HomeMy WebLinkAboutPermit Building 1987-08-13-
^{;lnj-t- 1l?l l(1
INlt m
COI1BI IIATI ON APPL I CATI ON/ PERMTT
Job Address /33O F/alur^t L 6lucl.
l-egal Description -o3 .liater Heater
Ranqe
EIIERGY SOURCES:
Hea t
Owner 8..r. n Bros Ef,'
Val ue of l,lorksR-55o-oP
Sq. Ftg. Access._
Sq. Fto. Other_
_f'lew_AddJtteffeo. -
_Fence_Demo Change/Use
-other-
. Ftq . l.1ain
vnone"/fi11,431Address / 3JO Flo ha,sL 13lr,/.nq Pernlit Info: Descr'
Residence l'li th Attachr
Bui Icii
Fami l y
l^lo rk
Ga ra
.e., Bui1d Single
filorl;f, (*r*,,),i^l {lo,'a 1,
Construction Lender /tjo ,. a {^. i *l+. t Lt^r {il* Proccsr r'r,rc,
Addre s s Phone
k
-f,Ot^s
\
DES I GN TEAI{name address tcs. no.exoi res nen
Primary Or t) c4ev'
St ructura l
El ectri cal
Mechanical
C name address I CS. nO.exol res ohonp no, )
General Er tfil i. €-rL"r'{o,n /doo N ,4,wn s-rc(of,w izoz z-5'r) 772szL>
Pl umbi nq
I'lec ha n i
PLUHB I NG ELE CTR I CAL |'4ECHAN I CAL
FFF CHARGF NN FFF CHARGF NO FFF l^HAPG F
(Each si ng l e fixture 7p ?.+Res idence of
SQ. FT
furnace/burner to
BTU, s
Relocated buildinq
(new fix. additional )
New circuits alts
or extensions2afr,&aBa a.Sz
Floor furnace
and vent
S . F. Fles i dence(l bath)SERV I CES Recessed wal I
Soacp heatcr and vpnt
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
qFDa ra tp
[,]ater servi ce Change i n exi sti n,q
res i dence
Stati onar.v evap
cool er
Sewer mul ti f ami'ly, comm. or
IndustriaI
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
COI.IN./IND. FEEDERS Mechanicai exhaust
hood and duct
Instal l,/al ter/rel ocate
d'i strib. feeders l'lood stove/heater
amp s.0f
ISSUANCF OF PFRIlIT
TOTAL CHARGES 7e*TOTAL CHARGES 22.*TOTAL CHARGES
I^JHERE STATE LAN REQUIRES that the Electrical work beshall not be vali.l until the label has been signed by an
done by an Electrical Contractor, the electrical portion of this permit
Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for permit, and docorrect, and I further certif-v that any and all work performed shall beSoringfield and the Laws of the State of 0reoon oertaining to the work described herein, and that NC OCCUPANCY will be
ssion of the Building Division. I further certify that m.y registration ylith the Builder's
I.rAr.1E(prease print) €14 lu P, 6 e,r7Jo u'r S I GIIATURE
Ci ty
made
true
of
of
Boa
6-
hereb.y certify that ali information hereon is
and done in accordance with the Ordinances of the
any structure without the permi
rd is in full force and effect as required by ORS 701.055, that if e the basis for exemption i no..d f;iE') and thatonly subcontractors and employees who are in comcliance with 0l?S 701.05
xempt
5 vrilI be used on this 772326,
747 or-s1
Fire Zone Bedrooms 0ccy Load Sq. Ftg. Access
Bto r.-?ss
x
s cr. Ftg. l,la inT'yoelConst.ts al
Group Sq. Ftg. 0ther__________x Val
Zone
TOTAL VALUATION
Flood Plain Stories
Val ue
Plan Ck. Comm/Ind
65%/B1dq Per Fee 95, c3 tr lo-87 Systems Deve
Charqe (1.52 o pmen t ,ry.4BUILDING PERI'1IT
Charges and
Surcha rges
___?_8-2?__
7 Plan Ck. Res
30%/81dq Per Fee
FencePLUI'4BING PERMIT
Charges and
Surc ha rges .So
ae
Dgmo
SidewalkELECTRICP.L PERIlIT
Charges and
Surcha rges
?<1t?_
A/C Paving Total Comb. Permit
Curb Cut14ECHANICAL PERMIT
Charges and
Surc harges ?5.s6TOTAL
I
:IORS
Etectricar .!1".p1e S,n t'/urlrti^ I
COMBINATION APPLI CATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
SEilnlTieta EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. exampl e- he2. ExamETe- waE. Square footage
atlel 'I ceili or forced aiLgas
or solar
or vaiuat on, etc.1. example- 1250 sq. foot house, 500 sq. foot garage
2. exampie- if new project, check new - if addition,
EIecR add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specia.lty CodeH. DESIGN TEAI{ AND CONTRACTORS
To avoid design or construction deiays, Bui)ding
Division Staff must be able to contact appropriate
persons regarding design information or job site
II corrections, etc.
Abbreviated Plumbing, Mechanica l ,A. Except where blank spaces occuportion of the I'lechanical and
the applicant need fill-into the appropriate item(s)Full Plumbing, Mechanical,
onl
& Electrical Schedules
rr in the description
El ectricai Schedul es,y the No. Boxes adjacent
B
to be installed
and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you shou'ld consult the
ful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricalsupervisor. The generai contractolis.not authorizedto sign the electrical label.III. Applicant to sign and date
Whenever possibie, the initial application will be used as
a worksheet onjy. Where possible, Building Division Staffwill prepare a type wnitten copy and return it to theapplicant at the time the actual permit is issued for h.is
si gnature.
IV. Fees and Charges
PIan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
ut t lo
(q
g,t1
-
Permit Clerk C!,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name a si g nature date E:782