HomeMy WebLinkAboutPermit Building 1987-8-11
Job Address
S-';;5"(", E, fJ1A IN (IYI+ /( T~I
, -
. CITY Of SPRl1lGFIElD
COIIBl1lATJOfl APPlICATION/PERMIT
E!IERGY SOURCES:
Heat e~ .
!-Iater Heater ~
Ranqe~ _____
INFORf1A TI ON U Ni:.
726-3753
Sq. Ftg. I.lain ~t)on"~ ~t)
~q. Hn. Access.
Sa. FIg. Other ~
Hew Add Alter ~eD. ~
-Fence Demo Change/Use 'J
7pt -/,1.91 ValuE of r::/(f3-S, -Other- - I \It
Phon "',>,. :1 ~..auil(:;nq Permit Info: Describe I'lork(;-,e" Build Single ,. ~
C 1"~;" ..:__0. )Familv rtesidence \-Jith fl.:ttache,d l1araCle) f\..
?...~ ~~~C".."t 9&'Lh~ I V
n~ C .6~ C:-'if8'~ *
I, rJ /
.
1 HI5PECTIOII 1I11E
726-3769
Legal Description
Owner YVlUIe/AL. PONTI
Address
Construction lender ~~
Address Phone
Ut~l(irl ItAf.\ (name) (address)
prima1t!?~""", ~I)~ 1'lJ."F____~
.)) " Pile. ec--,I,O~~~ .
JJ ii, I Ie.. c...1I.'1~ ~ ~ ~ a.M..- w.dAJl Ai~...d,
-JtU.U,.(, 7 ,- ~ ,~~...ILv LA""/~_. j)...u. ~.
(name) - -l JJT(;dd;~~ (1 ic<:^ no.)
. -
General lJ-/ ~~l2ll(-r/~'Vy Ro()h~~
(1 ics. no_)
(exniresl
fnhone nn, \
Structural
Electrical
!1echanical
CONTRACTOR5
(pxnirp.;)
(ohonp no _-,
PlUI1BING
ElECTRICAl
~
rJiEA5AN.,..II/~(.. tJ,{ 97~J"-S-
/ 'II~ ~ t( '? S B'"
Jt:, 727 I/J1d!IIMItA/r
Plumbina
Electrical
'6d:~
'1::'" etl
;)~ .....
~1echanical.
MECHANICAl
/10.
I FFF CHARGF Nn
I=H fl-1ARr.r ~Jn
rn rUAQr.:r
Each Single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wa 11
s~~~p h~~tpr ~nrl vpnt
Hater service
ITempOrary Construction
IChange in existing
ri=><;.; (tenc~
Imultifamily. COIll!1. or
Indu<;tri~l
Storm Sewer
10f
amps.
Appliance vent
seoarate
Stationarv evan.
coo 1 er v ,
Vent fan wi th
s;nole duct
Vent syste~ apart from
heatino or A_C.
Mechanical exhaust
hood rind duct
Additional bath
Sewer
-
" V\
,
COMM./INO. FEEOERS
Install/alter/relocate
d;<;trih_ fpprlpr.;
Hood stove/heater
<-6
Of
amps.
I
I
(~'lS \~'-(
IS5UANCF OF PFR!IIT
TOTAl CHARGES I TOTAl CHARGE5
WHERE STATE L\\I REQUIRES that tile Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
TOTAl CHARGES
Electrical Contractor~ the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the completed aprlication for lJermit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Ore~lOn pertaining to the work described herein, and that rw OCCUPArKY \'Iill 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 ORS 701.055, that if exempt the basis,for exemntion is noted hereon, and that
only subcontractors and emnloyees who are in comoliance with ORS 701.055 will be used 'on this ~roject.
IWIE(please print) II/AleE. U), $771NUi.lj SIr.iIATURE _~,.~
r FO~ OfFICE usr-OrJlY'" { I
Units Sq. F.tg. riain x: Value
Occy Load Sq. FtQ. Access x Value
Occy Group Sq. Ftg. Other x Value -/
TOTAl VAlUATIOIlr 4'33/':;."""
<....--2 ,;
omfl ~f7
J
Zone
Type/Const.
Bedrooms
Fire ZonE'
Flood Plain-
Stories
BUilDING PERI,IIT
Charges an~ \
Surcharges /' r
, 0 'Plan Ck.
____~Q.~__ 65%1Bldo
., 53 Plan Ck,
eX. 30%/Bl da
Fence
COIIJnIl nd
Per Fpp
Res
Per Fee
'Systems Development
Cha rae (1. 51,)
PlUt1BING PERMIT
Char..ges and
Surcharges
------------
I 061110
I Sidewalk
I A/C Paving
~_-__-__----: Curb Cut
ITotal Comb. Permit
ElECTRIC~,l PERI:IT
Cha rges and
Surcharges
11ECHAflICAl PERMIT
Charges and
Surcharges
TOTAL
S3,b3
-'
.
~-~
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax Lot 100. lane County Map Reference
17 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examolea heat/electrical ceil;nq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- Tflnew project. check-nfw - if addition.
check add, etc.
F. Building pennit information:
1. example ~ construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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 TEAI'I ArID 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 OOT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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.
V. FOR OFFICE OSE ONLY
J
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
~
PERMIT VALIDATION
lf~~1~b
q / ( ( "'~ 1
,-
Permit Clerk
~
Permit applicant exempt from registration with the Builder's Board because:
---j
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date