HomeMy WebLinkAboutPermit Building 1986-12-31
'I IrISPECTIOII LIflE
726-3769 '
.
Job Address
,)'312
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Legal De5cr;ption
Owner
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Address
Construction Lender
Ll91
Pr"l?~(~i-
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Address
UESIGfI I tAil
(name)
Primary
Structura 1
El ectrica 1
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C 1 TY UF SPR WGF I ELD I NFORl1A TI Oii 11 iit.
COMBIilATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: So. Ftq. I,;ain
Heat ~q. ~tg. Access.
Hater Heater Sq. Ftg. Other
flew Add Jl..lter Reo.
RanQe -Fence Demo Change/Use
ValUE ~f Hork:..R/tt[} Other--
Buildina Permit Info: Describe Hork(i..e., Build Single
Famil y nes; dence I-Ji th ,I'l,ttached (ia raae)
....\hji)~AJII7 . /l,? O./) /.k ./
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Phone 7 if 0
R'r2 3 ()
C:>
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VVv.,..,,+
Phone
(address)
(1 ics. no.)
(exoires)
(ohane no.
1\\ ..-" c.. '\
AV.~'i '
_A "
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Ii K~J
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t1echanical
CONTRACTORS (name 1 (address)
General Iflr2RV HIlRtEN / Ket/ limo
I /
Plumbina
Electrical
~'echani ca 1
PLUIIBIIIG
lID,
FFF I r:HAR(;E
Each single fixture
IRelocated building
(new fix. additional)
IS.F. Residence
(1 balhl
IDuPlex (1 bath) each
IAdditional bath
~!ater service
Sewer
I
I
I
I
I
I
I<i'J w!. ~ '0
'\~/n )
'\Ji
Storm Sewer
TOTAL CHARGES
WHEnE STATE L~W REQUIRES
shall not be valil until the
f1 ic'i. no.
(pxoirps)
'1-t1
(phnnp nl'l )
1lfb - ~:l3<J
;3i/;r1ts
ELECTRICAL
MECHANICAL
NO I
Residence of
I 1="1="1=" I rl-l.ll.Rr:;1=" ~JO I
furnace/burner to
SQ. FT. BTU's
1m
I fl-l.ll.Rr:;1=" .
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~r:p hp~tpr ~nrl v~nt
ITemporary Construction
IChanoe in existing
rp~ i dJ'Jlrp
Imultifamily, comm. or
Tnelll<;.triitl
Appliance vent
'ipoitr",tp
Stationary evao.
cool~r v ,
Vent fan wi th
<;.inole duct
Vent system apart
heatino or A.C.
Hechanical exhaust
honel .:tnd e1urt
from
IOf
amps.
CO~1./IND. FEEOERS
Install/alter/relocate
.rli~trih f~~rl~r~
Wood stove/heater
Of
amps.
I SSUANCE OF PFR!1lT
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Ore()on pertaining to the work described herein, and that rw OCCUPAIKY 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 ORS 701.055, that if exempt 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.
IIAHE(please print) Lt.f"L{ ~,OS dell SIGrl^TUR~"
'F6~ OFFICE USE O!ILY /',
Zone Tvpe/Const. [Jnits Sq. Ftg. f1ain
Fi re Zone Bedrooms Occy load Sq, Ft9. Access
Flood Plain Stories Occ.v Group Sq. Ftg. Other
I 0 00 Plan Ck, ConmlInd
- . 65%1Rl do ppr ~pp
---------;-'O-PTiin Ck, Res
. ~ 30%/Bldo Per Fee
____________1 Fence
Demo
BU I LO lUG PERfil T
Charges an': <""'L
Surcharges r
PLU'1BING PERMIT
Charges and
Surcharges
j) J..b."/~ omf, -31.q~
,
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
CharQe (L 5~ 1
"ELECTRICP,L PERI:IT Sidewalk
Charges and -------_____
Surcharges A/C Pavi ng
!lECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
Total Comb. rermit
I TOTAL
la,Lm
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COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100. Lane County Map Reference
17 U3 43
2. examole- Lot I. Block 3, 2nd AddiIion to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinqlor forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. 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. 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 SecIion 303 (a) of the
Structural Specialty Code
H, DESIGN TEN~ 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 fil1~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. 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 1S 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 USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
II
I
PERMIT VALIDATION
I
,
f3r; 700/
I 2 -3 ( - t to
Permit Clerk
C(!
'I
Permit applicant exempt from registration with the Builaer's' Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date