HomeMy WebLinkAboutPermit Miscellaneous 1986-8-14 (2)
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ValuE of l'lor~:
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Buildina Penn; t Info: Describe Hark( Le..
Far.lilv P-esidence l'lith fi,ttached r.araoel
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~d~~. no. i (exn; res) (onone no.' I
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-, iIlSPECTlOll LWE
716-3769 .
Job Address
Z/ If? )-.4/'///7
57:
Legal De"ription /?-o3-~t:.. '1':? . t') :<,6(!)
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Owner 0/)r...~ 6v~:_~I"~
Address 1?Or'h>=->r :?~B6/
~';?7C~ ~d ""7&,/:::?q
Construct inn lender
Phone
Address
Ul:.~lull ltt\rl
(name)
Phone
(address)
Primary
Structural
Electrical
r1echani ca 1
CONTRACTORS I name 1 (address)
Genera I h.....:::;:,N~ :::;;'-vn t ~7'" J..-6?'
Plumbino
(1 its no.l
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Electrical
'1eChani ca 1
PLUlIBlIIG
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i-EIu~'n
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ELECTRICAL
FFF CHARt;F t;n i
Residence of
sq. FT.
New circuits alts.
or extensions
I SERVICES
I
I Temporary Construction
I Change in existing
rp'i- 'i riJ~nrp
I jmultifam;ly, CQITr.l. or
Tnnllc:.tri;11
I Of amps.
I cor~'1. IIND. FEEDERS
I IInstall/alter/relocate
rli~tr1h fpprlpr~
I Of amps.
I
I
I
Each single fixture
Relocated building
(new fix, additional)
S.F. Residence
11 bath\
IDuplex (1 bath) each
IAdditional bath
~!ater service
Sewer
Storm Sewer
JNfORl1ATION L~ltt. Ii
726-3753
So. Ftq. "lain
~q. ftg. Access.
Sq, Ftg. Other
r~e\<I Add Alter ~ep.
Fence_Demo _Change/Use
_Other
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N
Build Single
(px~\
(ohnnp nn )_
~qr..s?~/
MECHANICAL
1 n'~
. rL4llB.G.E.
furnace/burner to
BTlI's
Floor furnace
and vent
I Recessed wall
~n~rp hp~tp~-~nrl vpnt
I Apol iance vent
~~Oilr~tr:a
Stationary evap.
cooler ~
Vent fan wi th
s1nole duct
Vent syste~ apart from
heatina or A.c.
Mecnanical exhaust
hood and duo
I Hood stove/heater
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I ISSUANCE OF PFRtllT
TOTAL CHARGES .1 TOTAL CHARGES .1 TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pe~it
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAr1WEO the completed application for lJermit. 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 Orel)on ~ertaining to the work described herein, and that flC OCCUPAUCY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my re~istration with the Builder's
Board is in full force and effect as reQuired by ons 701.055, that if exemp the sis for ex tion' noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7Q1.055 w 1 b sed on thi oje
IlAIlE(please print)~I)~
· DATE ~tl ~
S mlA TURF.
FO~ OFFICE USE 61iLY'
So. Ftg.
Sq. Ft~.
Sq. Ftg.
Zone C. c.:
Fi re Zone
Flood Plain
Tv~e/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
riain
Access
Other r/91.~,-/ -,
",
BU I LD IIIG PERI.IIT
Charges an':
Surcharges
Plan C~. Comm/Ind
65%/Blda Ppr Fpp
------------"""fi"fan Ck. ROes
30%/Bldn Per Fee
I Fence
I O~mo
I S1dewal~
I A/C Paving
I Curb Cut
I
Value
Value
Value 7C"38.--=-
TOTAL VAlUATlOII
,
,
"--"
Syste~s Development
CharQe (1. 5~)
PLU'1BWG PERMIT
Charges and
Surcharges
------------
ELECTRIC;.L PERr~IT
Charges and
Surcharges
fI~.
I1ECHAN I CAL PERMIT
Charges and
Surcharges
~~ ~~ Total Comb. Permit
I TOTAL
u
38-SC>'
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B, Legal Oescription
1. examole- Tax lot .100, lane County Map Reference
11 UJ 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
C. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electr;cal/or solar
E. Square footage or v~luat;on, etc. ------
1. example- 1250 sq. foot house, .500 sq, foot garage
2. example- if new project, check new - i.f addition,
check add. etc.
F. Building permit information: .
1. examole - construct single family house with an
attached garage . ,
2. examole - remodel existing garage into family room
3. examo I e - convert s; n9 1 e .family res; dence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specia,lty 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
8. 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
Z. 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 011 THE SCHEDULES
D. As noted on the CAPy 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 possibley 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ITY OF SPRINGFIELD
. City Hall
Sprlngftald, Dragon
Depertment of Public Works
OFFICIAL RECEIPT
(I 'No. B
Date At..Vi 1'1 19 ~. .
(I Rec'd From ~.ElYt!= ~12..1~..4-.4 y~
'R6..7:!C,JC l~7
Address Cc.-'CJ'C'~"" c:;; 7V 1'5 /
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Received For:
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Amount Received
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tr;> ALJ'rHORlZED S1GNAT~FlE r - '1.
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Permit Clerk
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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
Ltt>7U/Cf ~r~':;( signature
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