HomeMy WebLinkAboutPermit Building 1989-3-9
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lltlSPECTIOIl L1ilE
W3769.
I Job Address
E!IERGY SOURCES:
Heat
t-/ater Heater
Ra nrle
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CITY UF SPiWMIELD
COIlBllIATlON APPLICATION/PERMIT
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ValuE of l'/ork.~ __.-
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uildna Permit Info: Describe \~ork(i.e., Build Single
Family nes;dence I-lith fl.ttached r;araqe)
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Leg. 1 Description 17-b>2-~/-'3/ ..t:' Z Za:::>
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Owner
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PN'"c
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Address
Construction lender
Address
DESIG1I fEAlI
(r;"ariie,l
Phone
(address)
Primary
Structural
Electrical
!1echanical
CONTRACTORS /fname) .
General t/~--t.~j,~
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INFORI1AT: ..'1 L'",
726-3753
So. Ftq. 1.,.inL2.&:':26
~q. !'ll). Access:
SQ. Flq. Other
/lei" Add ~.1 ter ~eD.
--Fence Demo Change/Use
Other - -
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Temporary Construction
Change in existing
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Tnrlu"-tri<l.l
LlLJ.Of q~ amps.)
---I licor'H./IND. FEEDERS
I I 'Install/alter/relocate
rli"-trih. fppdpr,,-
I I IOf amps.1
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I TOTAL CHARGES
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
Plumbina
Electrical t)Q ~ S f. tJy01Yt \.1' )
t-'echanical
PLU1IBIrlG
ELECTRICAL
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FEF CHARGE.
Residence of
Each single fixture
SQ. FT.
7/New circui.t' .~.i ts.
or extenslons .
'2 ~T-1. ;,--f; -
SERVICES
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15.?~
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Relocated building
(new fix. additional)
71Fba~~)ldence-" -. '.',
IDuplex (1 bath) each I
_____IAddition~ ~~th.~
~!ater service 1-
Sewer
Storm Spl,o/p.r
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TOTAL CHARGES
HIlEr.E STATE L\U REQUIRES
shall not be vali~ until the
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770- ~5'S' I
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MECHANICAL
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I furnace/burner "to
BTlI' ,
Floor furnace
and vent
Recessed wa 11
~o~rp hprltp~ ~nn vpnt
I Apol iance vent
<;po.al'iltp
I Stationary evap.
cooler
I Vent fan \oJith
sinolp duct
I Ven t sys tem apa rt
heatino or A.C.
I Mechanical exhaust
hood ilnd duc:t
r I-load stove/heater
from
ISSUANCf nF PFR'lIT
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TOTAL CHARGES
I HAVE CAREFULLY EXMlINED the comnleted aprlication for !)ermit, and do hereb,v 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 City
of Soringfield and the laws of the State of Oreryon pertaining to the work described herein, and that rlO OCCUPAHCY l.li11 be made
of any structure without the permission of the Building Division. I further certify that lTly re~istration ...lith the Builder's
Ooard is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemotion is noted hereon, and that
only subcontractors and emn10yees \...ho are in comoliance with OP.S 701.055 I.lill be used on this project.
{'1201 Syste~s Development I //L// 7-=<'
tJ CharQe (l. 5,,) LLL.?o" v
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Total Comb. rermit
I TOTAL
jlA:-1E(please print)
16,/',-""..,
At^ehCL~
S IGrlATURE /2..
~~:: ~t; iCE USE Dill Y
S~. Ftg. l1oio./2 ,b';;l.o 1"
SQ. FtlJ. Access
. S~. Ftg. Other
Zone C'-:::::'
Fire Zone
Flood Plain
Tyoe/Const. Q-/V
Bedrooms
Uni ts
Occy load
9ccy Group~--~
Stories
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BUILDIlIG PERI.lIT
Charges anG
Surcharges
_-_3..k~_~_
I~.::so
Plan Ck. Comm/Ind
65t/Blda Ppr Fpe
Plan Ck. R'es
30%/BldQ Per Fee
Fence
PLU'lB ING PERMIT
Charges and
SurCharges
------------
Demo
. ElECTRICAL rERI~1T
CharQes and
Surcharges
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3.75
Sidewal k
A/C Paving
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IIECHAIII CAL PERI1 iT
Charges and
Surcharges
------------
Curb Cut
72-......___
om 3/~
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xr:;..t:'6f!valueJ~
x Va 1 ue
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x
Value
TOTAL VALUATION
$16' t7.. 7~
16~t? ;3'2
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. COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant 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
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Source's '.
1. example~ heat/electrical ceilinq/or forced air Qas
2. example. waterheater/electr;cal/or solar
E. Square footage or valuation, etc. - -
1. examole- 1250 sq. foot house. 500 sQ. foot garage
2. example- ~ew project. check-new _ if addition.
check add. etc.
F. Building pennit information':
1. examole - construct single family house with an
attached garage
2. examole -remOdel existing garage into family room
3. example. 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 TEN1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information crr 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 OIVISION 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 Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
IV. Fees and Charges
Plan check rees 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 OCCUPMlCY:
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PERMIT VALIDATION
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Permi t
\ Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
J
name
L~;q#E ~-=g:;2?
signature ~~
'//, /'
date 3'-&;-&9'