HomeMy WebLinkAboutPermit Building 1986-7-11 (2)
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I INSPECTION L1IIE
726-3769 .
Job Address
legal Description
. CITY UF SPR1I1GFIELO
COMBIIIATION APPLlCATION/PERIIIT
EilERGY SOURCES:
Heat
. Hater Heater
Ranqe
e
~g31 fIIa0v
17-6Z-3/. '1< t:>z'7~~
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Owner
u'
/~/L
I ~/JIfJ.[&,d
Address
Constructi~n Lender
Phone
Address
Ut~llir, !tArol " (name/
Primary ;I'~~~
f1echanical
CONTRACTORS, I name) (address)
General hA~/!ll';)1{iPii/~ Z,-;'2C1.3of)
Plumbino Uy k: E.S PV" m /'J.,~J Z,.J ((! W-
Electrical t!ld:..",~ (F"<C..~ if
'Iechanical rt/.-C/A..L<..f.,-/ _ 4& d
PLUIIBII(J 0
Structural
Electrical
Phone
(address)
NO.
7" Each single fixture
Relocated building
(new fix. additional)
S. F. 'Residence
11 bath)
Ouplex (1 bath)
IAdditional bath
'water service
I Sewer
I Storm Sewer
Zone
c<:::
Fi re Zone
Flood Plain
BUILDING PERflIT
Charges ant:
Surcharges
PLUl1BING PERMIT
Charges and
Surcha rges
ELECTRIC~.L PERI~IT
Cha rges and
Surcharges
IIECHANICAL PERMIT
Charges and
Surcharges
FFE I rHARr,F
7. s-e r; 7$0
Residence of
NO
, i,,~tll tK\ .
["t 'WI (JXJ
.'" INFORllATION LI,'lt I!
. 726-3753
Sa. Fta. 1.lain
~q. ~tlJ. Access.
Sq. Ftg. Other
Ilew Add Al ter P.ep.
F ence _Demo_Change/Use
_Other
cf:!. .
E)'
0'
;t::.
I -=c
IIU'\
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Valu, of )lark:
l'f, .ME)
BUlltilno'Pennit info: Describe Hork(Le..
Far:1ilv f!.esidence "lith Jl.ttachpd r.araoe)
(/amn-!//ff ~vf :ij;~~
M Ll(jr /,j/~.A"_./
() ~ f[( L-
Bui Id Single
.~
(1 ics. no.)
(exniresl
fohone no. I
A
.~
,#- ""
(lice;.. no ,
(pxl)jrpc.\
(phnnp nn )
1- /~-S-6 3'L/c;- ?~~ I .;:;},./ n'.//~
1/-210 -Yb '
a r.(tfS3f)f)
ELECTRICAL
MECHANICAL
'"
(,l-lllIU~~, rJO
;:'H' IrJ..llllU::;:'
furnace/burner to
BTlI's
SQ. FT.
.-' I'New circu~ts a1t5.
or exte~lOns l:::Z~
-:z. tt:>~ /'nt?rr=
ISERVICES
I
each
I Floor furnace
and vent
I' Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
<--1 ix~ ft-cTW4f: "f
I I
160"i
I
I
!
:?Z~
amps,
I Appl iance vent
<;eoarittp
1 Stationary evap.
cooler
V~nt fan with :l!:"r/< ";_ a.,ol
slnole duct t::..r /..I~ ,..
Vent system apar;t from 1":2..... /'? ClCt
heatino or A_Cr~.,l , '...
Mechanical exhaust
hood .1nd durt.
Temporary Construction
Change in existing
l"'pS- j qp..nrp
multifamlly, COIl1!l. or
Induc;.trirl1
IOf
I COI~'1. /IND. FEEDERS
Install/alter/relocate
rlic;.tl"'ih fpprlpl"'c;.
Of
WoOd stove/heater
I
~ -V".:?--
,
I
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1.'5'
It{
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I ISSUANCF OF PFR!lIT
TOTAL CHARGES ~7.S01 TOTAL CHARGES 2:;?- ~I TOTAL CHARGES ~9. "'0
WHERE STATE L;\\~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed application 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 Spri ngfi e 1d and the Laws of the Sta te of Ore,:!on perta i ni ng to the work descri bed herei n, and tha t IlC OCCUPAr~CY wlll be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemPtion is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 701.055 will be used on this nroject.'
IlA!IE(please 'print) ~ ~~ . SIGilATURE . Cf./-AetI~ erODE. Y
/
Tvoe/Const. "'}.;...y Units
Bedrooms .,Occy Load
Stor~es2<~~rccy Group.1?- '2
amps.
2. /1-/<::: C/;(I/T5.
I
I
om '1 ~.I \-f{k,
FO~ 6'rF I CE USE DilL Y
So. Ftg.
Sa. Ftg.
Sq. Ftg.
, /A ~.r".:=> 'PI an Ck. Conm/lnd
. JY L ~ v" 65%/Bldo PPl'" Fpp
--- --Li/4i"-P"ianCk. Res
-r. ~ 30%/Bldo Per Fee
. 6"7.S'o I Fence
------~~7(;-1 D~mo
"2"2.5"0 I S1dewalk
-------~~o-I AlC Paving
~____2-j;;_1 Curb Cut
t1ain x Value
Access x Value
Other 7'f,;r~;/~ Value
TOTAL VALUATlOII
_...~I
/y~
,
'(A7.q~ J3U~l.\~ '~h~~~~s(~~~~lopment
N,~
Total Comb. Permit
I 2t.!Z. 8</
'2 '1<.87'
I
I TOTAL
~
e
(
I
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, lane County Map Reference
II 03 43
2. examole- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
~. examole- heat/electrical ceilinq/or forced air Qas
2. examoJe- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-new - if addition,
cneck add, etc.
F. B'uilding permit information:
1. example - construct single family house with an
attached gar~ge
2. examEle - 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 TEM~ 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, 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 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 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
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
applicatfon. 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.
6&011~
~-/ll ~~ 0
V. FOR OFFICE USE ONLY
Permit Clerk
cu
J
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
. ,
PLANS REVIEWED BY:
.~
name l.~RN~ h.~~ Signature~~AO.L. ~~
// I -, ~
date7-7-8~