HomeMy WebLinkAboutPermit Building 1989-5-16
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!1echanical
CONTRACTORS (,h1me) (ilddrec;c;\ (lic". no. I
A"L 7) f//7s-" ,;y.e;/~.~~ >>,",. //...~
General / /X/></ fj.. ~y';; t":, ......_;:,~ <:" ~_ ~;''''I 7 -/ /7?
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PlumbinQ ;?~
Electrical~~m'~~ .'
Lrrr flJAllGl:UlIl....J
.-furnace/burner to
BTlI's
Floor furnace
<"2'-$) and vent
I I Recessed wall
~~ilrp hp~tpr ~n~ ~pnr
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12
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-:::< Z- 5-&> I TOTAL CHARGES
PI HiSPECT IOU LlIIE
726-3769 .
. LIlY ur SI'RHiGflELU
. COIIBIIIATlON APPLICATION/PERMIT .
I E!IERGY SOURCES: .
Job Address 5":~<'3 M#//V "iT IIeat
'-tater Ileater
le9al Oec;cription
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Valu€ of Hark.:
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lluih:inCl Permit Info:
r"r.li 1 v nee; idence Ui th
Phone
e::9A:. ZJ .
Construction lender
AJdres5
UE51Grl Itl\/1
lnall1eJ
Phone
(address)
Pri ma ry
Structura 1
Electrical
t1f?chaniCi'l1
PLOr1BIIIG
ELECTRICAL
i:U,1
~IEach single fixture
-----'Relocated building
(new fix. additional)
IS. F. r.es idence
() bath I
IOuplex (1 bath) each
[Additional bath
Hf . rllARr.f
..lliL '
Residence of
7.S-a ~7--S-~
, /' flew circu!ts alts.
or extenSIons
-? ~;;r h>26/'i'"t!O
/SERVICES
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sq. fT.
ITemporary Construction
ICllanqe in existing
fPC; i dp':nr~
Imultifamily, conlf!l. or
TndlJ"triill
~!ater service
Sewer
ISlorm
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6 7~S-O
IOf
I COI~L II ND. fEEDERS
I Install/alter/relocate
di"trih fppdpr"
IOf amp,,1
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I TOTAL CHARGES
Sel'Jer
amps.1
TOTAL CHARGES
r.JIIEp.E STAT[ L.irJ REQUII1ES
sha 11 not be va 1 H vnl i 1 the
fNfORllAT: .:, LI..:.
726-3753
So. flq. "lain
~q. rtf). Access.
SQ. fto. Other
rte," Add P.l ter !~eD.
-rence Demo Change/Use
Other -- -
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IrJ
Describe Hork( i.e.. Sui Id Single
f\.ttached l1araoel
(1 ics. no. 1
fexolfPs)
(ohone no. I
{pxnirp.., \
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(ohonp no ) 1
/2> .2-~1
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MECHANICAL
iT
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I Apol iance vent
<;pOill'atp
I Sta"tionary evap.
C001H
I Vent fan with
s ioole dl/l'''f
I Vent systeM apart
heatinq or A,C.
I Nechanical exhaust
hood C1nd durt
I Uood stove/heater
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from
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ISSUANcr Of PfmllT
~AI'.
/,"): .,......
that tile Electrical \-iork be done by an Electrical Contractor, the electrical Ilortion of this perr.J1t
label has been signed by an Electrical Supervisor and returned to the Building.Division
I UAVE CM~HULLY EXNlItlCD t~e completed apnlication for f)crmit, and do herebv certify that all information hereon is true
and correct. and I further certify that any and all work nerformed shall be done' in accordance with the Ordinances of the Clty
of Soringfield and the Laws of the Stilte of Ore!)on ~ertaininlJ to the work described herein, and that UO OCCl!PAIlCY \'1111 be made
of any structure without the permission of the Ouilding Division" I further certify that my re9istration with the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemntion is noted hereon. and that
only subcontractors and er.lployees who are in comoliance with OP.S 7f'!1.D55 \"Iill be used on this nroject.
IlMIE(please print) S Ir.iIATURf
FO~ Orf I C~ USE DilLY
Zone C"-; lyoe/Const. 5:?V I!n"fts Sf"!. Hf!.
Fire Zone Up-drooms Oeey Load "5/ SQ. H!:,,,
Fl ood Plain Stories / Occ.y Group }?--;> Sn, ftg.
D~.TE
flain )( Value
^ccess )( Value
Other/..?..Sfl /~e.;5.;~ ~"Value' /=?
TOTAL VALOATlGrI
BOILDIIIG PERlIlT
Char']es an':::
Surcharges
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Syster.lS Development
f':,p"3 S-~~ CharQe (1.5..)
"Plan Ck.
65%1Bldn
Plan Ck.
30%/Bldo
Corrm/fnd
~p,. f"pp
Res
Per Fee
pLOI.mING PERMIT
C~Jrgcs and
SurCharges
----"J~__~~_
r. "7 ."3
67. sa 1 fence
------~-38-1 Domo
-::?7-J'O ISldewalk
- -_h_/--;3--1 A/C PavinQ
. /s..-= i Curb Cut
-_h_h,-;;,S=:--1
,ELECTRICf..L I'ERr~lT
Cha rQes and
Surcharges
llECIWIICAL PEp.r1IT
Charges and
SurcharC)es
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Ilota1 (omb. rermit
i iOTAl
21'3.~'9
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COMBINATION APPLICATION/PERMIT (CAP)
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I. Applicant to furnish
;A. Job Address
B. legal Description
1. example- Tax lot JOO. lane County Map Reference
II UJ qJ _'.
-2. eXdmDle~ Lot 1. Block 3, 2nd Addition to. ....
~pringfield [stales ..;i~ ~...~
Name. etc. ofowner'clnd construction lender
Energy Sources
1. example- heat/electrical ceilin'l/or forced dir Qas
2. examole- waterheater/elecl,-ical/or solar
E. Square footage or valuation. etc. -
1. examoJe- J250 sq. foot house. 500 sq. foot garage
2. example- if new project, check new _ if addition,
check add. etc.
F. Building permit information:
1. examole - construct sjn~le family house with an
at lached garage
2. examole - remodel existing garage into family room
3. eXdlllule - convert single family residence"_'i'nfo
restaurant~ (change of use) :. -' " .. ~
G. Value of'work as defined in Section 303 (a) of the
Structural Specialty Code
II. DESIGN TEAl.' ANO CONTRACTORS
To avoid design or constr'uction 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 fil1.in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, ~lechanica', and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form, the schedules
ha~e 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 ArID
CIIARGES ON TilE SCNEOULES
O. As noted on the CAP, the label must be deli~ered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to s1gn the 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.
." ,C.
" D.
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If.
11f.
IV.
V, fOR OfFICE USE ONLY
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PERMIT VALIDATION . '
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
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:
name
L6'~~.PL~~
signa ture
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