HomeMy WebLinkAboutPermit Building 1987-6-2
..lU1SPECTIOII L1IIE \ . ^ CITY UF SPRlIlGFIELD ..
r ':fF6;.'>769 IC40 Hen- & .~. COllBlilATlON APPLICATION/PERMIT .,_
i " , ErIERGY SOURCES:
., Job Address C4 4.1 K....'..] "Pl-~,-"" - t>>/)nl.l9W Heat ~~ _
I.egal De<criptlon 5:.~\i\J(, l" 1'I'i.~ Ilater Heater ~~f
\1-03 -fJ~-6b - 'tt21-Jrh, ~ .(R:~:: of Hork: ..
OwnerU.Ul!)l..''''~ ':. c.I4U.".~f(n.<, "T12.\:'l~( ~) 2'2. €>~C>o
I !3uil<;ina P~nllit Info: Describe I-Iork{i-.e.,
Address pro e,&bi V 41) Phone Famil V Res idence Hith fo.ttached f1araae)
Pt.:l'I.co. SAM I bllL_Lo bc2~
Construction lender
Address
Ut~l{jfl ff.JIf-1
C?I 7 4- 5" IS'
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IT/\ Q[t.g:..ICI1
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lnameJ
Phone
(address)
(I ics. no. I
Primary
lZe::. ~ It. ~ T So 1...\ / ::'!-llt(2.WOG 0
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General 12.. c.I4AJ....... (!'1\~1.. Poe.OIl'. !>Sc>St 1iu,,~j.t,~ '?Jl4.AI...- \ 030 ~h.,/A"1
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Plumbino Vc<-::, PLV,"",elN(, ~n~ -:2.\e.~ !r.l.ldttiMK ~74El-z. 'ZO-113t>B 4/~o/~"
Electrical 5\,)\ LOt1n.... 'lrLtti, '7' '7, ~~ 1- II Z.t.-I-z.'- 10 I
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'Iechanical IJ4\Z\Jf(\1 ~ Rz..\(..(Y lb~~1t l ~\ 0 1E.~~",,(I!. ~ 7i4D, 17 I 01 ~ I ) ~ 1
PLUlIIl!ll~ ELECTRICAL I ME~HANICAL
Each single fixture ~$O 1tltJ.-
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I !sERVICES
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+1-+
I I COHl-I.IIND. FEEDERS
Structura 1
Electrical
!1echan; ca 1
CONTRAqQR0
rJO.
2.'(
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<:'4"'" ",.
(name)
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-z ~~ ,(.ftll ~ Q.Q. ~ -.s \ 7C. uea {l(lo.Jfl
(address)
(l ir:~_ no.'
I FFF [HAR(;J:" ~Jn I
I ~rr 'rL..lAQr.r fJ()
Residence of
SQ. FT.
-----'Relocated building
(new fix. additional)
IS. F. Res i dence
_____ (1 bathl
,- I Floor furnace" I
~~~ and vent
~ -h-' I Recessed wall I
SO_rl'!, hpilt.rr ,rlnI' Y.en..L_
I 3 ,,-~r4A "')'I ~K)"I!i'dA;, /&-0
VtrC:71,.,bK".:r II:> roo
I I Apol iance vent I
seOi'lratp
I Stationary evap. I
cooler
1/ I Vent fan with 1"'<'
~ slnole dlJct d
I Vent syster:1 apart from I
heatino or A.C.
.1 Mechanical exhaust
hood and du; t
I
7).4>f
I
I
I
--1"NeW ci rcu~ ts a lts.
or extenSlons
"2.-~.l.),~&
Additional bath
Duplex (1 bath) each
~!ater service
I Sewer
Storm Sewer
I
-----I
Temporary Construction
Change in existing
rp<:,idpl1rp
Imu"1t{familY. corm. or
TnrllJ<:triill
Of
amps.
J NFORllM r: }:l L;,,~
726-3753
Sq. F tq. '.ia i,..
~q. ~tg. Access.
So. Ftq. Other
Ue\~ . Add .0.1 ter ~eo.
