HomeMy WebLinkAboutPermit Building 1987-07-13C.
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COMBI NATI ON APPL ICATION/PERI.IIT 726-3753
Job Address
Legal Description
EIIERGY SOURCES:
Heat
l,later Heater
Ra
n
Sq. Ftg. Access._
s
N
\h
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Value of l,lork:
/A f,ae, aowner {y' F /?vs>>= :z=
Address n tln ,e., Build Single
Construction Lender
Address Phone
7
name addre s s exDl res ohone no.
Primary
Structura l
El ectri ca l
Mechanical
CONT ACTORS n ame a ddrps s lics. no.'exn i rps )nhone nn
G"n""u1 ZZtYrrlER
Pl umbllq
Electrical ? jlj EC :<-n
PLUI,IBI NG ELECTR I CAL
N0.FFF NHARGF NO FFF CHAPGF NO FFF CHARGF
Each single fixture Res idence of
sQ FT
furnace/burner to
BTLI' s
Relocated bui lding
( new fi x. addi ti ona I )
few circuits alts.
or extensQ ,ar?i ons,,D*E
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES Recessed wal I
Snace hpatpr and venf
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seoa rate
tlater service Chan
res i
ge in existing
dence
Stationar.v evap.
cool er
Sewer multifamily, corrn. or
IndustriaI Vent fan with
sinole duct
Storm Sewer 0f s.Vent systern apart from
heatino or A-C-
COI.II.I. / IND. FEEDERS l4echanical exhaust
hood and duct
I nsta I I /a I ter/ rel ocatedistrib. feeders l'lood stove/heater
0f .r'amps!a-fra*+ ?4u7P,
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES 27.5>TOTAL CHARGES ,z12ly. ./S.oo
-I.IHERE STATE L1Iishall not be vaiiC
REQUIRES that the
unti l the label has
Electrical work be done by an Electrical Contractor, the electrical portion of this permit
been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAIIINED the completed apnlication for permit, and do hereb.y certi fy that all information hereon is trueandcorrect, and I further certify that any and all work performed shall be done in acc ordance with the Ordinances of the CityofSoringfield and the Laws of the State of 0regon
the Buil
oertainin-r; to the work described herein, and that NC 0CCUPAI,ICY will be madeof any structure without the perm
Board is in full force and effect
only subcontractors and employees
ission of di ng
70t
Division. I further certify that my reqistration urith the Builder'sas required by ORS 055, that if exempt the s r exemption is noted hereon, and that
who are in comcliance with 0l?S 701.055 wilI on this nroject.
l{Al'lE (pl ease pri nt eote S IGNA t3
(
Zone____TyDel Con s t.its Sq. Fts. nain*lfzlrsz* /r*F.ius1us fac>.-Fire Zone Bedrooms Load Ftg.
Ftg.
Access x Value
Flood Plain Stories 0cc.y Group 0the Val y2 ft).aa,e
.._. J,./
TorAL vALUATlou /2.#q3.--------7--
BUILDING PERI'IIT
Charges and
Surcharges ---Qr---:-
Plan Ck. Conrn/Ind
65%/Bldo Per Fee
,1z,t7rrPt6q7450 vt7a>sYs
Cha
tems Deverqe ( 1.57
opment /sz+Plan Ck. Res
30%/Bldq Per Fee
PLUUEING PERMIT
Charges and
Su rc ha rges
Fence
Dgmo
ELECTRICAL PERTIIT
Charges and
Surcha rges
v-s8
3
Sidewal k
A/C Paving Total Comb. Permit ?7-es
I,IECHANICAL PERMIT
Charges and
Surc ha rges
Ae
5 Curb Cut
TOTAL 26279
Ftg.0ther
MECHAN I CAL
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PERMIT VALIDATION
Permi t Cl erk
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coMBrNATr0N APPLTCATToN/pERMrT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
TfT3-43
C. Name, etc. of owner and construction lenderD. Energy Sources
F. Building permit information:l. exampie - construct singie family house with an
attached garage
2. example - remodel existing garage into fami)y room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are avaiiable at the Building Divisionl. 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 should consult the
fu l I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date
Whenever possibie, the initiai application wilI be used asa worksheet only. Where possible, Building D.ivision Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed untii these
fees are paid. A'll other fees and charges are due and ,'payable when the permit is issued.
V. FOR OFFICE USE ONLY ,,
,
. exampl e-. example-
quare foota
example- 1250 sq
example- if new
EIEEk-add, etc.
aragesi
2
air gas
foot house, 500 sq. footproject, check new - if add ti on,
Lot I. Block 3, 2nd Addition toeld Estates
examp 1 e-
SEmnsfi
I
2E. S
1
2
..PNO'EC' CONDITIONS TO BE SATISFIED BEFORE OCOSPAftEII /5SC>4'Z<€ 2F T2EZMT2^:
, Kaceryea q-/ -gZ
7- lVzc> Orus.,< 4- 5P.u <7<a F4*e7 aR B-o*.-4@rR
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
s i gnaturename .da & 8-a-97
E*,aro*z xtR
8 ?o {sz
t?/1 rta,*4t<.( FY-
C&Eare he
alread
DECLARATION OF PRIVATE EASEMENT
KNOI, ALL MEN BY THESE PRESENTS, that the undersiqned, hereb.v cal'led Qrantors,
are hereby declarino that the following described nrorrertv is a Dermanent
n,on excLusive driveway easement.
Investments, otrvners of property occupied by Heritage Restaurantreby granted non-exclusive access to a certain l5'5" easementy established on west side of property described be1ow.
The easement shail be used for the purpcse of no.n.exclusive aCCeSS
dr.rteuay serving the fol lowing described property:
Beginning at the most Southerly Southeast corner of
Block 7 of Mohawk First addition, 3s platted and recorde
lat Records, running thenc
lot
at
No
,t
500
e
et
10.0
County P
ng the N
.0 feet;f Mohawk
5
page
23 of volume 15, Lane
4TrInJest I51.0 feet alo
North 29o L3t East I3O
to the lnlesterly line o
feet along said lnlester
ortherl
thence
Road;to the
on
y1
So
the
poi
ine of trMrr stree
uth 5Oo47 ' East
nce South 29o L3
nt of begginning
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in
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, t9 t 2 befora me,
St,aGl oersonal l.y
STATE OF CREGON
ss.
County of Lane
BE iT REl,lEl'tBEtiED, That on this
an
day
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of
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w'ithin instrument anC ackn:wledged to me that {i,xt(.uiea' tiie same
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the undersicined, a-Notary
ai:i:earerj Lire w'itnin r,amed
kiit'v,;ii to i'ne ;O De 1\g icjen
and voluntarili'.
TTST I!4CNY I.'I{TR[OF
e da.,i ano yrar las
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f iee l.y
have hereunto set m.y hand and aif ixed m3' li'f icial
Lruve wri tten.
Publ'i in nt.,y" e n
sea I
. ,. 7''k,
u QT reg.);r
l'ly Comrtssion expires :2 /au /di)
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