HomeMy WebLinkAboutPermit Building 1985-02-25II'ISPECTION LINE
726-37 69 COHBI TIATI ON APPLICATION/PERMIT
N
37
Job Address b
Legal Description l,later Heater
Ranqe
EIIERGY SOURCES:
Heat
0wn
Value of l,lork:2@.n
Sq. Fto. l.lain_
Sq. Ftg. Access._
Sq. Ftg. Other_
_llew_Add-ArIer RAE.
_Fence_Demo Change/Use
-other-
Address 5;-Og 22d*b2 Buiiciin
Fami I y
q Pernrit Info: Describe Work('
Residence l,lith Attached Garaqe
.e., Build Single
(ao*q**t)tz)
Construction Lender -
Addre s s Phone
s
s
m\0
DESIGN TEAM name addre s s tcs. no.exD res phone no.bznsZaa- zs/*Q.#sr-?26f,6<?Pri mary
Structura l
El ectri cal
Mechani cal
CONTRACTORS n ame addres s I ics. no.exoi res Dhone no.
l
?7/o/Pl umbi nq
a
E I ectri ca I
l,tec ha n i ca I
PLUIIBI NG ELECTR I CAL MEC HAN I CAL
FEE CHARGE NO FFF CHARG F NO FFF CHARGF
Each single fixture Residence of
FTsq
furnace/burner to
BTU' s
Relocated building
(new fi x. add i ti onal )
New circuits alts
or extensions
Floor furnace
and vent
SERV I CES Snacp heafpr and vpnt
Recessed wal lS. F. Residence(1 bath)
Duplex (1 bath) each
Additionai bath Temporary Constructi on Apol iance vent
seoa rate
l,later servi ce in existing
CE
C han ge
res i den
Stati onar-v evap.
cool er
multifami1y, comnn or
Indrrst-rial
Vent fan with
sinole ductSewer
Vent systern apart from
heat-i no or A - C.Storm Sewer 0f amps.
COMI'I./IND. FEEDERS
Mechanical exhaust
hood and duct-
Instal I /al ter/re1 ocate
distrib. feeders ['lood stove/heater
0f amps.
ISSUANCE OF PFRtlIT
IOTAL CHARGESTOTAL CHARGES TOTAL CHARGES
[/HERE STATE Llll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali,l untii the label has been signed by an Electrical Supervisor and returned to the Building Division
and correct, and I further certify that any and all work performed 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 OCCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for sxemption is noted hereon, and that
only subcontractors and employees who are in comcliance with 0l?S 701.055 wi1I be used on this rrroject.
tlAl'lE(please print)IGNATURE
t
apr)rcatonLY t, and do hereb.y certify that all information hereon is trueD the comp
Fire Zone Bedrooms Occy Load Sq
Ftg
Ftg
Ftg
l,la i n
lueFlood Plain Stori es
q
@re/const Uni t ssq
TOTAL VALUAT rcN 22b. 'a
Group
Val ue. Acces:
. 0ther
Plan Ck. Conrn/Ind
65%/B1do Ppr Fee
Svsterns Deve
Charqe (1.51 opment ,/,,4BUILDING PERMIT
Charges and
Surcharges
_3_t,ee
%Plan Ck. Res
30%/Bldq Per Fee
Fence
Dgmo
PLUI4BING PERMIT
Charges and
Surcha rges
Sidewalk
A/C Paving Total Comb. Permit
ELECTRICT.L PERI|IT
Charges and
Surcha rges
Curb Cut 'r?aI1ECHANICAL PERMIT
Charges and
Surc harges TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job AddressB. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot l. Block 3, 2nd Addition to
SEFTngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
/* 6/a?</
l.
2.
Sql.
2.
exampl e-
exampl e-
uare footag
hea t,/el ectri ca I d a f
n or forced air gas
wate or soTar
E e or valuat'ion, eE
example- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check add, etc.
II.
F. Building permit information:l. example - construct single family house w.ith anattached garage
?. example - remodel existing garage .into family room3. example - convert single family res.idence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fil'l-in only the No. Boxes adjacentt0 the appropriate item(s) to be installedB. Fu11 Plumbing, Mechanical, and Electrical Schedulesare available 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 onthe abbreviated schedules you should consult theful l 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 his electr.icalsupervisor. The general contractor is.not authorizedto sign the electrical IabelApplicant to sign and date
Whenever possibie, the initial app)ication will be used asa_worksheet oniy. Where possible, Building Div.ision Staffwiil prepare a type written copy and return it to theapplicant 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 theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
III.
IV
v Perm'it Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from reg'istration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
nu*"batr€k# ,isnatu date ?-25^'8.f
4 bI
I
77 -f'-..T--:l
o '-/
o
1
o
5f)gINKLT iRt ?r/
:}t ,f :t
@ tu:I
I
$;ffT FL i-
&x'o x o
@t,,Y ;a4n
I!_q -f@xt\Z uI total-v-<r'a r aoo
I
\r3e
?
4l ?\
I a-zr&iru" f 3An4El 7 WAU47 I
I
li?TE F ,,6YR w,TlttNc
wtfa aIqt-b'tll6t
t FA, 'IP€,
lirH2 ?at '4 Wl?ax EtRcll
KeTttt NE :lNttflruLY U
I
i
I
J
!
D IEET,N6 RU V:t t/*u=l'-ePROI"058
Ii
ytvlEt57478 EPIPLO
t
G)
T
-l-otv,tstoNl oFF/6€
I
i
I
III
I
II
I
!
T
I
I
I
I
I
I
I
I
I
III
IIIII
IIII
II
t-
t-
t a 't
rufe
-F
J ---ir
FE
(T
j