HomeMy WebLinkAboutPermit Building 1987-3-10
Wu( of Work:
:/ l? "1, n,-ofl. -
BunGinO Permit Info: Describe Work( Le., Build Single
Familv nesidence With A~~99hed Garaoel
[J Al\SWJ) (J-I1Y1'__-m(\ ~ reA
1;1. ..-L
J' ITemporary Construction
IChange in existing
rPsjq~nr~
Imultifamily, comm. or
Tnrlllc;t.rii'll
I IDf LJ n/) amps.1 ~.:>t
I CDMI_I. /I NO. FEEDERS I I
1 Install/alter/relocate I 1
nic;trih_ fppnprc;
'2 IOf "200 amp~/:?....~S$:4
I I I
I 1 1
1 1 I I I SSUANCF OF PCR!lIT
TOTAL CHARGES ::?/:S: ='> TOTAL CHARGES ;:::ZZ.Scj TOTAL CHARGES ~I'/Y. Lc;:'e>r>
. WHERE STATE L'\~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the complete~ application for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the Laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n. and that NO OCCUPAHCY will 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
!WIE(please print)})J.fW lY-I f/.ll1irJ!" SI('.!I^TURE.A//__SJA~ DATE;>-ti)-~7
FOP. OFF I CE USE ~!IL Y ...., I
Zone c::;c. Tyoe/r.onst. 9A(__units______Sn. Ftg. !lain2~2c:?__...x____._.Value_ .8..? '3~ ,.: _:
Fire Zone Bedrooms Occy Load ..<)'8 Sq. Ft9. Access_ x Value
Flood Plain Stories I' Occy Group RoO? Sq. Ftg. Other~I',.,.?,-"I7.~. Value~7. ')~
U5E C6D2 "3 -=<7 'B~'b6'7q . . TOTAL VALUATION /L>5. 600
~~~~~~~Ga~~RI-IIT ____ 3'2?_~:"_ ~~~~Bi~~ ~.~::",~;~d ,}6~.'7~ ~h~~~~St~~mopm"')t ! <)7~""'C>
Surcharges S:,Q.e:;> Plan Ck. Res
I . e:>= 30%/Bldo Per Fee
""215:'=> Fence
------"8."i;;- Demo J/?~G
L2.<-:>0 I Sidewalk 3&c/
------~-9~1 AIC Paving~7aoP 1
_ _ _ _ jr_~,:,JCU~b .cu~ '2: -Si' I
otbe> I. I
/ /JvS pl/ St'd
;' pn~~mON L1NE/975 m~~OMBJ!lm~Nulp~m~m~7~ERfoIIT
~ . Job Address It) T1i ~ 111Cl" 'L ST. - 19 t4 ~ A ST ~~;~GY SOURCES:
Legal Description l7~o?,-3b-)1 1-o'is.P48Ov~1l7600 I~ater Heater
Range
.
Owner .Q;.(o(.~ Ca.,;;/;;.., ~w.
Address 1 C;IO XL",} '1 q AI.
f/LPJP-/^.€/ () ~ 97vo:J.
ConstructioJ Lend~r (;~ ~ ~ .
Address / ~ I 0 ~ Q'9 ,{/. Phone~-{)&3(,
DESIGN TEM Inamel' (address)
~ :" rn~(~~e-
Phnne6sg -oU(,
nics. no,)
Primary
I C:;IO ~..... '19 AJ,
I
Structura 1
Electrical
Mechanical
CONTRACTORS
1)rw,
(name)
(address)
M~ T.,*, <Q. '?b1r30 ~/1:'e.. G..,1ll,ll eiJ
o
Plumbino /) /"" ..,. ,il/ /".n'(,_~
Electrical ;/;11111/11['5
Mechanic'al ,R;:::~~'~A~./
PLU!lB I NG
(lir:s. no.l
35-<0
I<{
~t) -/<:c:c.
~~/.,
. ,
<<< r"~-HP.
Genera 1
ELECTRICAL
NO. FFF r.HARr,F ."
Each single fixture Residence of
1'1 . 7.~ 1/l5- SQ. FT.
Relocated building New circuits alts.
(new fix. additional) or extensions
S.F. Residence / SERVICES
II bath)
Duplex (I bath) each
Additional bath
I'<;<>D
/ ~Iater servi ce
I
I
(tJ?' ~;-
7lP' ~-
(9:>' 5'e>-
Sewer
,Storm Sewer
PLur1BING PERMIT
Charges and
Surcharges
INfORllATIDN UN"
726-3753
Sq. Ftg. I.lain /L(,"1 Z.
~q. Ftg. Access./...~~--
Sq. Ftg. Other
t-Ilew Add A Her Pep.
-Fence Demo ChangelOse
Other- -
~
o
\0
W
\}J
lexoiresl
(ahoM no,')
~"""Jgg-O~3('
Ar
..
(pxoirpc;\
(nhnnp no \
:5 -9-;>,
6'87-ntfl
c?</.<:;- 1n.<::'-
3,-/3-7Zt;')
~J' q-.( fa"
7 -fR j
l? - 26-n
MECHANICAL
~~L..c.JiAB.tiE.
I
furnace/burner to
BTU' 5
1t~~
. furnace 570N
-........t
6.06
Recessed wall
~n~rp hp~tpr i'lnrl vpnt
Appliance vent
seoari'ltp
Stationary evap.
cooler
Vent fan with
sinole duct.
Vent system apart from I
heating or A.~.
Mechanical exhaust I
.. hood i'lnd durt.
I
I
I
I
3'-ate
I
'Wood stove/heater
~4-~....A;;:~ A~:i/~:r
jz;;.a "'1.<"-,,,,:,.:,., ~ - a:?7 I
~__o
_?? <so
/2:'5. So
::5.5: ~C>
I
I TOTAL
ELECTRICAL PERIIlT
Cha rges and
Surcharges ~.~
I
ITotal. Comb: Permit
1t/t7~. 28
MECHANICAL PERMIT
Charges and
Surcharges
25'TtP.S7
~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 U3 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example. if new project, check new - if addition.
cned add. etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached 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 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 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
.
,
PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
I
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. . '\ ','
date
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Add!~ional Project Informatio~:
PLANS REVIEWED BY:'
name
LO/?N€ 7?",,~<5'.R
\'":'- . '.
: signature /2 ~?',.
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