HomeMy WebLinkAboutPermit Building 1987-5-12 (2)
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~ WSPcCTIOII LWE CITY UF SPRIiIGFIELD
f726i3769 . COIIBIiIATlON APPLlCATlDN/PERMlT
E!/ERGY SOURCES:
Job Address 't.}-7A IUA"J S-r-. <;"i:>R..l:'>, oK:-. Heat_ F/ ~-,_,,,,.J.c..
Legal Description 1"l-6rl_ ::<\c~L~~-.Olq{)7) Hater Heaterf;lC'CJ1Vi'
Ran"e E'LELnU. ~ .
Valu, of 1'lork:~I!S,O'=~ I.
Z5,_~(P9;u,d C~.ur.t
Phon..J...._~....,,~ Built:lna Pe'rmit Info: Describe \~orkt i.e..
D.~::{Jl,.AJI~ Familv nesidence Hith fI.ttached rlaraoe)
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INFORllAT:-=:1 u,.~
726-3753
Sa. Ftg. '.iain
~q. Ptg. Access.
So, Ftg, Other
flel'l Add /1.1 tel" ~eD.
--Fence Demo Change/Use
Other - -
Owner (l.ill'ZE'1JS SlvJIJ6:. {. L:~p.0
Address ~ So'':> i(e.tLSE vA-, ; AI<i' ~JE":&J
Bui Id Single
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'~:tn.. OC:pLE q"'Arr= ~t>",.l'\.,)";
construe,tion Lender CrTTJt::/.JS. SllIl,U~ ~. lMJ.J, J"fu~ AIUD kl'n::I4{':u Ev;>ArV:;i()~
Address'1S<30 ~ ()JAy LAKE o-~~ rhon~ .
LJI::.~lliH ItAf-' (name' (address) (lies. no.l (exn;res) (ohone
no. J
Primary
Cu."iU1s 1:ESI. eoUJPMOJr bs (~r...l)A,L Loop
(address)
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flies. no.) (.€xnirpc:."\
b8:7 -'8;2. 2-9 l
Structura 1
Electrical
!1echanical
CONTRACTORS
{ name}
i
(ohnnp nn l~
Genera 1
Plumbina
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,,\_'Y
~"'J I
''i--J
1'\ I -,rhU
I. VI"{-
Electrical
t.1echanical
PLU/1BIIIG
ELECTRICAL
MECHANICAL
i:O.
FEE CHARGE
fin I.
I Residence of
SQ. FT.
New circuits alts.
or extensions
? L>JIi? ""DR.!:
FFF
fHARr,F
NO_
FFF
r~ARr,l='
13
Each single fixture
750 '7150
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath!
Duplex (1 bath) each
?2!JG
Floor furnace
and vent
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SERVICES
Recessed wall
~Onrp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Apol iance vent
c:eOiU'<'ltP
Stationarv evan.
cooler ~ .
Vent fan \1ith
~inole duct
Vent system apart from I
heatina or A.C.
.......... -i.lechanica 1 exhaust
hond nnd dlJrt
Wood stove/heater
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I 'IS.:> I
Additional bath
Temporary Construction
Change in existing
rpS; d~.nrp
multifamily, camm. or
Induc;trinl
~!ater service
Sewer
Cor~.1.IINO. FEEDERS
Install/alter/relocate
rli~trih fpprlpr~
Of
amps.
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ISSUANCF nF PFRtlIT
TOTAL CHARGES
ImERE STATE L.\H REQUIRES
shall not be valil until the
'7'7-5'0 TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
-:22. S-o TOTAL CHARGES r-/7//)/,
Electrical Contractor, the electrical nortion of
Supervisor and returned to the Building Division
/. <;:" ....
thi s permit
I HAVE CAREFULLY EXNlINEO the comp 1 eted apfll i cat i on for permit. and do hereby cert ify tha tall i nformat i on 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 Orel]on pertaining to the work described herein, and that He OCCUPAHCY \'Ii11 be made
of any structure without the permission of the Building Division. I further certify that my re~istration with the Builder's
Board 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 who are in comoliance with O?S 7D1.055 will be used on this project.
689-9570 ~.
IWIE(please prinv(PA"r'f'2.<c.t:- WAj2.l:I Slml^TURE /I? ~
FOP. OfFICE USE
omS -I,;> -go?.....
Zone C /'
Fire Zone
Flood Plain
Tyoe/Const. /5"=.,A.j
Bedrooms
Stari es
Units
Occy load
Oec'y Group A -:;
Sq.
So.
Sq,
Fto. rlain
Ft~.~~ct'~T
Ftg. ntherRF.h7."p€C:
x Value
x Value ~:).c~-
x 1/73".1:- Value /.5.~ ~
TOT^L VALUATIDr/ 7'~ <!'~....
V-:5.!!- ?-.PE~r-~S
BUILDIIIG PERI'lIT~ 1./t:).5'0
Charges an::: ~. __ L'_=-_____
Surcharges L/ ~
1JtHIp ",^, '.'" 'roo _ __7' r '"
PLUl1BING PERI1IT . QZ 5"0
Charges and ~ ___J_ ~____~__
Surcharges ~ 3'. 90
__.2.A._:?q___1
, 7<:::'
__J.s;~___
.60
Plan Ck, Comm/lnd
65%/Bld~ Ppr Fp~
Plan Ck. Res
}O'tlBl do Per F~~
Fence
6) t:d. 6hzJ'F.,
I3bi;;l47 Isystems Development
7/,93 Charoe (1.5"-1
u.
Demo
. ELECTRIU.L PERI~IT
Charges and I I
Surcharges '"1
Sidewalk
Ale Paving
Total (omb. rermit
11ECHANICAl PERI11T
Charges and
Surchar~es
~
i TOTAL
r;-s 5:' 32
Curb Cut.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A, Job Address
B. legal Description
1. examole- Tax lot 100, lane County Map Reference
11 03 43
2. examole- Lot I, Block 3. 2nd Addition to
~pr'ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air oas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, examDle- 1250 sq. foot house. 500 sq, foot garage
2. examole- if new project. check-new - if addition.
check add. etc.
F. Building pennit information:
1. examole - construct single family house with an
attached gar.!lge
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 soaces 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 cons.ult' the' "
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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 ~ authorized
to sign the electrical label.
III. Applicant to sign and date
Whenever oossible, the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will orepare 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,90NOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk
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Perinit applicant exempt from:registration with the Builder"s'Soar'd 'becaus'e:
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,Add i.ti,ona 1 P~oject Information:
PLANS REVIEWED BY:
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name La?.NC hE""" e:~
Signature~~ A~~
d,ate 5:- 2/'~/
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