HomeMy WebLinkAboutPermit Building 1979-10-16
., INSPEUION LIIIE
~..7:6-3769
NOTIFIED ~IQ-,q4
. INFORMATION L1No.1 '
726-3753
Sq. Ftg. I.lain (' ,\
/. ~q. Ftg, Access. //3b lfJ
Sq. Ftg. Other j
lC.New Add Alter Rep.
I Range -_ Fence_Demo_Change/Use
~ -~v~u~ of l'/ork, _Other II~ _ _
~ ~,OOO_OD
- '" ul1ciinQ Pennit Info: Describe Work(i.e.. BU11d Single I
P ne ;79?7-7~~ amilv Residence With Attached Garaae) .
.
CITY OF SPRINGFIE.O
COMBINATION APP.ICAT[ON/PERMIT
~ 0#'7 ./0 J E!lERGY SOURCES,
..Jrl<-lllA?..--/e Heat
r Hater Heater
Job Address &, 9 3 S- ~ /Y\ A / ttJ-
.egal Oescription C,6,ro
/t 02 3636
Owner. R.IIL Ph. L. JE /1/5 crV
~
Address (Qq 8':;-- /Y\ A IN
SPR.. r;;,c/e Id {f),eEClOIV "-., -,"
Construction Lender V ftL9"'j.;-3U
Address
DESIGN TEAM
(name)
Primary
Structural
Electrical
P.Uf.1BING
NO.1
-----lEach single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath) each
I Additional bath
Water service
Sewer
Storm Sewer
TOTA. CHARGES
WHERE STATE L\W REQUIRES
sha 11 not be va 1 i'J until the
<j-(l)UL~ -'~ 0/- w-Jo ~
Phone
(address)
flies. no.)
(exo; res 1 J,
,-JA
~'
.P~
(ahone no.)
Mechanical
CONTRACTORS (namel
~ Genera 1 (' /^2r r1? &-"<>...0--... 1
Plumbina
-- Electrical (~aQ..r 'c/:. 9~
~'echani ca 1
(addrps~1
(1 ir.<:;_ nn_ l
(poxoirpc:.l
(nhnnfll nn )
{"C/ ?, {" - rn~
(oq.3S: /na-v,-V
RECTRICA.
FFF rijARr.F Nn ", Nn
Res idence of
SQ. FT.
New circuits alts. 1/5d()
E- ar extensions
SERVICES I
I
If) t;!;> ITempOrary Construction I
IChange in ex;sti~g
r~s j d..eJ1cF'
jmultifamily, comm. or
Innuc:trial
Of amps.
CO~~./IND. FEEDERS
[nstall/alter/relocate
dic;,trih_ fppnprc:
/ Of #J..r4"..&'..... IN'\. amps. fSco.
1'J<!'l-7.;;l}?':2-
?<I?-?.:2Y2--
MECHANICA.
rrr r'::lAB.G.E.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~n~cp hp~tp~ ~nn vpnt
Appliance vent
S~Oari'itp
Stationary evap.
c:ooler
I V.ent fan wi th
sinole duct
I Vent system apart
heatina or A.C.
I Mechan; ca 1 exhaus t
hood and duC't
1 Wood stove/heater
I
I
I
from
I'()~ TOTA. CHARGES
[SSUANCf nF PFRI1IT
3l>~ TOTA. CHARGES
I
\~~~
IO-il-lq
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAHCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
N,,(l:lE(Please print) 'K A '- P fJ. J~N<'F..n/ S~~ATVRE,~~~ _~-1-'?~~~ V
L. DATE (I)c) /& - 7'1
.FOP-'OFFICE USE OllLY . v
Zonp Tyoe/Const. 'II-N Uni ts Sq. Ftg. /1ain x Value
Fi re Zone J:ZJ::. Bedrooms Occy .oad Sq. Ftg. Access II 'V. x 7.'1 Value 5ll/1Jt.. (,(/7
Flond Plain Stori es Occy Group M-( Sq. Ftg. Other x Value
~I Plan Ck. Comm/[nd
'11(.100 651/Rlda Por Fpp
------------PTan Ck. R"es
I. q a.. 301lB1 da Per Fee
______jlJ.QO_ Fence
.40 I D_
_ ___ __ _~Q,-ogJ .Sidewalk
I.;[l) A/C Paving
BUI.OING PERmT
Charges and
Surcharges
P.UI~B[NG PERMIT
Charges and
Surcha rges
E.ECTRICA. PERlm
Cha rges and
Surcharges
MECHANICA. PERMIT
Charges and
Surcharges
Curb Cut
: TOTAL
TOTA. VA.UATlON
SysteC'ls. Development
Charqe (J.5~)
Total Comb. Permit
q/..s~
97 (1;,6:2
-
.
COMBiNATION APPLiCATiON/PERMIT (CAP)
r:. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax lot 100, lane County Map Reference
11 oj 43
2. example- Lot I. Block 3, 2nd Addition to'
>pringtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceiling/or forced air oas
2. examole- waterheater/electrlcal!or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project. check-new - if addition,
cneck add, etc.
F. Building permit information:
1. example. construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examjJle - 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. OESIGN TEAM ANO 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 fonm the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 ,chedu I es
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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. -
Ill. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Oivision Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,
PERMIT
VALIDATION l:)l:)
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Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
,
-
Additional Project Information:L.z, A/..h.LdL ~-"--,,,---7,
SignatureL xL.~
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PLANS REVIEWED BY:
name
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