HomeMy WebLinkAboutPermit Building 1989-1-12
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COIIBIIIMIOII APPLlCMION/PERMIT
EIIERGY SOURCES:
lIeat
!later lIeat.r
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IHFORlII\T10H Lllll
126-3153
Sq. Flq, MaIn
. ~<i.' fl9.' AeceH.
Sq. Flq. Other
new Add Al ter rep,
Fence_Oem. _ Change/Use
_Other ,
, Iln~~mOH L1IlE
Job MdreH -'3875' Main' St..
I.egal Oe<erfptlo.n,; i 017023141
Addr~55
Troy Van Frock (Troy Finfrock)
3875 Main St., Springfield rh~6-3533
Oregon, 97477
Build Single
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, :t
Sodndield. OR
2500
RanrJe_
Vafu, of Horf-:
~WQ.
Built;'na r'ennit Info: Describe Work.\I\l!..
Famllv nesldence !11th Attached Garaoe\',
,~
Owner
Constructton lender
N/A
Hanufacture & In!lbiJ4.l..' Vinyl awning
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using customerls exi!'id.nR steel frame.
I'honr (back lil\htinp,) (see attached drawinl\.)
\addressl (lies. noil (exptru) (ohone nO.1
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DlSIl.i1l llN'
tnameJ
Prtmary
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Structural
Electrical
flechanlcal
COHtRACTORS
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,"'<' 1 c.., ,
,b ·
lnamel
(address )
Illes, no.)
(exDfresl
{Dhon~ no.
General (aiRn> RAY-O-L!I.Ul!1NS. 101~ene.ca..JUl:ene,JR. 20-160 CI.S IOill " 6RR-2~OO
Plumbtna
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Electrical
"echanlcal
PLUflBltlG
ELECTRICAL
MECIlAHICAL
Each Sfngle FI.ture
Restdence of
". .cJJARliE. Jill..
,;
FF L .cJJARliE.
110, '
FEE CIl~ Jill.-
So. FT.
furnace/burner, to
BTU's
Relocated bufldlng
(new Ff.. additional)
S.F. r.esfdence
11 bath 1
Ouple. (I bath) each
Addflfonal bath
New circuits al ts.
or extensions
;,
Floor furnAce.
and vent
SERViCES
Recessed wall
SDac@ hta!@r And vent
'-
::.;,
COI~1. /I NO. rEEOERS
amps.1
I
Appl1anee vent
sr.D~i'at@
Stationary evap.
cooler
Vent fftn wi th .
,in!!l~ d~~~'
Vent SyStCM apart From
heaUno or A.C,
Mechanical ~.h.ust
hood and duct
Hood stove/heater
"
"
.,-
Sewer
Temporary Construction
Change In exIsting
r~_sJjJ~nre
mu1ttfamtly, conln. or
I n~US tr 10 I
OF
;:
Water service
Storm Sewer
,
"
Install/alter/relocate
_dbtrfb, f.e.d.rs
or ______amps.
I.
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,-
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ISSUANCF OF prRlm
TOT^L CMARGES , TOTAL CIIfIRGES ' ,. '" TOTAL CllJ\RGtS ' 'I ".,,' _
WHERE STATE L,\\I REQUIRES that the El~ctrlcal work b~ don~ hy .n [I.clrlc.l Contractor, the electrical portion of thIS penalt.'
Shall not be valH until the label has been signed by an Eleclrlc.l Supervisor and returned to the Oullding Dtvlsfon ;:
....
I IlAVl CARlFULLT EXIIIUIIEO the completed application ror .ermlt, .nd do hereb.v certHy that all Inronnatlon hereon Is true
and correct, and I Furthe. certiFy that any and all work performed shall be done in accordance with th~ Ordinances of the City i:
of SpringField and the Laws of the State of Ore~on nertafnlng to the wnrk described herefn, and that 110 OCCUPAIICY will be made ~
of any structure without the permission of tho DlIildlng Division. I rllrthor ce.tHy that m.v r.glstratlon ,lith the Dullder's
Board Is In Full Force and eFFect as required by ORS 701,055, that IF e.empt the basis For e.emptlon Is noted hereon, and that
only Subeont..ctofs'lnd ~mployeeS who .r~ In compllanc~ with Or.S 101.055 will b~ used on thfs proj~ct. '
IlllllE(plem prlnt'-...(,.._~ ht'-6A.-L"". t1w"'~IC...-SIGIIA1UR[ ;~.>-,;::;;;-~;;k-._"'? r,~
FOr. OffiCE IJSE UlILY
___So' fig, lIaln x Value
Sq. Ft~. ^cecs, x Value
Sq, fig. othe~~i'"'_'Rl~. Value..:S-~ oI>-2o;i
TOTAL VALUATlori
OA1E/~~.ff~ ;~
~
lone ~,
F1 re lone
tlood Phln
Tyoe/Const,
Bedrooms
Stories
Unl ts__
.
Ocey loud .__
Occ.v f,roup
PllJ1\BING PERMIT
Charges and .r.,>~!"!"'.
Surcharges
ElECTRICAL PERIl IT
Charges and vI
Surcharges
I /r~CJ' Plan Ck. Conm/lnd
____Lc;.)...._____ -1~t/8Jdo ppr F,.p
,,- Plan n. Res
, ~~ 30%/Dldq Per ree
rence
'~yster.1s Development
Charqe (1. 5~
BUILOIHG PERmT
Charges an~ '"'
Surcharges d-
I':
Demo
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I1ECHAIlICAl PERMIT
ChargU and .' .,..... ,
Surcharges
.ti,e;- -0
c/o SIdewalk
---- -_:..----
i. ,./'5"" AlC Pavfng
Curb Cut
,
,~
Total Comb, PermIt
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PERMIT VALIDATION
I
a
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
17 03 43
2. exam~le- Lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. exam~le- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- T71new project. check-new - if addition,
check. add. etc.
F. Building permit information:
1. example - construct single family house with an
attac-hed garage
2. example - 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 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, 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 he 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
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.
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V, FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
~RHG",~.~
signature /? """'?............-:.?;;:~....., date
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