HomeMy WebLinkAboutPermit Building 1986-10-28
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11115PECTlr~1 LItlE
726-3769.
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CITY U, SPRillGFIELD . INFORJIATlO~ L1i" I
COMBIIIATlON APPLICATION/PERMIT 726-3753
EilERGY ~UI)CE5 i-- Sq. F tq. '.Ia i n I."..!. (, <0 D
Heat rLI;.C,I ~q. Ftg. Access: t'../\
Water Heater Sq. Ftg. Other ~
Ilew Addc<Alter ~ep. c--..
RanQe Fence__Demo~Change/Use ~ .
P,IUE of Hork: _Other a
;y /SOO.oo ~
Phone 7y 7.ro ' ~~~1 ~~ n~e~~d,;~~e inf~~ ~~g~~~~e G~~~~~ 1.e.. Build Si ngle ~
747-8'57~ rKE'/LI D ~)..:' ( E. X; S Ii _J <, ,?,2Dc/"/..11
~/o';:;{1o ~~Soq~/ ..54u:"_' d56"ic'(,/"k,:?1
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Job Address . ~ 1 n.Z::- /"\4 i ^ I
Legal DmriptionT[d ))- 0:2 -3/-.? / -{:IO:z.
1)_02-1:,1-3/ -.5,-1 o"L
Owner Ph: Ll I Cl-S , .!6A~'t.. i'J U Ll
Addre554I t,;<.. ~A is"",
Construction Lender
NONE
Address
Ut~Hilt fE.Atl (name)
Primary ~"C:-l<'P'- ~R+"~M(.\Nc,.=
r~o. I
lEach single fixture
I Relocated building
(new f,ix. additional)
IS.F. Residence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
IStorm Sewer I
>< ~A.E--4<:L-UAlUC;J:,-p
:"fl.pHJp'hLM"~ I
X /RR/~/6N i;..r
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TOTAL CH~.RGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
Structural
Electrical
!1echani ca 1
CONTRACTORS
Genera I ~A./!/"),jC
Plumbino
Electrical
1.1echanical
~!ater servi ce
Sewer
Phone
(address)
fI/h:.>.;/JJ?. '-})i.J3 ;'),a.;(V
}
(lics. no.)
(exoi res 1
(OL.IIlI&R. DcW?, ')
~\
"'> ~'C:;> 4.
~\I
(ohone no.
~41-PS7q
bAlI)
,
(name)
(address)
'flics, no.
(pxnirpc;)
(ohnnp nn..)
( ...q_" .\"::")'.....' _ 0Un,)
(
J-V)JPL("I.
PLUllBIIIG.
ELECTRICAL
MECHANICAL
FEE
rHARGF
"n I
Residence of
fI-lAJ:1r.r NO
FCC
CCF
r~ARr.r
furnace/burner to
BTU's
SQ. FT.
t/l
New circuits alts.
or extensions
Floor furnace
and vent
~~
I
I
I
I
ISERVICES
I
Recessed wall
~n~rp hp~tpr ~nrl vpnt
I
I
I
I
I~"'"
Appliance vent
seoarate
Stationarv evao.
cooler ~ ,
I Vent fan wi th
c::inole duct
~I Vent system apart
heatino or A.C.
Mechanical exhaust
hood 'Inri duct
Temporary Construction
Change in existing
rP'lid~nr.p
multifamily, comm. or
Tnrlllc::tri<'ll
,7.5~
IOf
ICOffi1./IND. FEEDERS
IInstall/alter/relocate I
rlic;trih_ fpprlprc;
Of amps.1
Wood stove/heater
amps.1
from
7.S-0
I
I
I
//;: <"0 TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
I
22.;)0
I SSUANCE OF PFR!IIT
TOTAL CHARGES
/6.0-1>-
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed aprlication for permlt. 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 oertaining to .~he work described herein, and that rw OCCUPArKY will be made
of any structure without the permiSSion of the Gu'lding Division. I further certify that my re9istration \.>/ith the Builder's
Ooard is in full force and effect as required by :1::5 701.055. that if exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees who are in co~~iiance with ORS 7~1.055 will be used on this project.
D ~ 7"
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S IGIIATURE v.V. ." '_ ,'-k"--;",,,...t/
IIAIIE(plea5e print)~L::- f<. V;!C);::'i< u..J! ,l
Zone CG
Fire Zone
Flood Plain
BUILDJIIG PERI.UT
Charges and
Surcharges ~~
PLUI~BING PERMIT
Charges and
Surcharges: .... ';;.
ELECTR I C~.L: PERI~IT
Charges and
Surcha rges!
11ECHAN I CAL: PERMIT
Charges and
Surcharges '.
DATE 1 c ~2S -8.'-
FOr. OFF I CE USE DillY
TYDe/Const. .'7-N Units Sq. Ftg.
Bedrooms Occy Load Sq. Ft!].
Stories / Dcc.y Groupj'-;?f hi" 'f Sq. Ftg.
f1ain x Value
Access x Value
Other~~~~~ Value
TOTAL VALUATION
/x"oo. ,sO
'j. ,~-\)
. ~ = . Plan Ck. Conm/lnd
__-::?...2.:.______ 65%/Bldo Ppr Fpp
I 0 c> Plan Ck. Res
r 30%/Blda Per Fee
_n.J..s;_~n Fence
. &0 DlIRlo
____;?_4::.~~_ Sidewalk
. 9.::> AlC Paving
.I.. 9. - I Curb Cut
---~ -_-6O"nl
p.,rnl7 ~ It:;
/Ie :28 I.Q:..?,I<-'fu
syste.ms Development
Charoe (J.5~)
.,', I
C
ITotal Comb. Permit
I
I TOTAL
go. 60
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example~ Tax lot 100. lane County Map Reference
II 03 43
2. examole- lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole. heat/electrical ceilinq/or forced air qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. -
I. example- 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 garage
2. exa~ple - 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 (al of the
Structural Special~y Code
H. DESIGN TEAN ANO 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, 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
full schedules
C. BUILDING DIVISrON 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 ~ivision 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
j 1
l3CoJj33CZ
IcD~31-'?(P
Permit Clerk
Oc---
Permit applicant exempt from re;istration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
,
name -L ",!p..</-&
I
signature
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,
date /t::J-3/-~
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