HomeMy WebLinkAboutPermit Building 1989-5-12
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7(6-31"9 COIIBJ;IMION APPlICATION,PERMlT
Job Address ~ aCCJS ~ J(\ ,,~O 0 1- ~~~~r,y SOURCES:
I-Ia ter Itea tcr
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Owner \<\'F..-t'fl<n t)LuY\ h~0
,'ddress ~ 5m 'S"\"(\ i.,0. Phonc!J.4Iq-
I constr~~~l f\\M1r' 9A \ \
tlfOmlAl :..'1 ll....
126-31;J
So. Ftq. nclin
~q. :tf]. Access.
So. Ftg. Other
lIel" Add JI.1 ter ~eD.
Ranfle -rence Demo Change/Use
i'luf I.j f:X:::) ') Other- -
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(Juilt;ino rmit In 0: Uescrllfe Hork(i.e., Build Single
F.li:Jilv Residence Hith (lttacMd r.ilranel
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l.elJal De~cription
AJdrcss
Ul~IGIl IlIll'
{name)
Phone
(address I
( ^Q -~b
(I ics. no.)
(cxnirf><;,)
(nhone no.'
Primary
~1echanical
COIITRACTO S
Q 5:\-T.o f\"'}.D
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A
wi-
fAf .
11 n .) (cxoires) ([)hone no.) ,
~~() ~ ~u,) c(~ '4 q~~? r
- \J III <)( ~ .C\8:;d
(](J'Tag' J
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,
MECIlAN1CAL I
.IIL J:lJARliL
furnace/burner to
BTlI',
Structural
Electrical
Genera 1
Pl umbi on
Electrical
11f?c:haniC<l1
PLUlm !fIG
ElECTRICAL
nu.
Each single fixture
..llL CIIARGE .J1U- ..ILL .LJlARG.!: II
Residence of
sq. FT.
I Relocilted bui Iding
(new fix. additional)
"S.F. P.esidence
II b,th I
-IOuPlex (I b'th) each
jAdditional bath
~!ater service
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'SERVICES
-,
New circuits aIls.
or' extensions
Sewer
_IStorm Sel'/f'f
ITemporary ConstructiQIl
IChanqe in existing
rf"l'l i d('.nr~
Imultifamily, conrn. or
Inc1u<;,triill
10f
ICor111.IIND. FEEDERS
I rlS ta II /31 ter/re locate
_.ililLi..tt fppr!prc:,
Of
amps.J
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I
I Floor furnace
and vent
I Recessed wall
,_ -5.fl:lirp tlp"tp.. "on
I
I I Apol iance vent
c;POiU"alP
I I Stationary evap.
cooler
I I Vent fan \o\!ith
sinnle dun
I I Vent system apart (rom I
heatinq or A.C.
I ~Iechanical exhaust
_ ...hood ilnd dur t
I
HOOd stove/heater
I
".+1
I ~I
I I
II
I
I I
'-I
I I
I I
I I
-,
-,
amps.j
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TOTAL CIIARGES I TOTAL CIIARGES TOTAL CIIARGES I
I HIIEP.E STATE L.\lI REQUlIlES that the Electrical \'Iork. be done by an Electrical Con-tractor, the electrical nortion of this perr.11t I
shall not be vitlH until the 1.1bel hilS been signed by itn Electrical SUflcrvisor a~d returned to the Building Division
I !lAVe cA'f(1"uLlYnAl1iuco l~le c:on-llllet'eITa[)~ncatfon (()r r)crmit-:-"dnd"do her-e.b.;" certifyUlatall-infor-mation hereon-iS true--'
and correct, and I further certify that any and all \'Iork. oerforrned shall be done in accordance with the Ordinances of the City
of Soringficld and the Laws of the Stilte of Orenon oertaininl) to the work. described hel-ein. and that UO OCC~rAUCY \'Ii11 be made
of any structure without lhe permission of the Huildin!l Division. I further certify that fTly re~istration \'lith the Ouilder's
Ooard is in full force ,lnd effect as required by Of~S 701.0~!i. t/lill if exemot the basis for exernntion is noted hereon. and that
':::,::::::'::::~ ;~';L~' D 'a:~::::,,::,,~' ." '~"llla4/' .,,? 7.l-n
I FO~ lifF ICE IISE O;IL Y 1
Zone Tyoe/Const. \Jnits Sf!. H!1. 11ain x Value
Fire 70ne Oed rooms _ Occy Load SQ. HI]. Access x Value
Flood Plain Stories Dcc.y Group SIl. rtg. Other x Value
TOTAL VALUATlorl~ \ ~ t~I'
ISysteCls Development I
Char"e (1. 5..)
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!Total (amb. Permit I
I SSU~NCE nF PFP.I\IT
BUILDIfIG PERI.lIT
Char"]es an:::
Surcharges
--~_.5D=
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Plan Ck.
65!/BldQ
Plan Ck.
30%/Bldn
COll1Tl/lnd
p",.. -=-,...
PLu'm IIlG PERMIT
C:'arges ilnd
Surcharges
Hes
Per Fef2'
Fence
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Dp'mo
_ ClECTRIUl PEm:1T
CharQcs and
SurCharges
Sidewalk
,"I A/C Pavin9
IIECIIAtII CAL PEP.111T
Charges and
Surchar'1es
,- Curb Cut
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COMBINATION APPLICATION'PERMIT (CAP)
I.
II.
Applicant to furnish
.A, Job Address
B. legal Description
1. example. Tax lot 100, Lane County Map Reference
II UJ ;3
2, examDle- Lot I. Block J, 2nd Addition to
~prlngtield [states
C. Name. etc. of owner and construction lender
O. Energy Sources
1. eXdm~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterhealer/electflcal/or sol~r
E. Square footage Or valuation. ctc. -
1. examolc. ]250 sq. foot house. 500 SQ. foot garage
2. eXilmple- lTnew project, checknew _ H addition,
check add, etc.
F. Building permit information:
1. examole - construct 5inyle family house with an
at lached g,]r~ge
2. examole - remodel existing garage into family room
J. examole. Convert single family residence into
restaurant (change of use)
G. Value of \"ork as defined in Section 303 (a) of .the
Structural Specialty Code
II. OESIGN TEAI.I ANa COriTR^CTORS
To i1void design or construction delays, Ouih.ling
Division Staff must be a~le to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Nechanical. .\ 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 instdlled
B. Full Plumbing, Nechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permi t 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. BUILOING OIVISION STAFF IIILL FILL OUT ALL FEfS AND
CHARGES 011 THE SCHEDULES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electriC<J1
supervisor. The general contractor is not authorized
to sign the electrical label. -
Applicant to sign and date
~henever 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 lime 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 ,.dll be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
III.
IV.
V.
FOR OF FJ CE USE ONL Y
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PERMIT VALIDATION
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Cler~m
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Perm it
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Permit applicant exempt from.registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
signa ture
'j
.'
date
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