HomeMy WebLinkAboutPermit Building 1986-9-16
~
I IrISPECT./OII LiIIE
726-3769 .
Job Address
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Legal De<cription !7'oz''?'?"3<:. Ot:.I.ot
Owner
~t"h ~cw>ecfiA
PO 13~ "3 ~C)
Address
Construct inn lender
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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...
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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
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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
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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
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