HomeMy WebLinkAboutPermit Miscellaneous 1990-6-18
MR. l<B\I ~.)
Address '2.fxJ Cj fllJltf<cgt.-A ~
3Pt<IN~lao O~ 17477
Construction lender ~ ; -
Phone
Address
DESIGN TEAH
Primary
Phone
(address) (1;/"'<:. nn 1 (exoiresl (ohone no.
?J)I ~(f~, ',\ ? 4"3-31*-
T
(address) (l;n t'l(l \ (p)'o;rps\ ..... fr)pnnp ni"l )
8'f970 HtOY 1"l NJF=rn ElJ€s\.E (~ ~M-C.7!il
(name)
Structural
Electrical
Mechanical
CONTRACTORS
(name 1
Plumbina
V~_t:boLS f\NJ :5~
/I
1 II
'I
Genera 1
Electrical
~'echanical
PLurlB I NG
ELECTRICAL
MECHANICAL
NO.
HF r.HARr.F NO
~~~ r~~ NO,
~~~..c.HARG.E.
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BlU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(l bath 1
Ouplex (l bath) each
Additional bath'
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
I,,/'" "Appl iance' vent
c:.eoarat,p
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I'
heatina or A.C.
Mechanical exhaust '
hood <ind duc-t
Wood stove/heater
~Iater servi ce
Temporary Construction
Change in existing
rec;.id..eJlce
multifamily, COITlT1. or
Indu<:tri<il
Sewer
sm fb:L
(~1'rL )
. ..
At<V 61>fzEJ3o
COMH./lND, FEEDERS
Install/alter/relocate
di"trih. fppdpr"
Of
amps.
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&~nf'/.4P'r ~ fA'z:; "t:?r
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ISSUANCF OF PFR'1lT
TOTAL CHARGES /"): P'"O TOTAL CHARGES
WHERE STATE L\W REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
TOTAL CHARGES
Mnv /L;: ~
Electrical Contractor, the electrical rortion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Spri n9 fi e 1 d and the Laws of the Sta te of Oregon pertai ni ng to the work descri bed herei n, and tha t rw OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IlAl,IE(please print)~""7_'
Zone C-L.
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
~A1
Units
Occy Load
Occy Group M-/
SIGIIATURE
FOR OFFICE USE orlLV
So. Fto. Hain x Value
S~. Ft~, Acces~"'-'-,,_ x/4"'7"~value
Sq, Ftg, Other~ ?~ Value
TOTAL VALUATION
D~.TE
/
-~~
BUILDING PERfl1T ___&5<2__ Plan Ck, Conm/l nd
Charges an':: 65%/Bldo pp~ Fpp
Surcharges L(.o3 Plan Ck, Res
3D%/Bldo Per Fee
PLU'1BING PERMIT ___/5::~__ Fence
Charges and
Surcharges .7S- D~R1o
ELECTRICAL PERr~1T Sidewalk
Charges and ---- -- --- ---
Surchq,rges 'AIC Paving
MECHANICAL PERMIT ---L~~-- Curb Cut
Charges and
Surcharges ,,_~D
f:)cY: ~~~~
Systems Development
CharDe (1. 5~)
TOTAL
'. " 1/6. 63
/(;8. 36 l
Total Comb. rermit
.
.
- . --
COMBINATION APPLICATION/PERMIT (CAP)
.,
". .
'PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B, Legal Description
1. example- Tax Lot 100. lane County Map Reference
II oj 43
2. examp]e- Lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender'
. O. Energy Sources' ~.' . \ : .
1. examele- heat/electrical ceilinq/or forced air Qas
'2. example~ waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
ehee k. add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached gar~ge
2. exam~le - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jOb site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No, Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to 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 Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, 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.
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V, FOR OFFICE USE ONLY
Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project InformatiQn:
PLANS REVIEWED BY:
~ame~~;c ;?t66;~ Signature,~__~__-.r> date :5"~9-'9'~
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