HomeMy WebLinkAboutPermit Building 1986-9-11 (2)
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'.IIliSPECTIOU LlUE
726-3769 '
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Job Address
LeIJal Description
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- CITY OF SPRIliGFIELD ,.. '--
COMBIUATION APPLlCATIOU/PERMlT
E!IERr,y SOURCES:
Heat
Hater Heater
J:; <1:../ 5' J:f1!J..U1) c.+
L7-/}?- '?'"3'- q~r ~""'-?-...........
INfORJ1ATlO~ UIlt. I' ·
726-3753 ~
SQ. FtQ. 1'1ain
~Q. !='tg. Access.
SQ. Ftg. Other ~
flew Add Alter ~ep. ~ .1
-Fence Demo Change/Use '-'\}
Other- - ~
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Describe 14ork{ Le.. Sui ld Single II
Attached r.araael
PI, ,,12 ff1A'I if.i.a.ue.O {\TAi(/"""";1
RanQe
<':T~"'~~
.":2<
[IV" .
Va lJE of Hark:
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Bui1c:in Perm; t Info:
Far:1ilv rlesidence l'lith
Owner . <:. ~I
Address P.,.., ~r.>l<
Phone
r l,,<II"r't1A <
Construct inn Lender
Address
[Jl:.~ I (ir~ r EAr1
Primary
Structural
El ectri ca 1
I~echanical
CONTRACTORS
'2..t)~.
IAlS701 J
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1
(ohone no.' i
(name)
Phone
(address)
(exniresl
(lics. no.)
IA
~
~
(namel
(address)
(1 ice;, nn.
(px'1irpc:, \
(ohnnp no
Genera 1
M;:I'l!llp'-f rOI7JH.Ad..~ <
<;'1:2/2
L.:Y
p,,., Ro~' 1'l./IJ.j.,
P"pTl"o".d /'Oil.,
Plumbino
Electrical.cL<2'~~
P,lechanical
~~w..:e.vU C,'t'Jd.Jt::
'~
...L W...
Pn't.IIA"-'''}/;)/P C!/7'7J?
p;) q A Y ," l.!it,
PLUIIBIIIG
"0'1
Each single f~xture
IRelocated building
(new fix, additional)
IS.F. Residence
f1 bath)
10uPlex (1 bath) each
Additional bath
ELECTRICAL
fI" I U:r,
Residence of I
SQ. FT.
/' New c;rcu~ts alts. I
or extenSlons _, ~
LOP N?_~ ~_'
SERVICES I
I
V ~.F8/<;:;.U~ur:
Apoliance vent
..eoarate
Stationarv evao.
cooler - .
Vent fan with
sinale duct
Vent system apart from
heatina Or A.L
Mechanical exhaust
hood and durt.
~!a ter serv; ce
Sewer
-I
Storm Sewer
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MECHANICAL
I FFF I r.Hi\RGF
'r"~"o
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rlJAB.!iE.
furnace/burner to
BTU's
~
Floor furnace
and vent
Recessed wall
~narp hpatpr and vpnt
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kG, <>c>
ITemporary Construction
Change in existing
l"p::;jdpnl"p
multifamily. camm. or
lnduc;trhl
Of
amps,
COffi1,/IND, FEEDERS
Install/alter/relocate
rlic;t.rih_ fpprlprc;
Wood stove/heater
10f
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amps,
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I ISSUANCF OF PFR!11T
:<'2.Sb .1 TOTAL CHARGES M/,'\f, /&": .-.
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
I HAVE CAREFULLY EXArlIrlED the completed apnlication for l)ermit, and do hereby certify that all infonnation 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 OreC)on pertaining to the work described herein. and that IlO 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 Or-S 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 7Ql.055 will be used on this project.
IIAI,IE(please print)
Zone G C
Fire Zone
Flood Plain
BUILDlIlG PERfllT
Charges anc
SurCharges
PLUliBlNG PERMIT
Cha rges and
Surcharges
ELECTRIU,L PERIIIT
Charges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcha rges
~'r\ (, ) .(\IQ,.{.Jt"r?
~p 4 {(J,~
OATE cy.//- y~
'.
S I GrIA TURE
FO~ OFFICE USE DilLY
Sq. Ftg. f1ain x Value
Sq. Ftn. Access x Value
IR-? SQ, Ftg, Other,.t:Y. ~n,~.'~'/~,_~alue
TOTAL VALUATION
~.?.72~"'"
Tyoe/Const, ~~
Bedrooms
Stories
\"';;>7;:>,Un; ts
Occy Load
Occ.v Group
27t:..1. """ Plan Ck. COlllll/lnd
. ______~~____ 65%/BldCl P..E"l'" Fpp
q Plan Ck, Res
/0, /6 30%/Blda Per Fee
h-E.~<1'R,:Z"___ J Fence
/":>",. 'EO I Demo
22-':>= Sidewalk
- --- -- -~--7';-1 A/C Paving
~____1~~_: Curb Cut
Systems Development
Charae (1.51,)
_/78. /1
//4
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. , I
~L.~-7 ..../T/;:r6C.. I
#;- '? ?7 '=? c..
,2=
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ITotal COMb. Permit
I TOTAL,
9' '2"3, 96
Itf5CJZ:87
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COMBINATJON APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax lot -100. Lane County Map Reference
11 03 43
2. examole- lot 1. Block 3, 2nd Addition to
Spnngr ield Estates
C. Name. etc. of owner and construction lender
" Energy Sources
1. examole- heat/electrical ceilinQ/or forced air oas
Z. examole- waterheater/electrlcal/or solar
E. Square rootage or valuation. etc. -----
1. examole- 1250 sq, foot house. 500 sq, foot garage
2. examole- if new project. check-new - if addition,
cneck add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garllge
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, OESIGN TEM1 AND 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
8. Full P.1umbing. 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
fu 11 schedu I es
C. BUILDING OIVISION 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 th~
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 Q;ILY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT'VALIDATION
:P67~S
13 t::. /0 '37
(7c;: 700;7C>
7"t3. 0 7
::<3'- 60
1)--: 60
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Permi t
Clerk ~____
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Permit applicant exem~t from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:,
name L.-!;>R~ ?c:.a::::t!9?
Signature~~_~
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da te 9-/'S--fiS6
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