HomeMy WebLinkAboutPermit Building 1980-12-01NL NE m
COI{BI NATION APPL ICAT ION/PERI,IIT
Job Address, /4 ?.O N. 31U _Sf Llt
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Legal Description
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Addriss / lzD /\/. 347!'-sr.Phone
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tiinq Pernrit Info: Descri be l.lork('1y Residence l,lith Attached Garaqd
Singlee
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Construction Lender
Addres s Phone
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DES I GN TEAIJ name address no exD r res ohone no.
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PLUIIBI NG ELECTR I CAL I4ECHAN ICAL
FEE CHAR6E NN F-F F .HARGF il0 FFF CHARGF
Each si ng'le fi xture furnace/burner to
BTLI' S
Relocated building
(new fix. additionaI )
New circuits alts.
or extensions
Fl oor furnace
and vent
S . F. Res i dence
( l bath)S ERV I CES Recessed wal'l
Soace heater and vpnt
Duplex (l bath) each I H,t/,Conn*hon tb.09 (ae
Additional bath Temporary Constructi on Apol iance vent
sepa rate
[,later servi ce ge in existing
dencp
C han
res i
Stationary evap.
cool er
Sewer Tndrr<tria l
multifam'i 1y, conrn. or Vent fan with
sinnle duct
Storm Sewer 0f apart from
,. c.
Vent systern
heatinq or A
H.H,Connazhi:n /59 /5.60I COMI.I./IND. FEEDERS Mechan ica l exhaust
hood and duct
Instal I /al ter/re l ocate
distrih. fppdprs I'lood stove/heater
0f
ISSUANCE OF PFRI1IT _ O .
TOTAL CHARGES /5.q TOTAL CHARGES lo,q -o-TOTAL CHARGES
WHERE STATE Llll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be vali'l unti'l the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb,y certify that all information hereon is trueand correct, and I further certify that any and all work performed shall be done-in accoidance with the 0rdinances of the C'ityof Soringfield and the Laws of the State of oreoon oertaining to the work described herein, and that NC oCCUPANCY will be madlof any structure without the permission of the Building Diviiion. I further certify that my reqistration vrith the Builder,sBoard is in full force and effect as required by ORS 701.055, that if exempt the baiis for Lxemption .is noted hereon, and thatonly subcontractors and ernployees who are in comoliance with oPS 701.055 vrill be used on this nroject.
l,lAl.lE ( pl ease pri nt)S IGiIATURE DA.\E /2-/'60
Ftg
Ftg
Ftg
Value
Occy Load
!q Val ue
TOTAL VALUATI off|bs6Ps
o X3x
x
ValSq
l"t t-\ unit
Group
l'la i n
Access
0ther
7o n e 1P[1ft11$_J tp e / co n s t
Fire Zone Bedrooms
Flood Plain Stories
Plan Ck. Comm/Ind
65%/81dq Per Fee
Svs
Cha
tems Deve'
rqe (1.5%
o pmen tBUILDING PERI,lIT
Charges anC
Su rcharges PIan Ck. Res
30%/B1dq Per Fee
FencePLUMBING PERMIT
Charges and
Surcha rges
,<oo
.(.,O Dgmo
Sidewal kELECTRICP.L PERI|IT
Charges and
Surchb rges
oo
49 A/C Paving Total Comb. Permit oo(o1^
Curb Cut14ECHANICAL PERMIT
Charges and
Surc ha rges Sat-ueAo.'*la- wt rlt 4o,q TOTAL # G6,o9
*.n I I )a'" /^o' l'rr<aA\-J3_v
c0lll lACTORS address 'I irc nn pYnt rpq
Residence of
sQ. FT.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptjon
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. exampie- Lot 1. Block 3, Znd Addition to
SprTn$field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
i. exampl e- heat,/e cal i i or forced air gas2. EIamiT-e- waE. Square footage
ea e ec sol ai
or valuation, el. example-_ 1250 sq. foot house, 500 sq. foot garage
2. Exaffile- JT-i-ew project, check-i-ew - if additio;,
check add, etc.F. Building permit information:. 1. g1empl_q - construct single fanrily house with an
attached garage
?. exalnple - rernodel existing garage into family room3. examole - convert singie family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAI,I AI{D CONTRACTORS
To avoid des.ign or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
correcti ons , etc.II. Abbreviateo Plumbing, l',lechanical, & Electrical SchedulesA. Except r^rhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacentto the aopropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electnical Schedules
are avaiiable at the Building Division1. To conserve space on the permit form the scheciules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful I schedulesC. BUILDING 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 h.is electrical
supervisor. The general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staifwiil prepare a type written copy and return it to the
dpplicant at the time the actual permit is issued for his
s i gna tu re.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, 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
PERMIT VALIDATION'Ud 552ct3
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Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from negistration w'ith the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name Si gnature date
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AL'|ERAT|0I{S lNDiCAit0 ; ',lf ,rrED PENCIL By Ttf, SEITR L Cil tr
PARTMEI{TS AS IhiTirli i I
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NRE DEM. CHECKI,
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