HomeMy WebLinkAboutPermit Building 1987-5-12
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'I 1;;.sPECT 1011 LlIIE
p26-3769 .
LITY Vi SPRIIIGFIELD
COIIBIiIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat F.l P'=.T'T:'..(c...
! Hater Heaterf:l~_71.~_J(~
Ranne E"~~~__
I ValuE of 1'lork::'fi5.0;).?~'1
I Z5:lW<P/T'>.J,d c~Lt1:l!-
Phon~~(~~1 ~~~~~~nne~~~'~~elnf~~ ^~~:~~~~eG~~~~~l.e" Build Single
1'""KE.MottL. 0 1=/=.'/C!:: ","'A n:: 'Th .b, U ,'\.;)f..
Construction Lender l:rrUCI.E. ~.v,..lr~ f' loN.J l"fu~ AIJ'b k"Td4n-J 'E'v;>>AIV:,iO---J
AddresMs<Xl I::"~ (JA'( LAKE ~.:.u::6::) Phon.&:i5-9l.&t
Ul:.~lGfj ItN' lnameJ (address) ,
Job Address '-\-Zz:? iUA,tJ ST, ~"DR l) oi2:....
Legal Dmription 1'1 ~Orl_ 7.,~-~;j~ l)lqtffi
NfORl,,,r: .:1 L..:.l:'
726-3753
So, Ft9, I':ain
~q. ~t9. Access.
So, Ft9, Other
r~e\y Add P.l ter ~eo.
Fence_Demo _Change I U se
_Other
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Owner OJTl'ZE,r..:.8 :5.11 VJU6:. e Lop,..)
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ill kt: Clli X3)<,
Address Lf 2.0'':> 5(e..l.L9:: (lA",.
(1 its. no.l
(exni res 1
(onone no. J
Primary
Cu;u,:. -e€Sl. 66UJPMOJI bs Co.r.ouU1AL Loop
b8:7 .g'Z z. '9
Structural
Electrical
!1echanical
CONTRACTORS
(name)
(addrpss)
(l1r,,_ no.)
(pxoirpc:.)
(ohnnp no )
Genera 1
Plumbino
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A.
_.-n~
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/y"u.
Electrical
f"echanical
SQ, FT.
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MECHANICAL
PLUIIBIIIG
ELECTRICAL
i;O.
Each single fixture
I FEF I (H"Rr,F .l'n
1150197.50
I
no,
13
Residence of
furnace/burner to
BTlI's
Cf,LICHARr,F
Relocated building
(new fix. additional)
S.F. Residence
11 bath I
Duplex (1 bath) each
INew circuits alts.
.....- or extensions
..., ,-'?P N?",P&:
I SERV-ICES . -,.
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Floor furnace
and vent
Recessed wall
~oarp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
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""2"2. S-al TOTAL
Apol iance vent
seo.aratP
Stationary evao.
r.ooler v .
I Vent fan l-li th
sinale duct
Vent system apart from ,.
heatina or A.L
-- -Nechanica 1 exhaust
hood .'lnd duct
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I 'IS'o ;
Additional bath
Sewer
Temporary Construction
Change in existing
rp.c:..l ctf'nrp
Imultifamily, COIm1. or
Indllc:.tri;1l
~!a ter servi ce
TOTAL CHARGES
WHEP.E STATE L~W REOUIRES
shall not be vali~ until the
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'7'75'0
COI-lfl./IND, FEEDERS
I Install/alter/relocate
dic:.trih fppdprc:.
IOf amp~1
I I
Hood stove/heater
ISSUANCF OF PFRillT
TOTAL CHARGES
CHARGES
/,/7/#,
IS 00 !
that the Electrical work. be done by an Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED the completed apr1ication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerfonmed 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 OCCUPAHCY \'Ii11 be made
of any structure without the permission of the ~uilding Division. I further certify that my re~istration 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. and that
only subcontractors and employees who are in comoliance with ORS 7~1:055 will be used on this Droject.
689-9570 ~. .
IIA:tE(pIease printj(?~c.l:- WAF-D SIr,;IATVRE"__W;Z~ OATES-I.;> -g'7
FO~ OFFICE USE WI.( .~--,--. ~
20ne~
Fire Zone
Flood Plain
Tyee/Const. S:N
Bedrooms
Stories
Units
Occy load
Oec,V Group A -8
Sq.
So,
Sq,
Fto. t1ain
Ft~, ~~1'-~"'T
Ftg, OtherR.I"h7.::>p€<::
x Va 1 ue
x Value ::?:::S':C~-
, 1/7~ Value /5:~. ~
TOTAL VALUATION~.c> ~"'=2--
u?~ ?-?/E~r-~.s
~~~;~~~\~~RllIT ,___jt~,-9:.~__
Surcharges L/ C/"""">
&,s"'D"".N$/~""""",' 7' r'" 30%/BldQ
~;~~~~~Ga~~RMIT _nX2_€'='___-' Fence
SurchargeS?~ 90 Demo
_ _ ...:?;? 5 c:.')
. 7.0 lAIC Pavin9
./...5'; 00 I Curb Cut
-- ~~-o-nl
Plan Ck.
65%1Bl do
Plan Ck.
COllVll/lnd
Ppr Fpp
R"es
Per Fee
qxj,6/rzj'Ai
7/,....~. ""i;;l47Is,Vstems Development
or? ""<0 CharQe (1.5',)
I/A.
. ELECTRIC?L PERI:IT
CharQes and
Surcha rges
Sidewalk
Total (omb. Permit
/1ECHANICAL PEP.l1IT
Charges and
SurCharges
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I TOTAL
255":32
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description 'I'
1. examole- Tax lot 100. Lane County Map Reference
II U3 43
2. examole- lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole~ heat/electrical ceilin~/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, examole- 1250 sq, foot house. 500 sq, foot garage
2. exampJe- Tflnew project, check-new - if addition.
check add. etc.
F. Building pennit information':
1. examole - construct single family hous~ with an
attached garl!ge
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 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, r-lechanical, 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 sianature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
Ill, 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
l/f2 [9
5-;2/-%;
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Permit Clerk
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Permit applicant exempt from registration with the Builder's'Board because:
.Additional Project Information:
PLANS REVIEWED BY:
'~." . .' ';~
name L.N?,Ne hE"" e'A?
Signature,~~ A--.....
date ;')- '2/.~'?
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