HomeMy WebLinkAboutPermit Building 1987-1-23 (2)
11lFORtlATIOii Lt;lt. II
726-3753
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--Fence Demo Change/Use
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IIISPECTlOiI LWE
726-3769 '
Job Address 51.//5 /fIImAI
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(i,Y Uf SPRI;lGFIELD
Cm1BIiIATlON APPLICATION/PERMIT
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J Ranoe _ -
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Bur;.lr:inn "Pe,,,,,... InfO: Describe I.Jork( Le..
PhoneU7-~~ Familv I'!esidence Ui th flttached r,ilraqe)
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EtlERGY SOURCES:
He.t
!'/ater Heater
l.ega1 Description / 7-1')') ..,~ -1!'1 () _~'? C)(~
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OwnerC;M'(-\'J{:\,,1 S7T'e_f.~ ,~:C )f'.
Address 'l7. (), 'i3n..r 5.;;J, ~
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Construction Lender A/oJJE."
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Address
Ut~l(irl ff.J\r1
{name)
Phone
(address)
SIMI...J,J! ::;-rf>!?,e;. -:[;\)1".
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CONTRACTORS I name i i .ddress j
Gener.l ,4A/rUF':<~ ("dL,IM('crtPS,lrfl. ?f1, 'lfw /J/'It,
Plumbino Ifl}/~p. <; : <::rAiC: .[}LfJl>.. 'LJr.
Electric.l ;:: tf r-::,,1i,~.4-, /j)lJt.lb. Y<;U';J$, :TNr,
'Iech,nic.] l-/-fJj:J7n,.j C;;/-rr-:r Al",-.-A-C (Y,.',f1...Jr_
Primary
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I HAVE CAREFULLY EXAl1INED t~e completed apn1ication for ~ermit. and do hereby certifv that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done. in acco~dance with the. Ordinances of the City
of Soringfleld and the Laws of the State of Ore(:lOn pertaining to the work described herein, and that rw OCCUPA1KY \.0'111 be made
of any structure without the permission'of the Guilding Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that if exemot the basis for exemntion is noted hereon, arid that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this ~roject.
It~~ t(N$Ac77Jk"S 477'), , /f'
t1AIIE(ple.se print) .::J7JihJ .-) 'ntJI7i-Ai ';vP.J/:' 'lr,iIATURF.~id. ~ ..f..ee:..s,_DATE Ik,/87
. -----:LO!( 6F'F r CE USE DilL yt
20ne C<::.- ., TYOe/const~ ~Units So, Ftg, II.in x V.lue
Fire Zone Bedrooms Ocey Load SQ. Fta. Access x Value
Flood Pl.in Stories Occy Group.11,;z. Sq, Ftg. OtherM<!"R/....... /1~~< V.lueB9. 5'J2:>. ..a.;
, .~ ,/'.'-/'/.-',-/1'.:.... ;:-:';~_::.;.?J;::-I/ 7- :,.~-:.~.::r-:~ ;..'....."' L~,':~=.::) ,:;;,..1,., ~~"::) ~_'(;:"i':=' .-~... /. :", (:.J...\::..... ...,::~::;;= /~ ..~~~~- V~;~~TI?f':_D\_
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~~~~~~~G.~~RHlb;>, ___Lfq-,,_~!:?-' ~~~~B~~~ ~~:.'"~~~d \ I 7/. 33 ~?:~~~~s(~~5~loRment 'I 1J-cLI-.
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~~~~:~~G.~~Rlm , ___~_~?~~~J F~~ce I IU-
, S"!:.Ch.rg~~ _ _ _ 3.90 Domo I
l ELECTR ICP,L PERf:lT I/Jr. .,..." ,Sidew.] K I
Charges and _ __/..V/'
Surch.rges___.. V /.1. ..,.:;:. ,,' A/C P.ving I I
~ , ~ <' ~ Tota Comb. rermit
flECHANICAL PERMlT---,_IS~..-'a Curb Cut
Charges and ________.____
Surch.rges l,:, , . 6,0 I
Structura 1
Electrical
nechanical
(lie,,-_ no. \ (exoirpo;\
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I MECHANICAL
I ~~~ I r\.1ARr.~' tJO
PLUlIBIrlG
ELECTRICAL
nO'1
/3 Each Single fixture
!Relocated building
(new fix. additional)
IS.F. Residence
(] b.th\
Duplex (1 b.th) e.ch
I FFF I f.HARGF
"0 I
Residence of
SQ, FT,
INew circuits alts.
~~ or extensions
I SERVICES
7.50 9?StJ
furnace/burner to
BTlI's
fn.5'
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I Floor furnace
and vent
Recessed wa 11
50t1cp hp~tpr ~"rl'
Additional bath
I Apo 1 i ance vent
seoaratp
Statiop.ar'l evao.
cooler ~ .
2 Vent fan with
sinale duct
Vent system apart from I'
heating or A.C. .
Mechanical exhaust
hood nnd dlJrt
service
Temporary Construction
Changp in existin9
rp}idf'.nre
multifamily, comm. or
Tnou"-trit11
1 \!ater
I Sewer
Storm Sewer
Of
amps.
COffi~,/IND, FEEDERS
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1.r~ ::>/, Ljl, ,1/) LIl,'\.\
T L,IOI' ,
yjl ,'It) ,'ol.,q , "-4, 1'9
Install/alter/relocate
rli<:tr-ih fPPr1pr<:
I [Of
/ I ~oo /:.,..../)1
Wood stove/heater
225'
amps.
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TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be va1i1 until the
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'77.S~ I TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
ISSUANCF OF PFRmT
/t!)S. e><> TOTAL CHARGES /7//#.
Electrical Contractor. the electrical portion of
Surervisor and returned to the Building Division
I TOTAL
aui Id Single
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COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
I!.
Applicant to furnish
A. Sob Address'
B. legal Description
1. example~ Tax lot 100, Lane County Map Reference
11 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilina/or forced air qas
2. examole- waterheater/eJectrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
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 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 TEAM AND CONTRACTDRS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jOb site
corrections. etc.
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 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 th~ electrical label.
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.
Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans \.lill be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
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V, FOR OFFICE USE DNLY
Permit Clerk
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III.
PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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name
L~lJ"Hc!F ?c...~i!jTf' signature
4:.:'_fJ'~--'? date /-2,fi:-;5:?
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