HomeMy WebLinkAboutPermit Building 1980-10-28
1'\,:)1;* FJ:R 2 Q 1980__
CITY UF SPRJ;IGFIELO
COMBI;IATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat rhl+5 a EL~
Water Heater .
I Ranqe
ValuE of Work: ~.~.LJ'
$28,889.90
BuilGiM Permit Info:
nre Phone 7-17-7 )fia1l1ilv ~esidence Hith
747-75641
Construction lender Veterans of Foreian T,'Trtr~ I
53'1 . S " .' f. 11747-7%41
Address ~. HaJ.n t, .,nrJ.ncr. J.e C PHone
O!:~IGr~ TEArI (namel {address}
\
,
-II1ISPECTIorl,-~ '
726- 37 69
Job Address5344 Main St, SnrinQfie1d. Ore.
Legal Oe.cription ~ax Lot 6506
,
Map No, 17 02 33 3i
Owner' ve~erans of Fn:r:~5. o:rn War!'
5~4~sMain-St. SnrinQfie1d.
INFORJIATION Ll;k
726-3753
Sq. Ftq. Hain-'7.:l.7
~q. ~tg. Access.
Sq. Ft9. Other
UewJ(Add Alter Rep.
~FenCl Demo Change/Use
Other - -
~
---
Build Single
'-----'
interior' finish)
(1 ics. no.)
(exnires)
Structural
Primary Vet~rcni~ of F':'.'.~~_i_~n t'lars SDrinc;rFip 1 n, nrp("1("'H1'i,
C::ane
Electrical
. C.t~Ii'RA.cTG.~S
(narr:el
Genera J
C1!j:::bir:o:
~j~~.trical
"~<:"~~~,=~1
PLWmWG
':.i
) CHARGE
A 7 ,n- 'hC.I
--' L-
"i~
y",
(exnires) (ohnnp nn ,
~;}mp
(addrpss)
nino no.
ELECTRICAL:
MECHANICAL
.. ~ i r
SQ. FT.
I
I
I
I
I
I
I
I
I
I '. ISSUANCE OF' PFR'IIT
TOTAL CHARGES J TOTAL CHARGES I TOTAL CHARGES /
WHERE STATE L'H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penilit
shall not be valiJ until the label has been signed by an Elect~ical Supervisor and returned t~ the Building Division
IEac" singie fixt~re
:?eioca~ec ~ui'd;n~
I <new fix. additional)
" S.F. ?esioence
n bath \
IDuplex (1 bath) each
_____IAddit1onal bath
~Iater service
Sewe r
. Storm Sewer
Residence of
furnace/burner to
BTU's
'I
L
iUl
IUl
I~
j
,
New circuits alts.
or extensions
I Floor furnace
and vent
Recessed wall
~n~r.p hp~tpr ~nrl
(ohone no.
I
I.
L.EEL.! J:liillilil
./
I
I
I
I
I
I
I
. .1
I
I
I
I HAVE CAREFUllY EXAtlINED the completed application 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 Oregon pertaining to. the work described herein, and that rw OCCUPAIlCY will be made.
of any structure without the permission of the OUilding Division. I further certify that my registration with the Ouilder's
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted ~e~eon, and that
only subcontractors and em~loyees who are in comaliance with O?S 701.055 will be used on thls,P~ct. < .
NMIE(please print) Le..;;J(", If; r::h".,-J. f-. m;IATURE 1(:~c1 fYo~ OATE,d -"-,2~--yO
.......,. FOr! OfFICE USE DillY . .'- .- .
Tyoe/Const. V-IJ Units I So. Ftg. l14in Ji?,'7. x
Bedrooms Occy load !$:.D Sq. Ftg. Access x
Stories Occy Group ~-?, Sq. Ftg. Other x
Zone (' - 4-
Fire-ZC;-ne -rrr
Flood Plain_^ I ()
BUILDING PERMIT
Charges anc
Surcharges
<. '~t-QA6--
I SERVICES
I
I
I
<~
I
I
<'
vpnt I
1
Appl iance vent I
seoarate
Stationary evap. I
cooler
Vento-fan with I
sinole duct
Vent systeJ:! apart from I
heatino or A.C.
Mechanical exhaust I
hoort itnd duct.
