HomeMy WebLinkAboutPermit Building 1991-3-1
IIllSI'ECTIOIl L1IlE LIlY uf SI'RllluflELO ,
726-3769 ' COIIBIIIATlON APPLICATION/PERMIT
Job Address '''If? 2'3' )vI fA il/l J-{)1Jp YV~.si:l ~~:~r,Y SOURCES:
I..gal O.,cription 1702 3Z"32--()f1t!u I Hat.rll.ater
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.~rd "'a..{.,~<;"~..-~~ ';JAfn7i~111 Valu, of Ho~~: 31~~8q
Own.r ~7?'( lAJis+ I htvLdc t3-7;?i u. t./U
AJdress Ir\'? / ,;n.,' l1'I{J-;A~ I;)". Phone ",,[._1 uiltiino P.rmit Info: O.scribe Ilork(i.... Build Single
.K..J/-1 - In ,., rVl..{(l FI>.-_ '7 tYO-f Farnilv nesidence Uith I\.ttached (jaraoel
CY) ()JDSf> ,{lfr fqzt,?:Je. 295 (g3'1-'1'1of ,_
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726-3753 I
So. flq. '-lain
~q. rtl), Access.
SQ. Ftg. Other
lie,,, Add P.l ter :~eD,
--rence Oemo Change/Use
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Phone
address
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Construction lender
Address
eXOlres
no.
Electrical
hone
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Primary
Structural
!lechanical
CONTRACTORS
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(name)
(address )
C I ics. no.)
(exoires)
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G.neral IAI".C. it/--n /A~.~.U-___. ,
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PlumbinQ LtJ 77/-,J'>>;!?/~ , -:;>fl/~<L#~ LJ"'?A:t't:::.
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Electrica~R<(;o c.,7'~~.
".Chanic'al~~fi~'hw.z::; ";':5;40"'1' ~~,
PLOrIG IrIG
HF rllARGF 1...llO.-1~
Residence of
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MECHANICAL
ELECTRICAL
Each single fixture I
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each I I I
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-'12 I .rA....~1 I., /Install/alt.r/relocate
/7/~13lFJ'f ~ ~~~~ ctic:tr-ih. fPPl1pro;, .
'74bM~,~_"A,~_:Of
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sq. fT.
furnace/burner to
BTlI's
-----/Relocated building
(new fix.'~dditional).
IS.F, P.esidence
n bath)
I Duplex (I bath)
New circuits alts.
or extensions
I Floor furnace
and vent
I Recessed Wit 11
'~n~cp hp~tpl" ~nrl
I
I SERVICES
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'Additional bath
~!ater service
ITemporary Construction
IChanqe in existing
rpc: j 1~n"'r.
Imultifamily, conJ!l, or
Inrlllc:triill
IStorm Sewer
10f
ICOI~I.!INO.
amps.1
I Apol iance vent
<;poa,'atp
I Stationary evap,
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatina or A.r..
I ~1echanical exhaust
hond ilnd riurt
I Hood stove/heater
Sewer
FEEDERS
amps.
J SSUANCf OF PFR!IJ T
TOTAL CIlARGES I TOTAL CHARGES
I-HlEnE STATE UU REQUIRES that tile Electrical work be done by an
shall not be val H unti I the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contrac or, the electrical ~ortion of this permit
Supervisor and r~turned to the Building Division
I HAVE CAREFUllY EXNtltlED the comrleted aprllication for ~ermit, 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 Ore,:!on pertalning to the work described herein, and that UO OCCUPAUCY \"i11 be made
of any structure without the permission of the Duildinl) Division. r further certify that ITlY r'e~istration ",ith the Gullder's
Goard is in full force and effect as required by ons 701.055, that if exempt the basis for exemDtion is noted hereon, and that
only subcontractors and employees ,,,ho are in comoliance with Or.S 7~1.055 ,.,ill be used on this nroject.
IIM1E(please print) H
WA-tGtfTs1r.UATURF )./._f W~p DATE 3/1/"1
fO~ OrflC[ lISE ~Y #'
TYDe/const..~~~nits s~. ~~~~ x Value~7./27
Bedrooms Occy Load hi!?; 3' Sn. Ftn. Access~..._" Value j;:-i,9SC>
Stories / ncc.y Group .N'-:::::> SQ. Ft~. Other~ I... ,i...~. Value '2?>:;U>7
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f~ TOTAL VALUATIOI~.:z.gy'-
3&Jz,. 4!S
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Zone c:::. tC...
Fire Zone
Flood Plain
BUILOIrIG PERI,lIT
Charl)es an~
$urcharQes
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PLOP1BIIIG PERMIT
Chilrges and
SurCharges
__8Z4?:.~___
~. 9::f
Plan Ck,
65%/Bldo
Plan Ck.
30t/Bldo
I Fence
COIllTl/lnd
Ppr F'pc
R-es
P~r FeE>
Syster.1s Development I J~, ...;.a, . .".r-
Charne (1.5') L4-'7~7. ""'==>
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ITotal (omb. rermit I '722. "/~
'Demo
,[L[CTRICf..L rERr~1T
CharQes and
SurCharges
11ECIlANICAI. PERI11T
Cha rges and
Surchar'les
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Sid.walk
I A/C Pavin~
I ~urb Cut
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'I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. APPlic~nt to furnish
A. Job Address
8, legal Description
I.J examlJle- Tax lot 100, lane County Map Ref~rence
' II uj 43
Z. eXdnlIlle- lot l. Block 3, 2ud Addition to
Springfield [stales
(, ',Name. etc. of owner and construction lender
O. Energy Sources
1. !l eXdm~lp._- heat/electrical cci.!J.!1.~/or forced di~~.
2. i examole- watet'hedler/elecl,.ica!/or ~
E.. Square tootage or valudlioll. clc.
I. II~Ole- J250 sq. foot house. 500 sQ. foot garage
2. I' eXdfllp'le- if new project. check new - if addi tion,
I Check add. ete,
f.; Building pennil illformalion:
1. examnle - construct 5jny)e family house with an
attached go1rllge
2, :,examole - remodel existing garage into famlly room
3, :exdllmle - convert single family residence into
,Irestaurant (change of use) . ,
G, Va lue of \'1ork as defined in Sect ion 303 '(il) 'of th~"": ' . , .....
,~trJ:qu.ral Spec,idl,lY:C.ode' -:.... -", ,':''::.. ~.. ,":-.....-.~,
H:-OESIGN TEAI.I AND CONTRACTORS
. To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
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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 ~pplicant need fill-in only the No, Boxes adjacent
to the appropriate itern(s) to be installed
8, FullllPlumbing, Nechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. llf the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ArlO
CHARGES 01/ THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
elect'rical contractor for signature by his electrical
super'visor, The general contractor is !l2!. authorized
to sign the electrical label.
III. Applicantllto 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 i'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 lJOtil these
fees are p'a id, All other fees and charges dre due and
payable wh'en the permit is issued.
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V. FOR OFFICE USE Ol/LY
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PERMIT VALIDATION
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PROJECT CO~DITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder~s Board because:
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Project
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I n forma t i on:
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PLANS REVIEWED BY:
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name , ~HE~L~6PFS igna ture
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date
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