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HomeMy WebLinkAboutPermit Building 1989-5-30 fTi:~I'ECIIOII L1ill I 72.::J7';9 J ..' --~~._----: LlIY,)/ SI'RlllliflllU COIIBHIM ION APPLICATION/PERMIT --- , E!/ERr,y SOURCES: Ileat Uater lleater Owner fY\.e ~p I ,'.!dress 1f'l'J I dr.. r ,,..,.,/ , , ~"r I '''Co. s;:. I C2. lci Construction lender....) Y\f''II ~_' NIA- name ", Job Address \ D'7 \ tC9a1 De~cription ,\dtlress Ul~llirl IlAfl Primary Structural Electrical . f.l~.,.. \l'\LLl 1<<:\ I '1 _ tl ":2. -.::l ( :::l,. .::t . lIHORIIA1: .:1 ll.... 726-J7;} So. FlQ. /.iain ~Cl. ftl). Access. So, ft~, Other UCli Add f1.1 ler ~eD. -rence Demo Change/Use -Other- -- ScA\..J \ +-1 ,:q.c_ ! Q/t j i I I I I p Ranf'Jc -11 :):~1:~nfo, r~c.,R5<l -r;lc:iilv-r.~ence lIith S7 '-f']rl \ ~ \{"' \ Describe \-Jark( i.e.. Bui Id Single f\.ttached r.ara'lC\ ~_ ~.C\ (C(\~~~ \/ ~ UC"J' ': i2rl n~ I ics. no. hOne no. !lechan i Cd I CONTRAt-fuI\:l ~ I n.lme \ General ,,\"9(\ ~ ~\t::::::~ Plumbin(1 Electrical "echanica I ------ rr~~ ~< , I i -. ! I I I I I lexolresi f 1 ics. no.) (nhnnp nn PlUIIBlIlG I lJ:l1ARGI. -;;;; '-ITLI.ClIARGL. ' I I "''lL I -, I I I , I I I I I ElECTRICAl IIECIIAN I CAl i;O.1 ~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 1 I -, I I I 1..liL CHARGE J/(L_ I ,- I I each '-I I I I I I / /multlf.:lmily, conlr.l. or !nrlllslrial \ '_rn::: _IOf J ICOI~l./INO, FEEDERS I Install/alter/relocate distrib fppnpr~ I --I .-, I I I / <rr Residence of furnace/burner to Bill's sq, rT. INew circu!ts alts. or extensIons ISERVICES -, ,-- I I I I I I I I I 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 -I 'TempOrary IChan'le in rp'jldt:ni~ Construct ion existing al11ps.1 Of amps.1 I I I I 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 _-~2Cl.~__ V...l1 1Lc).UU. I ----\-.-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 ------------, ITotal (amb, rermit LOT" IlL ~L 6\,Ci'7 , .. 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 . \ /. " 1 ......l__,~. ~ . PERMIT VALIDATION c:e ' NeeD / o ~ ... Permit'Clerkc\~ - '" '" ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY: L d, . I! f Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS EVIEWED ~,~ ,",,6w'(;Q , ........, n~ If'_ \.. '\ '(=' "- " signatur~ ,~ .~ '~