HomeMy WebLinkAboutPermit Building 1986-12-9 (2)
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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
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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 !
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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
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(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
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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:
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PERMIT' VALIDATION
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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~ -
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