HomeMy WebLinkAboutPermit Building 1990-6-19
jlNSPECTION LINE
726-3769
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(I 'Y Il:' ;PHJNGfIELO
CC~B1i'iATlON APPLICATION/PeRMIT
E!lERGY SOURCES:
Hea t E>U:vT'
Hater Heater ~
Range N""E.
INfORllATION LINt
726-3753
Sq, Ftq, I.,ain-I..a: JI1TO
~q. Ftg. Access.
Sq. Ftg. Other
~w Add Alter Pep,
--Fence Oemo Change/Use
Valut. of t./ark' -Other- -
$IJ90(),brro'~ I ~AfIEA~/bPIJ
~uilainQ Permit Info: Describe Work{i~e.. Build Single
F~mil~ R~sidence With Attached Garaoel
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Ho~/HtJiE,1.. - ~ ~(2.'1'-
POVL.-VE&!M-I/BVli.-O .
Pho"e ~l' 1Zl'" 1't,f;~S - DlESI"" 8v/41
{namel (addre!sl {lies. no. l (exoires) (ohane no.
e>~ ..h1lN!;c)N IN", '-701 OENOC~ gl.-llP, 36-TItfiI;OR,ND,/1os.-n ~/}tI1l;t~
Structural b~N$ EN6-/NEERJNC:r- (!Q. /&'15' ~ 8~VD" Rc.:1(\fII..I.E,Mp, lQi~ r..oJ)'i~N"NIIf
,ElEctrical t3~IJ~ ...i:>ttNSON INC-, ~701 Dei-ftJU!flO( '81.110, 'BE1'lI~A /.(0, WfI7(3111)I/Q3.8t/go
BflZNA1ZD ..JoH/oISoN /NC, C,701 fJE:M()t-AA<..'( 154'0, 8e~. M 0 'U>RJ 7 ~1I)lff3 -jl/Q?>
(name) faddr:ess'L (1j"51 n~. ~ (exoires) (ohnne no.)
~'1'f~ ~.w' l,j~YE"7"'Y/-!?,/~E#~
General ~o.O.-fllJ!"'" LAI"'P ,5w~4''':2 ~....'TL'-_:D_R. 97"72_~
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I Plumbino
Electrical
Job Address -:1~I,/(} 6A;".:ti&'RY .11[~;.:."6i:./
Lega I Oescri pt i on 'T1\-t. LoT ':i100 - PAIUf.(.. I
/7~t!) '?- / ~ ~ <.0 5/ t:)o
MA~IOTT Q,f:,.f'. /r;;./h'r/6'C.O /##
Address ONE- ~OTT P12IV€' Phone (SOl)
WA6HlI\JO'rCN I D, e" 'UIO!>K 3'i"'O-6Z?>'l
Owner
Construction lender
Address
OESJGN IEAr-l
Primary
~,
Mechanical
, CONTRACTORS
~1echanical
PLUf,\BING
ELECTRICAL
, FFE I CH~RGE
'1(1'
Residence of
r"A.IlG.E. NO
<FF
NO.1
Each single fixture
37'tl 7.6".0 ';?~~e)
Relocilted builcti.".9_ _"". ,New circuits alts.
. (new fWMdll,n&1'Onal~1 : t/ or exu.nsions
~; , ,7~~~~~~
,S.F. ~__, ffMl SERVICES
-.J,N~ _..
,_\!l!1oJ""~"V..,~~lrtJ.. ,..... ~11
. ~j~,uIl.a:M~f- .-,. r~ ~ Temporary Construction
j, . Vi "~I( Change in existing
I U1,1"', r.,.~ j dj'T,ce
?~ H multifamily, corm!. or
...., Jnduc;.trial
SQ. FT,
Z2~
, --m ~."..e<MI-
1f5' Sewer
CJ
9~~ /'7
IJI'3 Storm Sewer
/~~. I Of I::?~ amps.
COMM./INO. FEEOERS
Install/alter/relocate
di~trih. fppdprc;.
\DS '\7.>
\)JI'"
MECHANICAL
~~1=' r~'1B!iE.
~
furnace/burner to
/1.HJ._tf> BTU's
~-7'-r..2" .,.
Floor furnace
and vent
6..' /9.'-"
J
':2..
h
Recessed wall 1tI;9-/
~n~~p np~tpr ~nri vpnt
6.- .6.~
t:,
'3
1'.( (.I / f ')_
App 1 i ance: vent
~eoarat~
Stationary evap.
eoeler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
/2.-
I.g.-
~... ':l'? N!.
t..j,~$tB. <;t '
:3 Of ... / <::w:l amp~ /5....,. Y"$:"" ., ~s .c?...7~ 1FT:> ,~ 'I.~
"7 ";2,2S 4.. ' S'/.~3A5i .
