HomeMy WebLinkAboutPermit Building 1990-03-14L H
CCI1 B I RMITLICAT
Job Address EIIERGY SOURCES:
Hea t
Ftg
Ftg
Ftg
n
Sq . Access._
. 0ther
Add Al ter-Tep. -l-egal Descri ption l.iater Heater Sq
Ran l,leur
Value of l,lork
;ence_oerno Change/Use
0ther
Owner 6a
Add Phone Builiinq Permit Info: Describe tlork('
Fannily Residence t,lith Attached Garaod
.e., Bui1d Single
Szaryzs {aq> h>..2-a-
Constructi on Le h VP=r<; ds_?-Ze> > =-
Addre s s Phone -,/f'22DE5 I iN TEAI4 name address lics. no.exoi res phone no.
Primary
Structura l
E I ectri ca I
HechanicaI
CONTRACTORS name addres s (Iicq no exot res )(ohonc no-
Genera I
umbi n
I'techanical
PLUIlB I NG ELECTR I CAL MECHAN I CAL
FFF CHARGE NO EFF CHARGF NO FFF NHARGF
Each singie fixture Residence of
SQ. FT
furnace/burner to
BTLI' S
Rel ocated bui I dino
(new fix. additioial)New circuits alts
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES Recessed wal I
Soace heater and vpnt
Duplex (1 bath) each
Additional bath Temporary Construction Apol iance vent
seoa rate
[,later servi ce Change in existing
res i dence
Stationary evap
cool er
Sewer multifamily,comm. or
I ndustri a l Vent fan with
sinqle duct
Storm Sewer 0f c Vent systern apart from
heatino or A.C.
coMr'r./IND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al ter/rel ocatedistrib. feeders lJood stove/heater
0f ampr
ISSUANCE OF PFRI,IIT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LIt,l REQUIRES that the E'lectrical work be done by an Elecsha'lI not be vali'l untiI the label has been signed by an Electr"icil supe
trical Contractor, the electrical portion of this permitrvisor and returned to the Building Division
and
I HAVE CAREFULLY EXAHINED the compl app cat on for oermit, and do certi fy ta n omati on hereon s truecorrect, and I further certi fy that any and al I work pe
State of Oreoon oertaini
rformed shall be done i n accordance with the Ordinances of the Ci ty
made
of Soringfield and the Laws of the ng to the work descri bed herein, and that NC 0CCUPANCY will beofany structure without the permission of the Building Dfect as required by ORS 70I.
ivi sion. I further cer ti fy that my registration vrith the Builder'sBoard is in full force and ef 055, that if ex the basi s for exemption is noted hereon, and thatonly subcontractors and empl oyees who are in comcliance with 0l?S 701.055 used on this nroject
l,lAl.lE(please print ).t-L SI TE J -/*?c>
Zone_Tyge/Cons t Uni ts So. Ftg. t,tain xrVa lueFire Zone Bedrooms 0ccy Load Sq. Ft!Access
0the r
Value
Flood Plain Stori es 0c c.y Group Sq. Ftg x Value
TOTAL VALUATION-
BUILDING PERI'IIT
Charges and
Su rc ha rges
L//- tia
---?-?------
-=
Plan Ck. Conrn,/Ind
65%/81dq Per Fee 28.9=Systenrs Deve
Charqe (1.5%
opment g-4
Plan Ck. Res
30%/81dq Per Fee
PLUt4BING PERMIT
Charges and
Surcha rges
Fence
D6no
ELECTRICAL PERIIIT
Charges and
Surcha rges
Sidewalk
A/C Pavi ng Total Comb. I.ermi t
14ECHANICAL PERMIT
Charges and
Surc ha rqe s
Curb Cut
TOTAL 7s-66
TOTAL CHARGES
COMBINATION APPLICAT]ON/PERMIT (CAP)
L Applicant to furnish i .
A. Job Addr"essB. Legal Description
1. gIgIB]g- Tax Lot 100, Lane County Map ReferenceT7-If-€2. example- Lot l. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. exampl e-2. examFfe-E. Square footag
ir gas
1. exampie- 1250 sq. foot house, 500 sq. foot garageZ. example- if new project, check new - if addition,
chec-[-add, etc.F. Bu'ilding permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. exq1p|e - convert single family residence intorElTilFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specia Ity CodeH. DESiGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need filI-in only the No. Boxes adjacentto the appropriate item(s) to be instal'ledB. Full Plumbing, Mechanical, and Eiectrical Schedules
are available at the Building Division1, To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult theful l schedulesC. EUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his e'lectricalsupervisor. The general contractor is not authorizedto sign the electrical jabel
Applicant to sign and date
lJhenever possible, the initial application wilI be used as
a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of the
appl ication, 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.
II.
III.
IV.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
ffc?r
/bzea
Permi t Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Proiect Information :
PLANS RE VIEWED BY: _c-eq*a 1-f.qs7
n /t*7-6
S1 gnat date