I
I
I
I
I~ Temporary Construction
Change in existing
rpc;irfpn('p
mul'tir"ami ly, comm. or
1I1dustriitl
Of
IC0I1fl.IIND. FEEDERS
Install/alter/relocate
rli~t.rih^ fpprfpr,
amps
Wood stove/heater
Of
amps.!
<.
~
.~?
TOTAL
Value
Value
Value
V ALUAH OII---Z..(Yj()
PLUI1B I NG PERl<lT
Charges and
Surcharges
ElECTRIC,<L PERI~IT
Charaes and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. Res
30%/Rl1n P~r ~p~
I Fenc;--- --
I D~mo
I S~de~~~ -- ~-,--.
I A/C Paving
Curb Cut
ISystems Development
Charae (!.5~)
Total r.o~b. rermit
I iOTAL
I to. SO t
._.. ... . _. ,_._ __ .0__"'_'
------------
0/'\
:
r'
-
.
.
......
if.
Applicant to furnish
A. Job Address
B. Legai Description
1. examole- Tax Lot 100. lane County Map Reference
11 UJ 43
2. exomole- Lot 1. Block 3. 2nd Add'"
~Dr1ngrield Estates .
C. Name. etc. of owner and construction ,~~
O. Energy Sources
1. examole- heat/electrical ceilino/l
2. exarr.JJe- waterneater/electrlcal/ot p=
E. Square rootage or valuation. etc.
1. eXdMo.le- 1250 sq. foot house. 500
? e~amoje- if new project, check-nfw
cneel: add. ete.
F. Building perolt information:
1. e:.:ar.:~le - cons:ruct :;.ingle:'family h
.H::~c..~ea garJge . .
e~a~,Je - remodel existing garage if
exaiiiJie - convert single family res;
re~t~UrJnt (ch~nge of use)
u. Value of work as defined in Section 303
Structural Specialty Code
H. D~S;: G:: TEM-l AiiO CONTRACTORS
To ;void design or construction delays. S
Divlsior. Staff must be able to contact ao.
per~cns regarding design information or J(
corrections. etc.
;'bbrevia!.:d ?lu:::bing. :'lechanical, oS Electrical
A. :::(ce:r~ ,<:here biank soaces occur in the des,
=:r: i on "f ~:-:e :'lecr.an i ca 1 and E 1 eetr; ca 1 S<. IV,
tne ao~:ll Jcant need fill-in only the No. Bo}!. \dt"-
:~ ~~e aooro~riate item(s} to be installed
B. Full !'lu;;.oing. ~'lechanical. and Electrical S,
are available at the Building Division
1. To conserve space on the permit fonm thE ~hp__
have been abbreviated
Z. ~f ~he i~em(s) to be installed are not e,
~he Jbbrevi~ted scnedules you should con! ('
full schedules __
C. aUILali:G ~IVISION STAFF WILL FILL OUT ALL FEE
CHA;;GES 0:/ THE SCHEDULES
D. As notad'on the CAP. the label must
electrical contractor for signature
suoer"':isor. The general contractor
to sian the electrical label.
Applicant~to sian and date
Whenever possible. the"initial application will be
a worksneet only, Where possible. Building Oivisio
will prepare a type written copy and return it to tl
applicant at the time the actual pennit is issued fe
signature.
Fees and Charges
Plan check rees are due and payable at the time of tl
application. and no p-lans will be processed ur.til thE ('
fees are paid. All other rees and charges are due an
payable when the penmit is issued.
"1'"
,
~
J
~
.. _.0. ..~ .... ...'
COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
r
c\TY
I
Of
(
\
"
(
55033C
(
(~~.;'''''~___ -:jOeJ)
C-~_~'qn .5,0
-
~((
, '. ~
' .~
j
l
I
.Qole
i'-
,t.
I
~
I
J
I
I
2.
3.
c:" .!!.ec'd
r-
Address
..-
-"
-
(
-
l.'
(
be deliver
by his e],
is !!.2l aut
=c
G~
_.~-._ . ..~. ~a
--.-.-- (' ., ~ ---
- . d _. - .
G AmounlJl-ecel~- --' <II
I I I.
IV.
C~1
::-('
-
s..~\.to..,t..."......\.\.
f
f
1--
. ~ Permi t Cl erk
'.
.1 _' .." . . . .._
~
V. FOR OFFICE USE ONLY
I
I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'.
l
I
"-
i
I
,
I
1
,
Permi t appl icant exempt from regi stration with the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
-.9
name
signature
date
.. .."n '_.L'
d
...