HomeMy WebLinkAboutPermit Building 1987-9-11
'''SPECTIOIl LUlE
n6--3769 '..
CI lY UF SPRIfIGFIELU
CorlB IIIAT! ON APPLI CA T ION/PERMIT
-
3523 ~~$hnf, I
Legal Description I r -()~ - '22..- L -rL-:/:L [DC') I
,
I
Job Address
fNFOR'lAT:~:1 Ll,.:'
726-3753
So. Ftq. r'la 1 n 1_\.f:X)
~q. ~t!l. Access.
So, FtQ, Other
_He\...~J.l ter _~eo.
Fence Demo Change/Use
ValUl!f.~.co Other--
uilt;ino Permit Info: Describe Horkti-.e., Build Single
Far.lilv nesidence Hith I\.ttached (;araClel
1 /JcV{,+,;n'v () 12.9, ~ -kf-. --k
r:zc..r dO :e.X~N-~'-\Q ~c..Jc......t-L
I
1 ics.
~~~~r;1~hjAQs
Hater Heater _~II'uJ"
RanQe
Owner --S'1~C\.'" D, Co.~-hl\~ '
Address 340.5'" ClOdd.., \.XG:S~r, -"hone7%-,
~r~.~:e.lc( 'rf}~1(11 Cj71-'77
Construction Lend~ ~A .
Address
lJl:.Sl(jrl TeN!
Primary
Structural
Electrical
~1echanical
CON'RAClUR,
Genf>r~ 1
Plumbino
Electrical
Hechanical
--.iill..:...1
{name
-::'\.\(,Ol,~\ ,\:>, Corp, ( t(f'J() Vh
l-kxrNi.s ~S~.O ("7::ct,;-r'1 I
i-Ia. clvi oJ ']
- :name)
~t:l"'^ P-. f)/'<,r
V\{)\Q,
IIQcJMa(.to\, ~',l(IDs t-Lo('
lI\.OY~
LL'Jt-e.o( a.0oUG
2,.r-,lIo'1
L..e E:,t P.u ed,
I:r:EE HA '.Jill.....'
Each single fixture . Residence of
sq, FT,
Relocated-b-uij"di~g- -""'"I New circuits alts.,
(new fix. additional) ~ or extensions
'2 c>P ~"~E'
IS,F, Residence I ISERVICES
(I bathl
Duplex (1 bath) each I
I
I I
t-
,'T'
I I
I I
I
I
I
PLUliBlliG
ELECTR1CAL
ITemporary Construction
Change in existing
rps- ; rl..~n{"p
multifamily, camm. or
InrlIJ<:.trii'll
IOf
I COI~'1. /I NO, FEEDERS
IInstall/alter/relocate I
di<:.trih. fpprlprc:.
IOf
I
I
I I
TOTAL CHARGES I TOTAL CHMGES
l'lIlmE STATE L.,\IJ REQUIRES that tile Electr;cal work be done by an
shall not be vali~ until the label has been signed by an Electrical
Additional bath
Ha ter serv; ce
Sewer
Storm Sel-Jer
-I
,
I
I
I
I
I
I
I
I
I
I
I
I
I I
72. :5<=> I rOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
amps.1
amp~1
I
I
I
)D-I'""Ptc (0/07
MECHANICAL
II
furnace/burner "to
BTlI's
Floor furnace
and vent
I Recessed wa 11
S"ilCP hP,:Itpr ;!Inri
I
I Apo Ii ance vent
spoariltp
I Stationary evap.
cooler
I Vent fan l<Jith
sinale duct
I Ven t sys ter.1 apa rt
/1~atin(1 or A.C.
I ~lechanica 1 exhaust
hood ilnd duct
Wood stove/heater
ISSUArJcr OF ,PFR'HT
i
I
001
01
IE) I
'~i
V\I
! I
7-Ir "2-/f(j(j{j I
'A>r ;C}2,R J
.
.
I
._ .)ohone no.) :
7t/tr!Jtl/C/ I
i
31.(S; 087c.j
I/pnt
I
I
['
I I
I I
I I
I I
from
I HAVE CAREFUllY EXAtlINED the completed application for ,oermit, and do hereby 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
of Soringfie1d and the laws of the State of Ore~on pertaining to the work described herein, and that flD OCCUPArKY \<Jill be made
of any. structure without the permission of the ~uilding Division. I further certify that my registration with the Builder's
Goard 1S in full force and effect as required by ons 701.055, that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees \<Jho are in comoliance with OP.S 7111.055 l.d11" be used on this nroject.
lIM1E(please print)
Zone C/'.
Fire Zone
Flood Plain
BUILOIIIG PERI.IIT
Charges an.:'
Surcharges
PLUI1BIIIG PERMIT
Charges and
Surcharges
,ELECTRICAL rERr~1T
Cha rqes and
Surcharges
11ECHAN I CAL PERI11T
Charges and
Surcharges
~
5 Ir:jJATURE ~4_g6..'-"',I" O~.TE 1-11-rf'7
FOr. OFFICE USE UiiLr
Units Sq. Ftn, 'lain , Value
Occy Load So, Ft~, Access x Val ue
Occy Group A-"3 Sq, Ftg, Other Ap7J /'"3'2 'if Value 4/,<)a::>, ..."
jrotal (omb. Permit
I TOTAL
i2.Juu A, !2tkr-&
Type/Canst. ~-/Y
Bed ro oms
.Stories "'7
Plan Ck. Comm/lnd
65X/Bldo Ppr F~p
Plan Ck. Res
30%/0100 Per Fe~
I Fence
I Demo
I Sidewalk
I A/C Paving
I Curb Cut
-----------"',
---2~'_.2~__
-::z - 53
------------
-__22'2":'__
1./ '"3
TOTAL VALUATIOtl
Syste~s Development
Charoe (I.Sn
~7,i""6
7G,66
I 'It(- /0
.
ill
COMBINATION APPLICATION/PERMIT (CAP)
I.
I!.
Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100, lane County Map Reference
II 03 43
2, example- lot I, Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/eleccrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exampJe~ Tflnew project, check-new _ if addition,
check add. etc.
F. Building permit information':
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole. convert single famlly residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. OESIGN TEAI'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.
Abbreviated Plumbing, ~lechanical, & Electrical Schedules
A. Except 'there 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, Nechan;cal, 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, BUIlOING OIVISION 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. - ,
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 rees are due and payable at the time of the
appl icalion, 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.
J II.
IV,
V,
FOR OFFICE USE ONLY
I'
PROJECT CONDITIONS TD BE SATISFIED BEFORE OCCUPANCY'~
.
. "
'.
,
.
PERMIT VALIDATION
! .
{0275"
q/tt/o1
-''1'
I
Permit Clerk ~
Permit applicant exempt from registration with the Builder's Board because: ...
1
'Additional Project 'Inforinat'io~:
PLANS REVIEWED BY:
name ~R.N~ ~c<; ~
.' ,
"
Signature~~
, , ("
date 9~'2 :<-8"/
.
1
~