HomeMy WebLinkAboutPermit Building 1986-9-17
~'l~.~w~;:-."_': ~-'.
.~(I-,j,;:t~<. '" h... ''-
\",,"l~,~. ' ....... '. .
;;.~~~;,~o\~.~. .,.;, ..,....
,~';1~~~"~; .-"" ,I LllOE
i\-~iP~"",~Y' _
. ~~~t~j.~:",~. .-
Jdress .s-I (_ c;- /Ylr-L IV.
... ,J.1 Description 17-02.,7_"'3<:.
.
C\C-; 'D. \b-\H
IOJwd CG
eln ui- SPHliiGf ILlU
cm'BIlIATlON APPLlCATlD"/PERMrT
EilERGY SOURCES:
Hea t j'1 ".... ~..,/..::
Hater Heater
" I
,
0':::'/.01
RaMe
I NfOl{)lA TI O~ L I..C II'
725-3753
,
So. Ftq. "lain I
~Q. f'tg. Access.
So. FtQ. Other
_UeW'_Add~Al ter _~ep.
__Fence_Oemo__Change/Use
Other
Address
Phone ~'r("'9
Valu of 1.larK:
-C)Cl~
. B l(;;nQ Permit Info: Describe l~ork( i.e..
Far.1i1v rlesidence "Iith f1,ttached (lflraoe)
Build Single
'0
~
c-::::-,
~
.\)
'\)
/
i
Owne r
'k,"',., ~TCft1".Cf?t~
PO 13cJ--<, ') ~C)
TRNE...C.EIC....
Construction lender
1/J.......,iA~
-j A.-.1et..J /I QfJ).
. (j
I
r/
auJrL-~
Address
o il T 11
nPlI'Pe
Phone
address
1 ics. no.
I exrll res 1
.1
(onane no. I
Primary
~L
~
>:...)AA-"'O=,{..,
Structural
r1echan i ca 1
CONTRACTORS
(name)
c::J LU' &..,t.!.."
(address)
(lics. no. 1
~
-....:..-. ./
~,
(chane no.)
Electrical
Genera 1
(exoiresl
Plumbino
Electrical
~'~chan;cal
PLUIIBIrlG
ELECTRICAL
L
11~1
MECHANICAL
r:o.
I
,
I
I
I
I
I
I
I
I
I
-,
I
,
TOTAL CHARGES J TOTAL CHARGES
WHEnE STATE UI~ REOUIREs that the Electrical work be done bv an
shall not be vali1 until the label has been signed by an Electrical
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
. r.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bathl
Ouolex (1 bath)
SERVICES
Recessed wa 11
~n~iP hp~tpr nnrl vpnt
each
Additional bath
Storm Sewpr
IOf
amps.
./.,'1,0,001 iance vent
seoarate
I Stationary eVdp.
cooler
Vent fan wi th
s;nole duct
Vent syster.l apart from I
heatino or A.C. .
rlecnan i ca 1 exnaust
hood ilnd dun
Wood stove/heater
?4
I
I
J
j\.!ater
jsewer
service
Temoorary Construction
jCha~~e in existing
I rt-.} 1npn("p
Imultifamily, comm. or
Indu<:triill
C0I1r'I./INO. FEEDERS
Install/alter/relocate
di<:trih. fppdpr<:
IOf
amps.
ISSUANCF OF PFRrlIT
TOTAL CHARGES
/17//'/
/. <; C-o
I HAVE CAREFULLY EXArlWED the comr1eted apfllication for lJermit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Soringfleld and the Laws of the State of Orel)on oertaining to the work described herein, and that rlc OCCUPArKY 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 Or.S 701.055, that if exemot the basis for exemotion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Electrical Contractor, the electrical rortion of this per~it
Supervisor and returned to the Building Division
rIAIIE(ple"e print)
Zone C c:.
Fi re Zone
Flood Plain
Tyoe/Const. ~/\I
Bedrooms
Stories
Units
SIr.;I^TURF.
FO~ nrFICE USE DilL \
Sq. Ftg. t1ail'1)( Value
Sq. Ftg. Access x Va 1 ue
Sq. Ftg. Other,&w ?"""'F~""""',,"::\,alue
h TOT^L VALUATlOII
&/01 .
".Co::? t1.L(.CVJ Syste~s Development
0<. "~I '0 Char~e (t.s~1
DATE
Occy load
Occ,V Group /I. - '-f
~~_.~# c:r-~
BUILOIrlG PERI'lIT
Charges an~
SurCharges
---~~.se__
-:? _ ~'2..
Plan Ck. Comm/lnd
65%/Bldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee
I Fence
I Demo
/1/1
PLUI1BlNG PERMIT
Charges and
SurCharges
------------
ELECTRICt.L PERI~IT
Charges and
Surcnarges
Stdewa 1k
AIC Paving
___...L)_~::-~_ Curb Cut
.6C> '1
Total Comb. Permit
------------
11ECHAN I CAL PERM IT
Charges and
SurCharges
I TOTAL
68, /2
-
COMBINATION APPLICATION/PERMIT (CAP)
I
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examl?le- Tax lot "lOa. lane County Map Reference
17 OJ 4;,
2. examole- lot 1. Block 3. 2nd Addition to
~prlngrield Estates
C. Name. etc. of owner and construction lender
n Energy Sources
1. examole- heat/electrical ceilinQ/or forced air oas
2. exam~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. examole- 1250 sQ. foot house. 500 sq. foot Qarage
2. examoJe- if new project. check-new - if addition.
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached gar~ge
2. examole - remodel existing garage into family room
3. examoJe - convert single famlly residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DES I GN TEAr.! AND COiHRACTORS
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, ~lechanical, & Electrical Schedules
A. Except where blank spaces occur in the descriPtion
portion of the /'lechanical and Electrical Schedules.
the. applicant need fill-in only the No. Boxes adjacent
to the aporopriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve soace on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated scnedules you should consult the
fu 11 schedu 1 es
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
suoervisor. The general contractor 1S not autnorized
to sign the electrical label. -
III. Applicant to sian and date
Whenever possible. the initial aoplication will be used as
a worksheet only. Wnere 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 wnen the permit is issued.
V. FOR OFFICE USE orlLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
.
,
(
11
i!
" I
'..,
I
PERMIT VALIDATION
. q_I]~l1
1
I
Permit Cl erk
'-r'
,
J
I
t'
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
'.
PLANS REVIEWED BY:
/-t>R//G" 7i:E'7~
nam~ ,l:N<"!&P-<.Lsignatur
U 'U
~
9'-/b'-gG;;
date 9- ~-rG