HomeMy WebLinkAboutPermit Building 1989-5-30
liISI'ECf IOU L1il( . LIlY UF SI'RItIGf IElU tHOR/1AT: .:1 LI..:,
726-)109 _ COIIBI1IM~P~ATION/PERMIT 726-J753
Job Mdress lOt)~ \\'\C\U\ \.rx\~ Q r, ' ~~~~r,Y SOURCES: ;~: ~~~: ~~~~ss.
I.e~al Oe<<rlpt Ion V \ ()~ ~c::::: ~ \ Q'f!:/iu) lIater lIeater So. Ftq. Other
lIel., . Add f1.1 ter ~eo.
--rente Oemo Change/Use
owne:V~~' ~\( v~. WI -\')-:Y)' \ .!1 0 . . . DIm cO-Other- -
,\ddrCSS'~, . C::., -~f"\, - "(\1'1 , Phone Uui It, no Permi l Info+-, Uescnhe I-lorkl i.e.. Bui Id Single
<).... \. l \ , \\}.).. ~ Jr r.lr.\i v nesidcnce Ui th Jlttached r.arane)
con~r~~~ t_~\Q~ ~ry\( \Ii
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,\JJress
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nallle
Primary
Structural
Electrical
Ranrte
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OJ'
6
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Phone
address
nO.J_l
cxnlres
!1echanical
::::::~T~\rlc;~n~_m (\C). d)lr~re~~[)f{JM VVi~'qni\~\~'nlrp<l
Plumblno ~ ~ \ .
Electrical
n~Ch~niCrll
PlUIIBlllG
j;O.
-ITL CIIARGE
Each single fixture
I ReloccHed bui Iding
(new fix. additional)
IS.F. P.esidence
r I hdth I
-----Iouple' (1 bath) each
jAdditional bath
I ~!ater service
I Sewer
_____IStorm Sewer
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ELECTRICAL I
1_
--EEL .ClIAl!!.( .JIlL...
I..llLI.ClIARliL'
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1-'
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MCCl/ANICAl
JIlL!
!ReSidence of
furnace/burner to
! Dill',
SQ. FT.
New circuits aIls.
or extensions
I Floor furnace
and vent
I I Recessed wa 11
,_ l\nu'p llitpr ~nri
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vpnt
/SERVICES
-----I
I Temporary Construct ion
IChanrye in existing
rp<;;dpn('p
ImultifamilY, conF.l. or
1 nrlllc;,tri.lI
I Apol iance .vent
".f"O.31",HP
I Stationary cvap.
cooler
I Vent fan ,.,i th
sinole duct
I Vent system apart from I
heatin~ or A.C.
I Ncchanical exhaust
hood ."Ind due r
jlJOOd stove/heater
'Of
ICor~I.IINO. FCEDERS
II ns ta II /a I tel"!re lacHe
n;c;,trih fppdprc;,
IOf amp~1
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amps.1
I SSIIANCf OF PFmll T
TOTAL CHARGfS TOTAL CIIARGES
HIIEP.E STATE l,ill REQUIIIES that the Electrical "ark be done by an
shall not be vali'J until the label has been si!Jned by an Electr.ic.l1
TOTAL CIIARGES
Electricill Con-tractor. the electrical nartion of this pemit
Surerv1sor and returned to the Building Division
I HAVE CAflUULLY EXNlltl(1) l~le completed apnlication for r)crmlt, MHI do her"clov certify that all information hereon is true
and correct. and I further certify that any and all ,...ork nerfonned shall be done' in accordance with the Ordinances of the Cfty
of Soringfield and the laws of the State of Oreoon nert.linin9 to the work described her"ein, and th<1t IlC OCCl!rAIlCY \...i II be made
of any structun~ without the nermission of lh~ lI11ilclin~ Division. f further certify that fl'I,Y rp.!]istration \-sith the Builder's
Ooud is in full force and cffect as required by or:s 701.055, that if exelll()t the h.1Sis for exemntion is noted hereon. and that
only subcontractors and er:lpfoyees .\...ho are in comnliance with Or.S 701.055 ,',.ill be used on this nroject.
IIA:1E(please print)
i.AI / /;,. r.-' /J/I P..rt-r.'j/
OATE .5 -;? Il - It
SIr.rIATI!RF. W~~ 1Jl-!1J~-
FO~ OrFIC[ USF. OIILY ,
Zone
Fire 70ne
Flood Plain
Tyoe/Cons t.
Bedrooms
Stories
DUllOIrIG PER/lIT
Char']es an~
Surcharges
\ ^ I
--\J3'~-
Units
Occy load
Occy Group
s~" H~. Ita in
SQ. Ftg. Access
SQ. rtg. Other
x V.llue
x Value
x Value
TOTAL VALUATIOII
Plan Ck.
65!/Gldo
Plan Ck.
JOX/Bldn
.. I Fence
------------, Dr.mo
--------___J Sidewalk
I Ale Pavinq
I Curb Cut
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PlU'iDIIIG PERMIT
C~arges and
Surchar'ges
. ClECTRIC/;l PERI~IT
CharQes and
Sut'charl)es
I1ECllAlIlCAl PERlllT
Charges and
SurcharlJes
COlllTl/lnd
Per f:"pl'>
fles
P€'r Fep
Systcr.Js Development
Char'Qe (1.5".)
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ITotal (amb. rermit
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
.A. Job Address
B. Legal Description
1. e~mple~ Td~l 100, lane County Map Reference
----U uj 4J ~
2. ..amnle- Lnt 1. Block 3. 2nd Additinn to
~pnllgfield (slales
.C. Name. etc. of owner and construction lender
D. Energy Sources
1. examr]le- heat/electrical ccilin~/or forced air qas
2. examole- waterheater/electrical/or solar
L Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. exampJe- if new project, checknew _ if addition,
check add. etc.
F. Building permit information:
1. example - construct sin!Jle family house with an
a ttachcd gilrage
2. examoJe - r~nodel existing garage into family room
J. examole - convert single family residence into
restaurant (change of use)
G. Value of \'Iark as dcfincIJ in Section 303 (a) of the
Structura f Spec iil lty Code J , I
II. DESIGN TEN I AND COrlTRACTOrlS
To avoid design or const"uclion .delays, Buildiflg
~ivision Staff must be able to contact ilppropriute
persons regarding cJesign infonnation or job site
corrections, etc.
II. Abbreviated Plumbing, ~lechanlcal. & Electrical Schedules
A~ Except "/here blank spaces Occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fiJl-in only the No. Boxes adjacent
to the appropriate itern(s} to be installed
B. Full Plumbing, ~lechanical, 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES 011 TIlE SCHEDULES
D. As noted on the CAP, the label must be deliverelJ to the
electrical contractor' for signature by Ids 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. ~here 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 \",ill be prOCeSSed until these
fees are paid. All other fees anLl charges are due and
payable when the permit is issued.
V. FOR OFFICE USE OrlLY
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PERMIT VALIDATION
/3CjQ-:s
!~ 30) \~~
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Permi t
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PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
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Permit applicant exempt from registration with the Builder's Iloard because:
Additional Project Infonnation:
PLANS REVIEWED IlY:
name
signature
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da te