HomeMy WebLinkAboutPermit Sidewalk 1983-07-06ECTIi
37 69
L
c0llBI AP RMIT
Job Address .Lh v EIIERGY SOURCES:
Hea
l,later Heater
Ran
Sq. Fto. l''lain_
Sq. Ftg. Access._---
Sq. Ftg. 0ther_
_llew_AddrA l ter_Rep .
_Fence_Demo Change/Use
0ther
cog
oo+t)
l-egal Descri ption
Val ue of l,lork
0wner
Address 3.a-m-Phone 7 Bui l cii
Farni I v
nq Permit Info: Describe Work('
Residence l{ith Attached Garaqe
,€., Build Single
Si ? o ^-,{rlConstruction Lender qqo'
Addres s Phone
DESIGN TEAI{name address exol res
Primary
Structura l
El ectri ca I
Mechan i ca I
CONTRACTORS n ame addrpss'lics^ no.)PXOI res ohone no-'
Ge ral J t ()
Pl umbi nq
E l ectri cal
l'1ec ha n i ca I
PLUIlB I NG ELECTR I CAL MECHAN I CAL
FFF CHARGF NN FFF NHARGF NO FFF
Each single fixture furnace/burner to
BTLI' s
Relocated building
(new fix. additional)
New ci rcui ts al ts.
or extensions
Floor furnace
and vent
S. F. Res i dence
( l bath)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
qpna rafp
llater service Chan
resi
ge in existing
dence
Stationary evap.
cool er
Sewer multifami ly, comm or
I ndrr st-ri a I
Vent fan with
sinole duct
Storm Sewer 0f amp s.Vent systenn a part from
C.heatino or A
COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct-
InstaI I /aI ter/rel ocate
distrih. feeders [,Jood stove/heater
0f amps
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LlN REQUIRES that the Electrical work
shall not be vali'l until the label has been signed by
be done by an Electrical Contractor, the electrical portion of this pennit
an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the Cityof Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that NC OCCUPAI,ICY will be made
of any structure without the permission of the Building Division. I further certify that m.y registration vrith the Builder's
Board is in full force and effect as required by ORS 701,055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and ernployees who are in comcliance with 0i1S 701.055 rnrill be used on this project,
t'lAtlE(please print)IGNATU Tb83'
Zon P /Const Uni ts Ftg
Ftg
Ftg
. l'lain x Value_
Fire Zone Bed rooms Load . Access x Val ue
FIood Plain Group $q 0ther Val
TOTAL VALUATION
Stori es
BUILDING PERI'IIT
Charges and
Surcharges
Pl an Ck. Conrn,/ Ind
65%/Bldq Per Fee 1 Rq
Plan Ck. Res
30%/Bldo Per Fee
PLUI4BING PERMIT
Charges and
Surc ha rges
Fence
DBmo
ELECTRICAL PERI|IT
Charges and
Surcha rges
Sldewalk qb Eo
A/C Paving Total Comb. Permit
I,IECHANICAL PERMIT
Charges and
Surc ha rge s
Curb Cut
TOTAL $qb to
Residence of
sQ. FT.
ue-_
'sterns
rarqe (
COMBINATION APPLICATION/PERMIT ( CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 43?. elaryrple- Lot 1. Block 3, 2nd Addition toSFFii!-fieta EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
I. example- heat/2. e'frfrFlE waterE. Square footage or
electrical cei l in or forced air gas
r solarterec0
C tzsvvai uati O0'
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.
F . Bui lding permi t information:l. example - construct single family house with an
attached garage
?. example - remodel existing garage into family room3. example - convert single family residence intoEiTIFant (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, Bu.ild.ingDivision Staff must be able to contact appropr.iite
persons 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 fiil-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Fu]I Plumbing, Mechanical, 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 onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUI ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical Iabel.
Applicant to sign and date
lJhenever possible, the initial application will be used asa worksheet only. l,lhere possible, Building Division 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.
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. AII other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
I
II
III.
IV
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name s i gnature date