HomeMy WebLinkAboutPermit Building 1987-7-13
JO,b Address 1& 7:5" M#/A/
Legal Description/?0'3_?!6_31
-57:
CITY Of SPRlIlGfIELD
CDMBIlIATION APPlICATION/PERMlT
E!IERGY SOURCES:
Heat
II t.../ (/ ~ Ha ter Hea ter
J ' RanQe
,
INFORltAT!Oj~ lWt
726-3753
Sq. Ftg. 1.lain
~q. Ft~. Access.
Sq. Ftg. Other
flew Add Alter ~eD.
--Fence Demo Change/Use
Other - -
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IlrlSPECTIOII LlIlE
726- 37 69 .
,
Address
DE~IGr, fEAr'
(name)
Phone
(address)
ValUE of Hark:
qC>t:Pe::>
Bu;Hiina Pennit Info: Oescribe \~ork(l,.e., Build Single
Famil v I'l.es idence l'lith J\ttached rlaraae)
!"::~A/""'7?~D<7 ~L..(.,J/Z?/..?A';r~Z)
d~--:v//V? /~./Co' c?N /~C? OF
6/?c>.c~RY' ::57t::>?l~ .
(1 ics. no.)
(exnires\
rl]hnn~ n0.
Owner bROL.i5?I T' ~7:5~ /h'c..
Address //:;"/L;> ;,t-", 9<9 k?1TN
~V6.~H~/ t9Jf'. <7?o/'t!P2
Construction Lender
.lmf.og~
Structura 1
<t. ~/I
"NO*
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Primary
Electrical
11echanical
CONTRACTORS (name)
General ./OAlTS' -:;::::&CV-V5Y':;7C~
r;..:
-,,"!I
(\~
(address)
" ire:;
no. ,
(p'IIrlil"pc:, ,
(nk,..,np nn I
Hh 7$ We:s7 77-a P7v~.
l,/ g9'-YO~ .2.
,
Plumbina
Electrical
~/-4KS' 6~cT. ,iP~& Wnv~.
--
g~;tP
?Y"3' - .:::> $"'7" ::<
~\echanical
PLUllB IrIG
L ELECTRICAL
I FFF cHARr,F Fe> r"IIRliE. tIn.
Residence of
SQ. FT.
/' New circuits alts.
or extensions 6:#0
/ ~;;JCL:...,7.
SERVICES
MECHANICAL
...lliL..1
Each single fixture
I ~~L\J:l:.i8.RG.E..
furnace/burner to
BTU's
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Add it i ona 1 ba th
Recessed wall
~n~~p hp~tpr ~nrl ~pnt
~Iater service
Temporary Construction
Change in existing
rp';l t1e.n('p
Imultifamlly. COfllll. or
TnrltJc;tr;;1l
IOf
I Cor~'I.IIND. FEEDERS
IInstall/alter/relocate
rl;~tr;h Fpp1frc;
IOf amps.1
I
I
I
amps.
Apoliance vent
seon rt1 tp
Stationary evap.
cooler
I Vent fan wi th
sinole duct
Vent system apart
heatino or A.C.
Nechan i ca 1 exhaus t
hnnrl and rlu('t
from
Sewer
I Storm Sewer
Wood stove/heater
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
I
I
I
r- pi>
//) . TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
ISSUANCF OF PFRIBT
I HAVE CAREFUllY EXM1INED the completed application for permit, 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 Oregon pertaining to the work described herein, and that rlO OCCUPAlKY 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 exemDtion is noted hereon. and that
only subcontractors and employees who are in comoliance with OP.S 7n1.055 will be used on this project.
IWIE (p 1 ease pri nt)
t-EU/ N ':}ONES
Fire Zone
Flood Pla;n
Stories
/
Units
Occy Load
Occ.v~ Group
S IGIIATURE
FOr. OFFICE USE DIlLY
. Sn. Ftg.
SQ. Ftg.
E -:2 Sq. Ftg.
~~.~
<./
DATE
7/'J!{s7
Zone
cc.
Tyoe/Const. ::;'-,1</
Bedrooms
f1ain x Value
Access x Va 1 ue
Other~WnnY0x Value
. TOTAL VALUATlDrI
<7 ~ .....
BUILDING PER/lIT 7~ <""0 Plan Ck. Co"'"lInd r/u"''' -=>
Charges an~ ,. _____L___~~___ 65%/Bldo PJ'r Fpp ..,."", t:r ~
Surcharges r::I-- ....., &>0 Plan Ck. Res
~ ~"r=> 30%/BldQ Per Fee
PLUI1BING PERMIT - I Fence -I
Charges and -----------_
Surcharges I Dt3:mo
"ELECTRICP.L PERI~IT /C- e>C> I Sid I k
Cha rges and \...1 - - - - .t. .i? ... 'ewa
Surcharges . {; c> lAIC Payi ng
Systems Development
Charoe (J.5~)
//-4 ~
Irotal Comb. rermi.t
11ECHAN ICAL PERM IT
Charges and
Surcharges
Curb Cut
I
I TOTAL
I'll-Sf
,
,
,
0,
"
.
COMBINATION APPLICATIONIPERMIT (CAP)
I.
PERMIT VALIDATION
II.
Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
5pnngtield. E?t.ates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinqfor forced air qas
2. examoJe- waterheater/eJectr;cal!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.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - 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 30.3. (aJ of the
.... Structural Specialty Code.
H. ' DESIGN TEAl.' AND CONTRACTORS '
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job'sHe
. corrections. etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fi1'-;n 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 ~ivision
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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOOLES
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. ---
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.
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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.
I II.
IV.
V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: ~~ ,k/l? # 8"7c:::>::?-;;>3
7J/HL?;;/Jif~' t-::>~~.
1
h::>R
PLANS REVIEWED BY:
J
name
l-Off#6 R ~':=:r'
// ~_~?6?.-N:>
/ /9'" -.. "" f---t:.,/
date C. -<Y-Z?7
signature
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