--Fence Demo Change/Use
Other - -
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::::>
.,~
l~
I
~'* Install/alter/relocate k
I .fu.t.ri h fppdpr<;.
E:: I I !-Z... Of _if Ot:) amps. 7.Sc
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Bui Id Single
121t. 1 A. L\..
c,P,e.~
0;;. P'A c..u:
I,
{exoiresl
{~i1one 1'10. I
I
341,"Z. e.017
t=.\JC.(':~\'\.
4:11 rO 'O'Z.. ,
(PXI11rp<;.1
!
(l1hMP nn~ ~ i
~e,7 94-
--. ~rrVGJD
z
74-""llt~
I
t:'t:'t:' rUAQr.r
furnace/burner 'to
BTU's
I
V8-J
1 I
I I
Hood stove/heater
<2'\4 ,Cil/()t)
I HAVE CAREFUllY EXN1INED the completed aprlication for ,ermit, 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 Soringfield and th~ laws of the State of Ore9on pertaining to the work described herein, and that flD OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard is in full force and effect as required by Or-S 701.055, that if exemot the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 701.055 will b sed o~his rroject.
~
IIAl-IE(please print) ~JfC.l't
P Z I//f rz. ~ 7.,
Zone r.:. /'..
Fire Zone
Flood Plain
BUILDIIIG PERI-IIT
Charges an~ '""\
SurCharges c^
PLUI1BIIIG PERMIT
Charges and
Surcha rges
. ELECTRIC~.L PERI:IT
Cha roes and \J
Surcharges l
11ECHAN I CAL PEP.l1IT
Charges and. I.
Surcharges'" ~\IJ
Dm~/"C-) 8:(
/ I.
,
Tyoe/Const.~./\I .<))'>~n;ts
Bedrooms Occy Load -:2/?
Stories J Occ.Y Group Jf. Z
S Ir.!IATURE
FO~ OfFICE U DillY...
'Sq. Ftg. flain x Value
SQ. Ft!J. Access x Value
Sq. Ftg. Other n;CM'&>l>EC.. x Value~.
. - ;
TOT^L V^LUATIDII
Systems Development
Cha rqe (1. 5'"
J/4
<;
Plan Ck. Comm/lnd
65t/Bldo ~pr Fpe
Plan Ck. Res
30%/Bldq Per Fee
I Fence
I Demo
I
I
I
I
I
I
I
__2~~:.:?$:.__
'<8.93
___!80.-=',
720
n__'tZ~~__
3.~~
~--:"~~":~-I
{.f,!
Sidewalk
A/C Pavi ng
.-.~'--'
Total Comb. rp.rmit
Curb Cut
I TOTAL
1~78. 2<
.
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COMBINATION APPLICATION/PERMIT (CAP)
'.'
I. Applicant to furnish .'
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
17 OJ 4J ,
t. examole- Lot 1. Block J, 2nd Addition to
~prlngtield Estate~
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole4 heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or .valuation. etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check new - if addition,
check add, etc.
F. Building pennit information.: ' I
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single family residence into
restaur,ant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code . . .'
H. OESIGN TEM1 A~O CO~TRACTORS
To avoid design or construction delays. Building
'Division Staff must be a6le to contact appropriate
persons, regarding design information or job site
correc t ions, '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: BUILDI~G OIVISIONSTAFF WILL FILL OUT ALL FEES ANO
CHARGES 0;1 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 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 cneck 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 O~LY
1
.,
, PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
...
.
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" "
, , .PERMIT VALIDATION
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~~[;~~543
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Permit Clerk
f1C
Permit applicant exempt from registration with the Builder's B~ard because:
.
Additional Project Information:;(b7',-"" .' ;V"", nR~/r /<;~UA'x:.- C~ Qh' 7/L
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~h~~D (J"r::v;=c ,",P/A'~H"'- ~ 7j>r<=c~h7'=-?7;r- Xr=CF/VEZ>.
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PLANS REVIEWED BY:
.
name L t?g#~ ;:z=c.ez;;.~
signature 4,?-j~'';';. date C-/:l?-g-:;>
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