HomeMy WebLinkAboutPermit Building 1987-1-23
I IrISPECTIOII LINE
726-3769 ,
Job Address 51.//5 ;t/A7N
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Cl TY UF SPRlIlGF I ELD
CDrlBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\-later Heater
-
I NFORllATION l!l'jt
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
Uew Add Alter P.eo.
-Fence Demo Change/Use
Other - -
Phonck67~~
va1 of Hork: ,g:;t-
'If 1., '1 ~ t),
Bu;]c:lna "Permit Info: Describe l'Jork(Le..
Far.1i lv f!.es i dence \'lith fit tached r.araae)
Bui Id Single
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57":
Legal De"r;ption / 7-n2 -'3. -<11 I) ~~ /!:),~
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RanQe
Address
,C;~-NA1 $meKA
'17.0. ~()\t 5.?~ '
-:I: U'..
Owner
rlA-cA<Pr-M- . Q(J.
t _.--'-~
Construction Lender Io./oAlE..'-
Address
Ut.~llir{ TEAr"
(name)
Phone
(address)
AhA) ,C:;~RAL ~rFe..In~
~--CIJ/~MbJr A-N-(J ;L1i-n1,J~
'KFIU~I'lf..L /D~../ / A,J/) ffA.f"5,~1J.../.
fliel" no.) (exn;res) (ohon/no.
q7 D/S
SA+F.uJAf ~71)RL.<;, :J;.JC.
Structural ;Jf')vE.. Ah S-r;e.vc;;-,/A-f_
Electrical F~r!7PAt.M..... ~AJ~c..;n').Q
~~~~~~~~~~S Mfn~~//01- tf,AfrP~~~
Genera 1 MMg.:r Cn:n-~;;7)~ ).rll. ~f"I. 1JrM 14/t/&,
Plumbino AWpc" f <:::""Ie. VL4. ' ~Ir. I(
Electrical 1t';;~;iit~ ,))IJU,f,. YsU>lJs,..:z;,!t, "
Ilechanical ,J C;W;:;-It/~ t!n;'b..J(' _ /I A/odE..
Primary
.c, A.1A r..
IUOIZ,y 'i?hlo IIf=,
. -
{)&~1!...._-t&IJ
(lies. no.) (I"!xoires)
rl(~ ILJ ,01<, 97:1/:1
..2.~-.:5oS~A
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(ohnnp nn f" -- _.~
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13 lEach single fixture
I Relocated building
(new fix. additional)
I S.F. Residence
11 bath]
1 Duplex (1 bath) each
Additional bath
I FEF
r.HARr.E
Nn I
Residence of
'OF
eorr,A-L.
MECHANICAL
I ('I-IARr,~ NO. I
furnace/burner to
BTU's
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SERVICES
rn.5'
1
1
I Floor furnace
and vent
1 Recessed wa 11
c;n':H~p hPlltpl'" ilnrl
1
I App 1; ance vent
seoariltp
Stationary evao,
coolpr ~ ,
2 Vent fan wi th
c;.innle duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hnort nnd dlJ('t
\lpnt
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I OF:, i r"~~' i
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PLUIIBJrIG
ELECTRICAL
7.~ 91.50
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SQ, ET.
New circuits alts.
~~ or extensions
Sewer
ITemporary Construction
IChangp. in existing
rps i dJ'J'Ire
multifamily, camm. or
Inrlllc;,tr;;l1
, 1
~.w b.~'
\!ater service
Storm Sewer
Of
amps.1
Wood stove/heater
'1$1>
I
I
com,!, /IND, fEEDERS
1 Install/alter/relocate
rlidrih fppc!pr,
/
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1
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L Of 2ZS- amp~
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1 ISSUANCE OF PFRrIIT
~7.S<t) TOTAL CHARGES /~. <!>c> I TOTAL CHARGES 1/1/#. is:'-''
that tile Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
17..sc:l
YS.,
TOTAL CHARGES
HHERE STATE L~H REQUIRES
shall not be vali] until the
I HAVE CAREFUllY EXN1INED the completed apr1ication for ~ermit. and do hereby certify. that all information hereon 1S 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 Orel]on pertaining to the work described herein. and that rw 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 ons 701.055, that if exempt the basis for exemption is noted hereon. arid that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this ~roject.
MtreKiE;:f CoAlte,qc..-Z>k!,s ,(..rO. // dill
IIAI'IE(please print):::J1Jt+rJ --r ~ '~SLSIGIIATURE' /.~ &8,
. , FOr. iJfF 1 CE USE OHL 'r"
Zone c<::- Tyoe/const3~ ~. Units Sq, Ftg, liain 'Value
Fire Zone Bedrooms Occy load Sq. FtC1. Access x Value
Flood Plain Stories Occ,Y Group..ll,2. Sq, ft~, Other~R/""" /7~ Value ~ 5'J2::>. ....
"D A '. .L-.....~ =_ _ ~,R.._ _ TOTAL VALUATIDII
rJe->/<-&>/~, eR~!?'-r== (;HC-~o 4;)>' :?~~ ~ ~t'i'd5' ,t~ =CJrC-'/r~.,"':
. BUILDING PERHIT /L//) """0 Plan Ck, Conn/lnd Q/ ~3 Systems Development .t / )I
Charges ant: . ____?~~_~_G__ 65%/Bldo p.P!" Fpe /, ..;7, Charfle (1.5~) p~.
~rchaLoes r 6, Z Plan Ck, Res ,
"(,"""'I#77~N~~ ~ .. 30%/Bldo Per Fl:'e
. PLU/1B ING PERMIT ., ;7. S"o Fence
Charges and ------______
Surcharges 3. 9t> D~mo
ELECTRICP,L PERI:IT ___ IA.". ~# I Sidewalk
Charges and t.V~
Surcharges '{. <.:> I A/C Paving
I1ECHANICAL PERMIT Ie ~ aa I Curb Cut'
Charges and tJ
Surcharges ------~-60-1
DATE~,~/8'7
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I
. Total Comb. r'ermi t
I
1 TOTAL
Q63:6S
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COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100, Lane County Map Reference
"1; 03 4)
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air QdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- 1l'Ilew project. check-n€w - if addition.
check add. etc.
F. Building pennit information:
1. examole - construct single family house with an
attached gar",ge
2. example - remodel existing garage into family room
3. example - 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 TEAM 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 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, BOILDING 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
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 USE ONLY
, ~ PROJECT CONOITlONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIOATION
i
B Icl1 d.-11
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Permit Clerk
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Perm~t applicant exempt from registration with the Builder's Board because:
~ CnIVA/l..ilrIA-L
Additional Project Information:
a/LJ
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PLANS REVIEWED BY:
iAJ/Bo~
/ .
A ),..,.,.- e-cA)/~
J
name
L::JlJ"/lL ?~i!jIj' signature
4'7 _ r:,~ date I-::Z Si? '1!? ')
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