F/C ..c- =-/ ....-/)/~~
Address P? tt), ~L9~ Z!?O_~
Construction lender
Address
DlSIGrl HAIl
(name)
Primary
:5r/ApOr;. ~
Structural
Electrical
!lechanica 1
COrlTRACTORS
(name)
Wd?47~.n..- '"
-r;7// ~V..d/,A~
Genera 1 B,6)v,/./p.s
PlumbinQ
Electrical
, ,
-5~ M 6"H'~?/,:J./-5e5"
~'I'?r. hrtn i cill
I'LUllnll1G
j;U.1
-----lEach single fixture
Relocated building
(new fix. addition"l)
S.F. r.esidence
rl bath)
IOuPlex (1 bath)
Additional bath
each
~!ater service
Sewer
t,../"I Storm Se\'/er
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TOTAL CHARGES
,./lIEP.E STATE L \II REOUIRES
sha 11 not be va 1 H uot i' the
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Phone
RcC4>.cJ:>--r;epc;r-
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Phone
(address)
(1 ics. no.l
p,v,,-..,,=-
/SL41VC7,s.
lexniresl
3:f7/ //ho
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L~- .1 TOTAL CHAnGES
that the Electrical \10rk be done by an
label has been signed by an Electrical
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(addrec;s)
flin.
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72,0
<;'~/.7
ELECTnlCAL
1~11ReSidence of
SQ. FT,
'1ew circu!ts aIls.
or extenslons
'7~~_~~
/SERVICES
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I..HL'_UJAHIiE '
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MECIlANICAL
Ilfl_
furnace/burner to
BW's
I Floor furnace
and vent
I Reees sed wa 11
~n~rp hp~tpr ~nrl
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I TOTAL
I Apol iance vent
"poal'ate
I Stationary evap.
cooler
I Vent fan with
os inolf~ duct
I Vent system apart from I
heatinq or A.C.
I Nechanical exhaust
hood rind due t.
I Uood stove/heater
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ISSIJANCf OF PfR/IlT
C IJARGE S
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ITemporary Construction
IChanfJe in existing
rp~id~ni~
Imultifamily, conf!l. or
Inrluc;.tri;d
Electrical Contractor, the electrical portion of this permit
Supervisor anG returned to the Building Division
I IIAVE CAREfULLY EXNlItlCO t~e completed apfllication for ~ermit, and do hereb.v certify that all information hereon is true
and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Sor i ng fi e 1 d and the Laws of the S tel te 0 f Orel)on oe rta i n i n4) to the work descr i bed here in, and tha t 110 OCCUPAIlCY \'Ii 11 be made
of dny structure without the permission of the UlJildin~ Division. r further certify that my re9istration "lith the Iluilder's
Iloard is in full force and effect as required by ons 701.055, that if exemot the basis for exemntion is noted hereon, and that
only subcontractors and emrlloyees \'Iho are in conmliance with Or.S 7111.055 \.,'i11 be used on this project.
20ne L L
Fire 70ne
Tyoe/Const. ;zz;-~
Bedrooms
FlOOd Plain
Stories
BUILOIIlG PERri IT
Char']es dn~
Surcharges
, __A.~S..::?~~
/0- 78 .
PLU'lBIIIG PERMIT
Cl<lrges and
Surcha rges
,ELECTRIUL rEn'~IT
Cha rqes and
SurCharges
I1lOlA/IICAL PEP-11fT
Charges and
Surchar!1es
IOf ~tYt::>
ICOI~I./INO. FEEDERS
I, ns ta Il/a I ter/re locate
rlic;.trih fpprlprc;.
IOf amps,l
I~~~~q
li~;""??h?/T.
f
amps.1
ffdsfl./- .-~~
Uni ts
Occy load
Occ)' Group
.Corrm/ J nd
P r Fee
nes
Per Fee
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O~,TE~~/J:;z:
Irotal
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f:Ol'lb. rel"mi t
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'WIE(please print)5 H. 50-/4 VP7:' . ~rlATURE
FO~ OfF ICE USE OrlLY
Sf!. Ftg. ,\ain x Value
So. Ft~, Accessh?..p--:,..,.....~/~'" :r r:' i:::..
~--~ Sq. Ftg. Other x Value
~\~ 11'~1~ TOTAL VALUATlOtl
\WO' o8vu'\,systems Development ~..",. ~~
"\ . - CharQe (1.5't::) ~,.s?..c~T~_~t'"'.
Plan Ck.
6S! BId
Plan Ck.
30UBldn
-::::?C>_~ :.1 Fence"
------;.~:-I Op-mo
I Sidewa 1 k
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lAIC PavlfHI
I Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
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Appl icant to furnish.
A, Job Address
8. legal Description
1. examole- Tax lot 100. lane County Map ~~(erence ~_
,.. 1?Oj,4J :''''',,,,'_''.
.... 2. example- lot 1. Block 3, 2nd Addition to
~pr1ngtield [states . ......; '. .
"t..... Name; etc', of Owner and construction lender
.. D. Energy Sources
1. examl?le- heat/electrical eei 1 inq/or forced air QdS
2. example- waterheater/electrlcalJor solar
E.... Squa~e tootage or va)uc:tlion...etc. ~'" "',
. 1. examole-"J250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new _ if addition,
Check. add, etc.
F. Building permH information-;
1. examole - construct sinyle family house with an
attached gc1rllge
2. examole - remodel existing garage into family room
J. examole - convert single family residence. into,
~.'\. restaurant. (Change of. use) .:....... .
G. .Yaiue'of \....od as defined in Section "303 (a) of the
Structural SpeCialty Code
H. OESIGN TEAI-l ANO COIITRACTORS
To avoid design or const,"uction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
Abbreviated Plumbing, Mechanical, & Electri"cal Schedules
"'A. Except \'\fhere 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, Nechanical, 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
fu11 schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AIIO
CHARGES UN THE SCJIElJULES
O. As-noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
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.
fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans \.,.ill be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
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be delivered to the
by his electrical
is ~ aut,horized
Ill.
IV,
V. FOR OFFICE USE ONLY
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'PE.RMiT'VAliDATIQN
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I Permit, Clerk J
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
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Permit applicant exempt from registration with the Builder's:Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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name
~NE"?L~e?f"
signatu4~~
da t e s-:./~ -&"7'
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