HomeMy WebLinkAboutPermit Building 1985-1-15 (2)
Job Address/"4t" /I~R.t-"W
Leg.l Description /7-03 -:22, 0;2 3t75"'
Owner~ .UYAI Sc..Jlmlb~ '])e.v
Address!. 11. 'ED"!< < 2-4-.. 1C~"T'lIN~ CA
1l1lSPECTlON lINE
726-3769
Construction lender
Address
Ul:.::llliN TE.Ar~
Primary
Structural
Electric.l
.
.
CITY Uf SPRINGfIELD
COMBI:IATION APPlICATION/PERMIT
E!lERGY SOURCES:
Heat
Ha ter Hea ter
Ranqe
~
I~
'J
V\
INFORtlATION liNe
726-3753
Sq. Ftg, 1,1. i n;/. ~ 7&.0
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add lCA lter Pep,
-Fence Demo Change/Use
Other- -
( "'/~J
PhonE:>22_eo2IS
V.1UE of I'lork:
/0".2. ,600 core>
BuilriinQ Permit Info: Describe Work(i.e.~
Fa~ily ~esidence With Attached Garaae)
Build Single
UdJl/E-
1(Em6,."EL Gtl/<;7"'/IV6- 'RUn:,~/I//&-
Ft!7TZ J/E/v '"7')Q~PtVr~n~
( tv/A/STdQ~)
flies. no.l (exn;resl (ohane no.
lnamel
Phone
f address)
Mechanical
CONTRACTORS In.mel
Gener.l '5C/~1J <;bF.II'~E.. ~p
Plumbina
Electrical
~1echanical
NO,
I
(address) f1 ir" _ nn \ (pxoi rpc:.) ......
Iqq~ CNl/~AJCe~ . 'fEibl>,AJI'-. w,. (~1J~ 3':'~
/ / ~
(ohMP no_ )
V)r,
~ 2I-tJ/~()
PLUrlBING
ELECTRICAL
MECHANICAL
HE
CHARGF
NO-.
Residence of
tEL..cJiARG.E. NO
FFL..cJiARG.E.
furnace/burner to
BTU's
Each single fixture
l).F.
Reloc.ted building
(new fix. .ddition.l)
/1>.-
SQ, FT,
S.F. Residence
11 b.th)
Duplex (1 b.th) e.ch
Addition.l b.th
;later service
Sewer
Storm Sewer
.:b~A. ',!:
~ New circuits alts.
or extensions ~
'2.. &>12 ~fi$c:
SERVICES
,s:ec .
Floor furnace
and vent
Recessed wa 11
So~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rp) j dJIJ1C'P
multifamily, camm. or
Industrial
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hond and rlurt.
IOf
ICOMI'I.IIND, FEEDERS
I Install/alter/relocate
rli~trih_ fpprlpr~
IOf
I -e~Aft"7\&I_
I
I
amps.
Wood stove/heater
........- &..~'f:'; 'l>IJc..T5
/~-
amps.
ISSUANCE OF PFRrllT
TOTAL CHARGES 1t'/(19, /c:7. 00:> TOTAL CHARGES Is:. ~ TOTAL CHARGES M/N. It:!>, ee>
WHERE STATE L\I~ REQUIRES th.t the Electric.l work be done by .n, Electric.l Contr.ctor, the electric.l rortion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED the completed aprlication 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
of Soringfield and the laws of the State of OreC)on pertaining to the work described herein, and that UO OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 emnloyees who are in compliance with~n~O?5 wi be sed on this project.
/- :13-as- A~ vl'i! .PAle "''''''7:''''' ~
UAI'iE(ple.se print0s:l<R4 tu_JG-AJ!"E4J SIGUATURE
FOr. OhICE USE OmA
Sq. Ftg.
Sq, FtQ,
Sq. Ftg,
Zone c: Co
Fire Zone
Flood Pl.in
BUILDING PERIIIT
Charges and
Surcharges
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI:IT
Cha rges and
Surcharges
flECHANICAL PERMIT
Charges and
Surcharges
om /-/S-8>..r-
Tyoe/Const. 5'/Y
~ Units
Occy Lo.d
Occy Group
f1ain x Value
Access x Value
Otherar.K....~.t V.lue~~,-
TOTAL VALUATION
Bedrooms
Stories
I
s~:z
-">>Q" ""CO Pl.n Ck, Conmllnd
..;.__~L~~~___ 65%/Rldo Pyr F'~~
Pl.n Ck. Res
30%/Bldo Per Fee
syste,ms Development
Ch.roe (1.5%)
N./?.
188_SD
II . ~<:>
__n/~:..-::~_
.~6
____is: -
.60
Fence
Demo
Sidewalk
A/C P.vi n9
ITotal Comb. Permit
q]"38 . erO
~2'G'."S"O
_____/~:..~J Curb Cut
. '1G' I
I
I TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
1, Applicant to furnish
A, Job Address
B, Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
11 oj 43
2, exa~le- Lot I, Block 3. 2nd Addition to
. ~prln9tield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole. waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
cneck add, etc.
F. Building penJlit information:
1. examole - construct single family house with an
attached garage ,---.
2. example - remodel existing garage into family room
3. exa~le - 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, DESIGN TEAM 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.
[I, Abbreviated Plumbing, Mechan;cal, & 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 I es
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. ---
[II, 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
~ 6_(,416;2.,.,
/
'r~ J)
Jy '1
, III
...
P,mit Cl",/Li..t.;
:":'.,
Permit applicant exempt from registration with the Builder's Board because:'
'. ,Additional Project Information:
1- S~""'AAT~ ;.r:-~'0#~'''7'4S A'ed:>~/~~ ~ 5/6~
~~n ~~ h~.,'T/d'~~/ ~~ h?.r""".K"/~
, . - -- .. . ,-
~ ~~/?;,NA~ W/ C/TY ~U/~P/~ ;::::}Y/~/C-,19
PLANS REVIEWED BY:
L~PN~ ~~~Signature~~
name
I
~.
'7
. date /-2r.e-s-"