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HomeMy WebLinkAboutPermit Building 1986-9-16 ~ I IrISPECT./OII LiIIE 726-3769 . Job Address ~ I z. c;- IYln.1I\ Legal De<cription !7'oz''?'?"3<:. Ot:.I.ot Owner ~t"h ~cw>ecfiA PO 13~ "3 ~C) Address Construct inn lender Vl...,L.,.~ Address DES I GII TEAr' (name) Primary a=~.... Q"""""'r".6t.. Structural Electrical f1echanical CONTRACTORS Inamel Genera 1 c:::> UJ ..A;.... Plumbino Electrical t.lechanical PLUllB WG riO. I FfF Each single fixture Relocated building (new fix. additional) S.F. Residence 11 bathl Duplex (1 bath) each Additional bath I Hater service I Sewer Storm Sewer . G\ ~ 7fl:%, \b-K q l~ifJJ C I TV OF SPRWGF I ElD COflBWATIDN APPLICATION/PERMIT E!IERGY SOURCES: Heat t-I.......n..c:: l~ater Heater NF0R11A TI ON l1lit. 726-3753 So. Ftq. '.la 1 n ~q. Ft~. Access. 5q. Ftg. Other _ -'~ew _ Ad~ A Iter _ f1.ep. Fence Demo Change/Use Other - - ~ ~ Build Single I~ .1 (ohane no.' \ , Ranqe TANF c.r;,/C... ~ .-- Phone "l'r6 B C;lM P rmit Info: Describe \~ork(i-.e., Far:lilv nes;dence Hith f1,ttached haraoe) I JJeu} fl 0&1 rr I V I au) /LiAr.. Q ....J Phone (address) flies. no,) (exoires) ~1 ~~~ ~ (addressl "i(7'" nn \ (pyn;r~c\ (nhonp nn ) ELECTRICAL FH^Rr.F un Residence of SQ. FT, New circuits alts. or extensions SERVICES I I Temporary Construction I Change in existing rE''',' rience I multifamily, COrtr.l. or I Indllc::trial I Of amps. I COf~'1.IIND. FEEDERS I I Install/alter/relocate rlic::trih_ fpPt:h>rc:: I Of amps. I I I MECHANICAL ~~~ rL.lIP:U:~' tIn I furnace/burner to BTU's '~~C I f"L.lCQ(:C ' Floor furnace and vent Recessed wall Sn~rp hp~tpr ~nrl vpnt 1- ~ Apoliance vent ( seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or,A.C, Mechanical exhaust hood <Ind duct !?l Wood stove/heater ISSUANCF OF PFRrHT TOTAL CHARGES J TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical I TOTAL CHARGES "-"l f,e--, ae> ' I'"hl ), Electrical Contractor, the electrical portion of this per~it Supervisor and returned to the BUilding Division I HAVE CAREFULLY EXNfINEO the completed application for oermit, 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 Soringfield and the Laws of the State of Ore9on ~ertaining to the work described herein. and that UO OCCUPAfKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemotion is noted hereon. and that only subcontractors and employees who are in com~liance with OP.S 701.055 will be used on this project. !lAI.IE(please print) SI,,:IATURE FO~ OFF I CE USE OilLY DATE Zone C L. Fire Zone Flood Plain TVDe/Const. ~/\I Bedrooms Stories " BUILOIIIG PERNIT Charges an>:: Surcharges '___.5"~,se__ -Z ,62. PLuriBIIIG PERMIT Charges and SurCha rges ------------ ELECTR I C~.L PERr:1T Cha rges and Surcharges Units Sq. Ftg. Occy Load Sq, Ft9. Occy Group #- - Lf Sq. Ftg. fiain x Value Access x Value Other~ ~""",,F'~,~alue _"')~."'-" TOTAL VALUATIOtI Plan Ck. Comm/Ind 65%/Bldo ~pr Fpp Plan CIc. Res 30%/Bldo Per Fee Fence jlKi Syste~s Development Charoo (1.5~) Demo I Sidewalk AlC Paving Total Comb. Permit ~~;~:~;C:~/ERMIT L__L2".~;;_1 Curb Cut Surcharges r ~ I TOTAL 68, /2 - . Ii COMBINATION APPLICATION/PERMIT (CAP) " " .. PERMIT VALIDATIDN I I. Applicant to furnish A. Job Address B. legal Description 1. examDle~ Tax Lot '100. Lane County Map Reference 17 OJ 43 2. examole- lot 1. Block 3. 2nd Addition to ~prlngtield Estates . C. Name. etc. of owner and construction lender n Energy Sources 1. examole- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-nfw - if addition, check add. etc. F. Building permit information: 1. examole - construct single family house with an attached gan~ge 2. examole - remodel existing garage into family room 3. examole w convert single famjly residence into restaurant (change of use) G. Value of work as defined in Section 303 (aJ of the Structural Specialty Code H. OESIGN 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 a~e not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES 011 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 cneck 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 Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: J I l Permit applicant exempt from registration with the Bui,lder's Board because: Additional Project Information: PLANS REVIEWED BY: L-oRI'/6 7'2:.~~ nameJ;h h (T:N~c-e.Lsignatur v U [, 9'- /C-t!S<f; . date q- ~-n