/ ~~; ~ 1S6-:-""
;'44; <=m/-<,,1L. ~"",.r,;r,,~...~ ISSUANCF OF PFR!1lT
~E;__..- ~;:";;'-'-""""'r~/.IO<o/"
TOTAL CHARGES 2 /?2:r:.'" TOTAL CHARGES ~ 9;6,", ,<).?; _' TOTAL CHARGES IYy'. :-
WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valiJ until. the label has been signed by. an Electrical Supe~visor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 oerformed shall be done in accordance with the Ordinances of the City
af Spr; ngfi e 1 d and the Laws of the State' of Oregon pe-rta i n i n9 to the work descri bed herei n I and tha t IW OCCUPArKY 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 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who a~e in compliance with ORS 7Ql.055 will be used on this project.
SIG1IATURE ~tR.~,JI;
FO~ OFFICE USE OiIL Y
TYO~/const'~-/AIf~,nits So. Ftg. flain ~.~,Q x Value /. 7~"'l'~
Bedrooms Occy Load -:::?~-r- Sq. Ftg. Access x Value.
S"tories '""3 Occy Group ;:2-/ Sq. Ftg. Other&V/#'<:' x Value 23::?~~
\ .
..,. _ .J:; /' A..,., _ TOTAL VALUATlOtl2..oI-'i: L)OO
d.,.,/,,~~r- f?#:.<;/ ~W.:!='~ ree=- ......~R);) /t> 2~~.~.5 ' ,
BUILDING PER/lIT ., ~'~1,a 75" 'Plan Ck. Conm/lnd '''';;(e< -9'4/ ""L7rYl"Systems Develo~ment _
Charges an~ __;,(...:2 J.J____ 65%/Bldo p.pr Fpp :Z.77.}. ~~ Charoe (1.5~) _2"25".
S Plan Ck Res' -- ~ ~.~~..... .
urcharges J 65: 8"1 30%/BI d~ Per Fee I :t?fi"Fi:>AL:> A:;.~ ,7?L#_' V..(d"Y\ (
~~~~~~~Ga~~RMIT ____~$_'Z~'_~ Fence I,pv~~~ /- _~.-@ :_
Surcharges 1'I/.'2~ 0flll10 \q~oo
IWIE(please print) ~ 'R,Luf6e.'f ;1L
Zone ..c L
Fi re Z6ne
Flood Plain
ELECTRICAL PERI~IT
Cha rges and
.v~'JP~~7AC'O
11ECHAN I CAL PERMIT
Charges and
Surcharges
S'" -2"6. "So 5 1 dewa I k
------ ---:--1
;'2./!.~ A/C Paving
___"L"!h.~~_ Curb Cut
7..Z0 I
.7,3,iP. ~
om (r It( -'/ tJ
Total Comb. Permit
7 3~ '3.1.,
/_ ?-.. \CA.
TOTAL -" ~'::J-" ,
'1..\I/,
_I f'.
. ~7;~8'1. 5'6
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COMBINATION APPLICATION/PERMIT (CAP)
L Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates ,
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam21e- heat/electrical ceilin~/or forced air Q8S
2. example- waterheater/electr1cal/or ~
E. Square footage or valuation, etc. I
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examp,le- if new project. check. new - if addition,
cneck add, etc.
F. Building pennit ';nformation:
1. examele - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam21e - convert single family'residence into'
restaurant (change of use)
G. Value of work as defined in Section 303 (a).ofthe
Structural Specialty Code
H. OESIGN TEAM ANO 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
fu 11 schedu 1 es
C. BUILOING OIVISION STAFF WILL FILL OUT ALL.FEES ANO
CHARGES ON THE SCHEOULES
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 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.
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
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE -QCCUPAN&f: ?<:'"'I"h'?/ r /,;55~4'#<:~"
''/c..--i/'kF-</r-; ;:;;/~-vC'c:> Z:;~lreLZn -- ~~--=-,,~_.--:,-'-~~/Y/ /;;!.~.:3 \..:::;~~
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2 - Ve/?/r:'r // ~?;?~=/ ,%~,.;.-r- C5>/' ~b::::J:;pS? YCZ:>/,49n.-,l/
??~I!~7:;> .;gy &;f:,/;". ~t'7/~ ~~ ~/d~)
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Permit applicant'exempt from registration with the Builder~s Board because:
Additional Project Information:
,',",'
PLANS REVIEWED BY:
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name /-L>;q~E ft ~~
Signature~~.';.,:~.
~., ~ . - r
I
date 7-/~'-9~
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