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HomeMy WebLinkAboutPermit Building 1986-12-9 (2) ;~,:ff( ..~~f; ~.. Vi OX' . 1 . . lo'IS"CTIOII LIIlE CITY UF SPRWGFIELO 726-3769 . COIfBlIlATION APPLICATION/PERMIT Job Address .323 MJtj.,.) ~?#-r ' ~~;~r,y ~~f.;:<!- Legal De<criPtionl?<J~.].s'31,/'Z;:t/tCr(~t!I ",' \later Heater ~/,.,t"tir;(!. Ranqe Sf?~f;/(!,. __ Valu, of \'Iork: c9V -ff/ (( ::;-7. Ph "'11-"'7"', ...Jluihiinq Permit Info: Describe \'/ork(i-.e.. Build Single onc~,/ /1JIr.1ilv I'l.esidence Hith fl.ttached Ilaraae) 'flf>3 tZdet1if.. -,. J.,t0./5'j)/C( F fh312:r.( C'et!./Ut:?!J r1z..UNr....e.- . Owner ,J iil-1 Hr1/l1~S Sr'. Address (1/9 ?IJ 51.1/; I( xl, . ,SdU', Construcfion lender Address UI:.::dlirl II:.Al1 (name) Primary e~.t?,,-,'E ur/;..,UIIs ~;.0d{CR Of8{C<!J&-' Structural Electrical INFORIlATIO~ kl,;< 726-3753 .., SQ. Ftq. I.lain ~q. !='t!). Access. So. Ftg. Other ~lIew__Add--!.lter~eo. Fence Demo Change/Use Other -- -- ~ ~ I~ I Phone (address) flies.no.1 (exoires) (ohone no. I t//5 Tti/i171<- .o<7t)'{. ?/~lln*"",,~( !1echanical CONTRACTORS Inamel Gen~ra I P:C(6:B.,'L~ (.~.t,* ;JJ@/}iLCS Plumbina Electrical t-lechanical PLUIfBIIIG '.. 110.1 Each single fixture 1 FEF 1 t.HARr.E rm I I I=H I rHARf:p ~m Residence of furnace/burner to SQ. FT. BTlI's I FFF I rHAR(;F I I I Install/alter/relocate rl;~trih fpprlpr~ t--f- I I I I I I TOTAL CHARGES , that the Electrical work be done by an Electrical Contractor. the electrical portion of this pernit I label has been signed by an Electrical Surervisor and returned to the BUilding Division 1 ! :1 II 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 Orel]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 re~istration with the Builder's 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 employees who are in comoliance with OP.S 701.055 will be used on,,~s ~ject. 1IA1IE(please print) , bjJ.l"""~ (J. fM&jy SIr.lIATURE U A, ~!fAd.dJ;'~ / OATE~9- It, /.. FO~ OFFICE USE miL 4 Units Sq. FtfJ~ riain x Value Occy Load Sq. FtlJ. Access x Value .II~ - -? -~. ...... Occy Group Sq. Ftg. Other/,~""N/,",,":::'_... Value "".....-> .". TOTAL VALUATlDrI Relocated building (new fix. additional) l's.F. Residence (J bathl louPlex (1 bath) IAdditional bath each ~!ater service Sewer Storm Sewer I -I I I TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the Zone ~~/ Type/Canst. Bedrooms Stories~ Fire Zone Flood Plain I I I I I I I I I r I I I I r I I (add res" ) (lie,,_ no.' (pxoirpc:;1 (ohonp no , ?J,~~I' c;t 31~-fL,J{fL ~ ""'!-tOe ,~.'3(oo1 ~7 . rwP /lV'" nil >-- ELECTRICAL MECHANICAL New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt ITempOrary Construction IChange in existing rp~ i rlJ'flrp multifamily, COlTl!l. or TnrllJ~trial Appliance vent o:;poflratp Stationarv evao. cooler ~ . Vent fan wi th sinale duct Vent system apart from I heatina or A.C. I Nechanical exhaust hood and rltJrt Of amps.1 COI~'1. /1110. FEEDERS Wood stove/heater amps.l I ISSUAIIC, OF PFRllIT TOTAL CHARGES ex <:6P~"# g.::?g BUILOIrlG PERfIIT --:::?e:::? [;"0 Charges and 1 ---;l~ ,... Surcharges.::r /_ 5 '7 PLU'1BING PERMIT Charges and Surcharges Plan Ck. 65t/Bldn Plan Ck. 3D%/Bldo Fence COITlIl/ rnd \ P€'r Fpp Res Per Fee Systems Development Charoe (1. 5~1 --;?, r e>"3' Demo I Sidewal k I A/e Paving j Curb' Cut ----~-------I ELECTRICAL PERI:IT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges tft:>. d Y , ~S:07 Total Comb. rermit I TOTAL . COMBINATION APPLICATION/PERMIT (CAP) " l. Applicant to furnish A. Job Address B. . Legal Description 1. examole- Tax lot 100, Lane County Map Reference 1/ 03 43 2. exampJe- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ!or forced air oas 2. examole~ waterheater/electr;cal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. examole- if new project. check-new - if addition. check add. etc. F. ,Building permit information: '-. :'-,\ ,1. example - construct single family house with an . attached garage 2. examole - remodel existing garage into family room 3. example - 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 TEM4 AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design informatipn or job site corrections. 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. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES O. 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. Ill. 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 , r;;&~ 5;L q /'2-- (0 -g- It> I I Permit Cl erk to Permit applicant exempt from registration with the Builder's Board because: 'Additional Project Information: !, PLANS REVIEWED BY: name~.73'N~ ?~~ signature 4~ - '// ~--- , /' . .....-~"{ :~~ ~ go 1. ..~-- ". ,. \ , l I i I . I ~l l' date J2-/~"':F?~