HomeMy WebLinkAboutPermit Building 1980-06-196r'i ty ,1b
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rb Addr ess v5 .r:fA
egal Description /
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Pri ma
Struc iura I
c0rlBI TI APPLICATI
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Electrical
iiec han i ca I
slOtfUGenera I
(:
Ran
l.later Heater
EIIERGY
Hea t 5q. Ftg. Access._
Sq. Fto. 0ther__
Y lier,r Add Al ter Pep.
]ence_Oenro Change/Use
0ther
l'1a
Value of llork:
6, cCC)Owner 33T',e., Build Singlenq Pe
Resi
rnrit Info: Describe t^lork('
dence l,lith Attached Garaqe
Bui ltl i
Fami l yPhoneAddress i3-r5 .*JogrH 3gr* \grtD
80raD 6At-h6E i*rrrr SrOP
Construction Lender
Addres s Phone
'I CS, nO.exDl res .( ohone no.
00oo
t\
name
NN FFF NOFEE _IIf-
la 5*s ./o.ao
Res idence of
SQ. FT
New ci rcui ts al ts
or extensions
furnace/burner to
BTLI' s
Fl oor furnace
and vent
Pec,:ssed wal l :
Soace heatpr' and ventSERV I C ES
Each sin3le fixi:ure
(new fix. additional )
F. Residence
ll_u4-b]_-
Duplex (l bath) each
i
bui lding
Temporary Constructi onAdditional bath
Chan
rpq l
ge in existing
dpncp
Stati onar.v evap
coo'l er
Apol iance vent
seDa rate
l,la ter serv i ce
Vent fan with
sinole ductSewermultifami ly, comm. or
IndustriaI
0f Vent systen apart from
heatinq or A.C.
COMI'I./IND. FEEDERS
Mechanical exhaust
hood and duct
"lStorm Sewer
llood stove/heaterInstal I /al terlrel ocate
di st-ri b. feeders
/6w/or /OO anos.
IT
TOTAL CHARGES
ISSUANCF OF
TOTAL CHARGES TOTAL CHARGES
I HAVE CAREFULLY EXAI1INED 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 accoidance with the Ordinancej of the Cityof Soringfield and the Laws of the State of Oregon oertaining to the work described herein, and that t.lO 0CCUPAI.ICY will be madeof 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 exemption is noted herqon, and that
,tS
s and ernployees who are in comcliance with I be used on this nroject
Beer T ;,tlsfu
only subcontractor
l,lAl'lE( please pri nt)
Ftu
Ftg
Ftg
Val ue /,oa
TOTAL VAI.LIATIO
x
X
X NmoaP-0cFlood Plain_4fi___S tori es
Load
c.y Group M_a
Zone 2-/oe/const. 3-t( unlts
. Val ue
, Val ue
Acce s s
0ther
l'lain /OOA
Fire Tone Z Bedrooms ^ Occy
Plan Ck. Conun/Ind
65%/B1da Per Fee
tems De
rqe (1
Svs
CIa
VE
5q
opmentBUILDING PERI'IIT
Charges and
Surcharges
4fr,u-Plan Ck. Res
30%/81dq Per Fee l_3,20
FencePLUI4BING PERMIT
Charges and
Surc ha rges
./o.Qo_ _
ty0 D6rno
Sidewal k 4, dL /3,soELECTRICAL PERIlIT
Charges anrj
Surcha rges
/5op-
Tota'l Cornb. Permi t 11,7LA/C Pavi ng
Curb CutNECHAI.IICAL PERMIT
Charges and
Surcharges TOTAL
PLUIlBING ]ELECTR I CAL T.IECHANICAL i
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}FSI(JN IFAI4 ladrlress I
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WHERE STATE LllJ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion,of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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PERMIT VALIDATION
BP
?Q
Aa,\lo
+4 .oc)
l,1b
to.oo
40t'lo
E? t+ttb
flo
PtA*^ cntde- l7.Lo
TOTAL B+.qL
2b# bflsq
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Permit Clerk
COMBINATION APPLICATION/PERMIT (CAP)
I Applicant to furnish
A. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
l7-I:-T32. examcle- Lot 1. Block 3, Znd Addition to
S[rTngTi e'td EstatesC. Name, etc. of owner and construction lenderD. Energy Scurces1. examcle- heat/electrical ceiling/o?. elqqql-.- waterFEa teTeJEctiJci'T7orE. Sqrraie f coGge or val uationl-ETc.-
r forced a'i r qas
solar
l. examole: 1250 sq. foot house, 500 sq. foot garage?. 913IETT-new project, check-nEw - ;t aOlitjon,
EIecr-add, etc.F. Building permit information:1. examcle - construct rrngle family house with an
attactreC garage2. exarncle - remodel existing garage into fam.ily room3. exarr"lE - convert single iamil,v-residence inio
restaurant (change of-use)G. Vaiue of work as defined in Section 303 (a) of theStructural Specraity CodeH. DESIGN T:Al,i AllD CoNTRACT0RS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.II Abbneviated Plumbing, l"lechanical, & Electrical SchedulesA. Except vrhere blank spaces occur in the descriptjonportion of the Mechanical and Electrical Schedules,
the appiicant need fill-in only the No. Boxes adjacentto the aopr'opriate item(s) to be instailedB. Full Plurnbing, Mechanical, and Electrical Schedules
are avai lable at the Building Division1. To ccnserve 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 DIVISi0li STAFF Wir-L FILL OUT AtL FEES AND
CHARGES (]N THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelei:trical contractor for signature by his electricalsupervisor. The general contractor is rrot authorizedto sign the electricai label.III. Applicant to sign and date
Whenever possible, the initial application wi'lI be used asa worksheet on1y. Where possible, Building Division Staffwill prepare a type written copy and return it to theapp)icant at the time the actuai permit is issued for his
s i gna ture .IV. Fees and Charges
Plan check fees are due and payable at the time of the
appl i ca ti on, and no pl ans wi l l be processed unti l thesefees are paid. A1l other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS IU BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration r,l'ith the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name signature ,c^-a/-date