HomeMy WebLinkAboutPermit Building 1980-10-13SPECTIOII LI
6- 37 69 726-37
Job Address EIIERGY SOURCES
Hea
l.later Heater ,:i-E{ ,
e
Ftg n
Sq. Ftg. Access
Sq. Ftq. 0ther
r
ha e/Ung e 2
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r-esal Descri otionf 6 X* VO 7-r-Q
Owner
Vai ue of l.lork:t6:1P9oo
Address Phone Builq,ino Pernrit Info: Describe l.lork(Farnily Residence l,lith Attached Garaqe
I
i
.e., Build Single
<,o{to 1 W,,?, is, Y*osTi,rvr - lera"rt r o C *<rtce
co*til.tiU L.no".E/*s5r^ri* T-
Address Phone
name i
Primarv to3
Struct';ra I l(
ElectricaI I I
rleahantCal t;
n ilr..e addres s I i cs. no.exol res ohone no.
t
Cenera I I
:1, -hi^^Ir
Elecirical I
":c;:.ical
PLUiIB I iIG ILLLl i1L^L MECHAN I CAL
Ci:CHARGF Iln I rFc i cHARcF ll0 FFF CHXRCT
Each single fixture
A
Res idence of
V5.7-sq rT
furnace,/burner to
BTU' S
I Peiocated buildinq
(new fix. additiona l )
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S,F. Residence
( l bath)-if,a:SERV I CE S
Recessed wa l I
Soace heatpr and vent
Duplex (l bath) each
Additional bath i*{)-l ,3aas Temporary Constructi on ,4./.:;{->:
Apol iance vent
s eDa ra te
l,la te r se rv i ce C han
res i
ge in existing
dence
Stationary evap
cool er
Sewer multifamily, comm or
Tndrrstrial l,Vent f an w'i th
sinole duct !-cd
Storm Seler 0f amps.Vent system apart from
heatino or A-C.
COI4I'1./IND. FEEDERS /itlechanical exhaust
hood and duct
Instal I /al ter/rel ocate
dictrih- fepders llood stove/heater ,1aa
0f amps./ft€*r i?ovt o.&,cA
I
ISSUANCF 0F PFRIIIT /AgC
TOTAL CHARGES {f,e1 TOTAL CHARGES 4{,.i:Jr Y TOTAL CHARGES 4q^9;
L'HER
shal I no
E STATE LltJ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrica) portion of this pemit
t be valil until the label has been signed by an Electrical Supervisor and returned to the Bu'ilding Division
I HAVE CAREFULLY EXAI1INED the completed apniic,rtion for nerrnit, and do hereb,y certify that all information hereon is true
and correct, and I further certify that any and all rvork oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of 0regon Dertaining to the work described herein, and that NC 0CCUPAI,ICY will be made
of any structure without the perm.ission of the Building Division. 1 further certify that rny re-oistration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon, and that
onl-v subcontractors and ernnloyees who are in comcliance with 0l?S 701.055 vrill be used on this oroject.
Nl,lAtlE(please print)I Gi{ATURE DATE
FOi? OFFiCI I]SE OIJL
Zone T.yp e/Const. E*f Units /Ftg
Ftg
Ftg
iratn /7t'{ x
Acces s
,.ji*Ira vurr"
, f,.5, vutr"
t,i3 7c. Lifr
4 -i4'{.ca-KTif a,,)
-
4Q 7.** /-nlL , y' i/ a. u t i
Fire ZoneAedrocms Load
Fl ood Pl ai n .Vf; Stori es
,-}
lX 0c c.y Group &-?-sq o the r /.flsy!$fu i -1< -fi lft--u a 1 u e
TOTAL VALUATION
BUILDING PERI|IIT
Charges anC
Surcharges
Plan Ck. Cornm/Ind
65%/Bldo Per Fee C.4- 9A, t n Svstems Deve
Charqe (1.5t opment ti?s, #
Plan Ck. Res
30%/Bldq Per Fee
n?3,s a-
PLUI4BING PERMIT
Charges and
Su rc ha rges
{J-( a\A
rJ<',i**
Fence f 4*o
Dgmo 0,*.e,x g\tia - /,1. bC
ELECTRICP.L PERI.:IT
Charges and
Surcha rges
{,&ee-Sidewalk
Total Comb. Permit
Curb Cut
TOTAL
33F, A.y
I,IECHANICAL PERMIT
Charges and
Surc harges ^1*'s-P-/,3 {
ohone no -
Af ;ii!-lS
A/C -Pavi ng
(P{7'52':,
&rilk
COMBINATION APPLICATION/PERI,IIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map ReferenI7t:--Ts2. qxqrnple- Lot l. Block 3, 2nd Addition toSpr-in!-iield EstatesC. Name, etc. of owner and construction lender0. Energy Sources
ctry oF s.pRi['drtErD
Ciry Holl
o", "ti;::lierd'-
o res on
oFFf c;fi.f ::T;,y;.u,
eiectricai c iti
hea ter ec Ld
or forced ar soTfF-
frfo. B 54887]' examoIe- heat/2. EianrilE water
SquaiET6otage or
e I9
E valuation, etc d
l. examole- 1250 sq. foot house, 500 sq. foot gZ. exampie- jf new project, check-n-ew - if addiEIEEk'-aod, etc.F. tsuilciing per:it inforr,:ation:1. exangle - construct single family house rvitattacnec oarege2. exancle - remodei ex.isting garage into fami3. examrfE - convert single iaiily-resiaence i r
^ restaurant {chan-oe of-use)G. Value of work as defined in Section 303 (a) of
._ Structural Speciaity CodeH. DESIGii TEAI,I AND COI{TRACTORS i
To avoid design or construction dela_vs, BuildiDivision Staff must be able to contatt approprpersons regarciing design informat.ion or job sicorrections. etc. l
Abbreviareo Plumbing, ilechanicai, & Eiectrical SclA. Except r,rhere blank spaces occur in the ciescriDortion of rhe i4echanicai and Electrical Schethe applicant need fill-in oniy the No. Boxes Ua,_ to rhe approoriate item(s) to be instailedB. Full PIurbing, i'techanjcal, and Electrica.l Sciare avaiiable at the Building Divisjon1. To ccnserve sDace on the permit form the herhave been abbre,r'iated2. If the item(s) r-o be installed are not cthe abbreviaced schedules you should conful I scnedules aC. BUILDIiiG DiVISION STAFF t^lILL FILL OUT ALL FI
CHARGES Oi{ THE SCHIDULESD. As noted on the CAp, the label must be de.l i,electricai contractor for signature by his {cttsupervisor. The general coniractorr ii notto sign the eiectrical labelApplicant to sign and date
ved For
Permit Clerk
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BY
Whenever possible, the initial applicat.ion wil: e ua.worksheet oniy. i.there possibje, Building Di, {.-wili.preoare a type v,ritten copy and returi it+_-.appiicant at the time the actuai permit is issueci for his
s i gna tu re.
Fees and Charges
P'lan check fees are due and payable at the time of theapplication, and no plans wiil-be processed unti.l theielees are paio. All other fees and charges are due andpayab'ie vihen the permi t is issued.
FoR oFFI CE USE oillY
€u€EnE oi graot ta![.s
V
P ROJ IE T ONC I IT N0 S TO E TJlA SI IF DE En
D 0F RE 0 PCCU AN Y
rmit applicant exempt from registration with the Builder,s Board because:Pe
Add i ti ona I r -P ro e tC ni fj o orm t on
PLANS REVIEWED BY
name da teSigna tu re )
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