HomeMy WebLinkAboutPermit Building 1986-10-294/6vu^
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6- 37 69
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COHBI NATI ON APPL I CATION/PERHIT 726-37s3
Joo Address
Legal Description
Hea
Ranqe
EIIERGY SOURCES:
liater Heater
Owner Vaz,vz kt,qz Va l ue of l.lork/fo2- oo
Fto. l'lain_
Sq. Ftg. Access._
Sq. Ftg. Other_
_l{ewJddJi ter_Pep.
_Fence_Demo_C ha n ge/ U se
0ther
Address P5" ilo_ );r=a 57 Phone .e., Buil
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Constructi on rc,Ge"
Addres s Phone
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DE5IGN TEAH name addre s s n0 exDl res ohone no.
Pri ma ry
Struc tura I
Electrical
Mechanical
CONT ACTORS name addres s I i cs. no.exDI res ohone no.
Ge I
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(-1 \>bE l ectri ca l
tttechani cal
ELECTR I CAL MECHAN ICALPLUI{B I NG
FFF (: HARGF FFF C HA ACF NO FFF (.HA AGFN0.NO
/Each single fixture Res idence of
SQ. FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional)(-"New circuits alts.
or extensions2 a,4,.6f3€n9 Floor furnace
and vent
S. F. Residence
( I bath)SERV i CES
Recessed wal l
SDace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa ra tP
[,later servi ce Change in existing
rps i dpncp
Stationary evap.
cool er
Sewer Tndrr<fria l
multifamily, corm. or Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system apart from
heatino or A.C.
COMI.I./IND. FEEDERS /Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di ctri h fppdprq llood stove/heater
0f s.
ISSUANCE OF PFRtlIT
WHERE STATE LAI.I REQUIRES that the Electrical work be done byshall not be vali:l untij the label has been signed by an Eiectri
an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building Division
4>'> €Zr TOTAL CHARGESTOTAL CHARGES 4>TOTAL CHARGES
of any structure without the permission of the i:'lding Division. i further certify that m.y registration vrith the Builder's
Board is in full force and effect as required by ilS 701.055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in corn:'iance with ORS 7n1.055 will be used on this project.
I'lAtlE(please print)DAIE./6:) t-f C
fy
any
of
Ci ty
made
het one do here rtce 'I th ta Ia 1I fo 'Irma t heon Ireon ts ruendarmrfocacomp!')ap b.yDE
dctorrecandIcerrtherIttthafunda II pe rfowork sharme c II dobe lne an rdancecc0 thw1 het naOrd i ESnc tof heanfyffo1'I Ie d and th e La ofws theSprn9 Sta te on0reo rtaDE nI nI f^wothe kr rdesc bed'I Ihere dan ttha 0ccuNC PANC Iw'l be'Ig
FI E
I GNATURE
Zone L?r? . tyoelConst. Units So. Ftq. t,lain Val ue
ToTAL VALUATI0N--
x
.s5
.0cc.y Group
Load
Ftg 0ther
x
x
Fi re Val ue
Val ue
Ftg. Acces
Flood Plain Stories.
PIan Ck. Corm/Ind
65%/Bldo Per Fee ' /6.2f terns Derse (1
Svs
Cha
VC
57
opmeflt //,4.BUILDING PERIIIT
Charges and
Surcha rges
{aey'-t---2
(5>Plan Ck. Res
30%/Bldq Per Fee 4zaz 2../#c
Fence F/zzzB .2ACharges anfl
Surc ha rges
PLUUEING PERMIT +
-c____.4o DBmo
Sidewal kELECTRICT.L; PERI,:IT,
Charqes and ./
Surcharges I
7
A/C Paving Tota'l Comb. Permi t 3D.ea
Curb CutCharges and
Surc harges 6D
I,IECHAN I CAL : PERM IT -rtD
"7.a5
TOTAL
,|es Qa4a s= Fa*
I lrzaa=*;
6tr
coMBTNATI0N AppLICATI0N/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descrjption
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Bjock 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. example- he2, example- waE. SquarET6otage
at,/el ectrical n or forced air gas
e EC or soTaror valuat OD,
II.
l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, checklt-ew - if addition,
check add, etc.F. Bui lding permit information:1. example - construct single family house with anattached garage
2. example - remodei existing garage into fam.ily room3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Speciaity CodeH. DESIGN TEAI,| AND CONTRACTORS
To avoid design or construct.ion de)ays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanicaj, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. goxes adjaient
- to the appropriate item(s) to be instaliedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Div.ision1. 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 thefull schedulesC. BUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the labe'l must be delivered to theelectrical contractor for signature by his ejectricalsupervisor. The general contractor ii not authorizedto sign the electrical labelApplicant to sign and date
lJhenever possible, the initiai application w.iII be used asa.worksheet only. Where possibie, Building Division Staffwill prepare a type written copy and returi it to theappjicant at the time the actuai 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 pians wili 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.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from re"rstration w'ith the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY
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1:oRM 1014 REV. 2/86
LICENSEE
LICENSE
TYPE
59
FO OD
HOH IS SALSA
VELHA H KIR,K
195 i.l 33RD ST
SPRINGFIELD
STATE OF OREGON
DEPARTM ENT OF AG RICU LTU RE
LICENSE
POST THIS LICENSE IN A CONSPICUOUS PLACE
FIRM NO.
BUSINESS
LOCATION
00075609-- ool
195 N 33RD ST
SPRINGFIELD
LICENSE
NUMBER
oo233?
PR.OCE SS lN G
0R, 97478
DATE DATE FEEISSUED EXPIRES PAIO
07/o L/86 06/3A/87 tC.O0
ESTAELISHHENT LICENSE
ORS
NO.
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