HomeMy WebLinkAboutPermit Building 1989-5-30
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COIIBHIM ION APPLICATION/PERMIT
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, E!/ERr,y SOURCES:
Ileat
Uater lleater
Owner fY\.e ~p I
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Construction lender....) Y\f''II ~_'
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Job Address \ D'7 \
tC9a1 De~cription
,\dtlress
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Primary
Structural
Electrical
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726-J7;}
So. FlQ. /.iain
~Cl. ftl). Access.
So, ft~, Other
UCli Add f1.1 ler ~eD.
-rence Demo Change/Use
-Other- --
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r~c.,R5<l -r;lc:iilv-r.~ence lIith
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Describe \-Jark( i.e.. Bui Id Single
f\.ttached r.ara'lC\ ~_
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!lechan i Cd I
CONTRAt-fuI\:l ~ I n.lme \
General ,,\"9(\ ~ ~\t::::::~
Plumbin(1
Electrical
"echanica I
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ElECTRICAl
IIECIIAN I CAl
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~IEach sin~le fixture
jRel0CdtCd building
(new fix. additional)
IS,F. P.esidence
(I bHh I
-louPlex (1 bath)
IAdditional bath
~!ater service
Sewer
Storm SCI.ter
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1..liL CHARGE J/(L_
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each '-I
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I / /multlf.:lmily, conlr.l. or
!nrlllslrial
\ '_rn::: _IOf
J ICOI~l./INO, FEEDERS
I Install/alter/relocate
distrib fppnpr~
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Residence of
furnace/burner to
Bill's
sq, rT.
INew circu!ts alts.
or extensIons
ISERVICES
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I' Apo! lance vent
sco.al"alP
I Stationary evan.
cooler
I Vent fan \~i th
sinnle duct
I Vent system apart from I
heatino or A.C.
I rlechanical exhaust
hood .'or! rlur t
I,",OOd stove/healer
I Floor furnace
and vent
I I Recessed wa 11
C;n;lrp h,.... rpr ...nri
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'TempOrary
IChan'le in
rp'jldt:ni~
Construct ion
existing
al11ps.1
Of
amps.1
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I TOTAl
ISSIJANCf Of PfmllT
CIIARGES
electrical portion of this
the Building Division
perr.li t
I TOTAl
I /lAVE CAI!UUllY [xNlItI[lJ t~le completed applic.llion for r>ermit. .Hld do her'eb.v certify that all information hereon is true
and correct, tlnd I further certifv that any clnd all Hork oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and tht:' Laws of the St.lle of Orenon pertaining to the work descrihed herein, .lnd th.lt 110 OCCt'PAIlCY h.ill be made
of any structure wit.hoLJt lhe permission of the nllildin~ Division, I further certify th.lt my refJistration with the Guilder's
Doud is in full force .lnd effect as required by OI:S 701.055, that if CXCU1l>t the basis for exemntion is noted hereon, and that
only subcontr,lctors and cr:1r>loycCSliho are in coinnliance with or~s ]()1.055 \','il1 be used on this nroject,
llAIIE(please nr;nt)LfOA 1" (1 &-b SIr.ilMlJRE (;e\~ (l
d fO~ orflCE lISE mll.Y
Zone Tyoe/Const. \Jnits S~, rtn. rlain
Fire 70ne Bedrooms Ocey load SO, Fl!:l, Access
Flood Plain Stories Occ,Y Group S~, Ftg, Other
BUIlOlIlG PERI,IIT
Char']cs an~
Surcharges
PlUllO IIIG PERMIT
C~arges and
SurCharges
,ELCCTRICf.l PERf:IT
CharQes and
Surcharges
/lECIlAN I CAl PERIl I T
Cha rges and
SurChar'Jes
ESe-r-'2...
.om oS - 3::J-R9
x
Value
Value
Value
,
,
TOTAl VAllJATIDrI
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----\-.-06---/
Plan Ck.
65!/Bldo
Plan Ck,
JOt/Bldo
Coom/lnd
Ppr FpI>
ries
Per Fer
Syster.lS Development
Cha roe (!, 5'.)
Fence
Demo
L________..::..::-' Sidewalk
r ,".1 AlC Pavin9
.1" Curb Cut
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ITotal (amb, rermit
LOT"
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6\,Ci'7
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COMBINATION APPLICATION/PERMIT (CAP)
L Applicant to furnish
.A, Job Address
B. lega 1 Descrlpt ion
1. examDle- Tax lot JOO. lane County Map Reference
1/ uj 43
2, e,ample- Lot L Block 3, 2nd Addition to
~prlngtield Estates.
C. Name. etc. of owner and construction lender
D. .' Energy Sources
1. examrl~- heat/~~~.Lceilin.9lor forced air qas
2. examole- waterhealertClectrlcal/or SOldr
L Square footage or valuation. etc. -
1. examole- ~ sq. foot house. 500 sq. foot garage
2. example- if new project, check new _ if addition,
check add. etc.
F. Building pennit information:
1. examole - construct sinyle family house with an
at lached garage
2. examole - remodel existing garage into family room
3. examule - COllvert single family residence into
restaurant (change of use)
G. Value of \'/'ork as defined in Section 3D3 {a} of the
Structural SpeCialty Code
II. DESIGN TEAr'I AND CDrITRACTORS
To avoid design or const,'uction "delays, OUilding
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Nechanical. & 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 inst.:JlJed
B. full Plumbing, t-leclld:nical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
ha ve been abbrev i a led
2. If the item{s) to be instal1ed- are not covered on
the abbreviated schedules you should consult the
full schedules
C, BUILDING DIVISION STAFF I/lll Fill OUT All FEES AllO
CIlARGES 011 TilE SC/lEUULES
O. As noted on the CAP, the label fIlUSt be delivered to the
electrical contractor for signature by his electrical
superv1sor. The general contractor is ~ authorized
to sign the electrical label.
III, Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. l-Jhere possible, Sui Iding 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 \.dll be processed until these
fees are paid. All other fees anlJ 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'Clerkc\~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS EVIEWED
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