HomeMy WebLinkAboutPermit Miscellaneous 1987-1-28 (2)
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TOTAL CHARGES I TOTAL CHARGES 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 valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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\' rrfSPECT 10;1 L WE
726-3709
Job Address 1001 r,1ai n Street
Legal De,cription 17-03-35 4.1
Lots 5300, 5400 & 5500
Soringfield Utility Board
POB 300
Owner
Address
Springfield, OR 97477
Construction Lender
Address
lJt~llirj TtJ\r1 \nameJ
Prf'mary Virgil Alonso, SUB
i Structura 1
Electrical
t1echanical
CONTRACTORS {name}
Gpnpr", 1 per bid process
Plumbina
Electrical
~1echilnical
PLUIIBIrIG
j;O.1
lEach single fixture
IRelocated building
(new fix. additional)
IS.F. Residence
11 bath)
louPlex (1 bath) each
[Additional bath
I ~Jater service
isewer
, FEE
rHARr,E
Storm Sewer
LiTY U~ SPRHIGFIELO
CDrIBIIIATlON APPLlCATlON/PERMtT
EIIERGY SOURCES:
Heat
Hater Heater
,
i NFORlIA Tl 0:, u :It.
726-3753
So. Ftq. '.tain
~C]. Ftc]. Access.
So. Ftg. Other
tIel" Add f..1ter [".eo.
_Fence_Demo _Change/Use
_Other
~
~
1t:J
Ranoe
ValUE of [.Jork:
:!:. $30,000
746-84' 1Builc;inQ Permit Info: Oescrlbe Hork( l.e.. Bui Id Single
p~o~_. .. Far.lilt. nesidence \Hth /lttached r,araoe}
,H~ 35,300 square foot asphalt overlay
5,360 square foot new paving
Phone
(address)
(1 ics. no. l
(exoiresl
(Dnone nO.1
746-8451 ext 402
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V.ri"l
,
\A~OO
AJt;.L~-J
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(address)
(lice:.. no.)
(exoi I"pc: \
('hnnp nn_ \
ELECTRICAL
MECHANICAL
tlO !
I.Residence of
SQ. FT.
INew circu~ts alts.
or extenslons
I J:'J:'~
I rI-lARr,~' no. I
furnace/burner to
BTU's
I FJ:"F
I
I rI-lAR(:J:'
Floor furnace
and vent
SERVICES
Recessed wall
SOrtCP hptltpl" tlnrl VF'nt
Temporary Construction
Change in existing
rF'~;qf>.ncp
multifamily. comm. or
Inrlll"tri<ll
Apoliance vent
e:.eoarate
Stationarv evao.
cooler W .
Vent fan with
sinole "uct
Vent syster.l apart from j
heatino or A.C.
j'lechanical exhaust
hood iln" dur:t
Of
amps,
COI~I,1. II NO, FEEDERS
Install/alter/relocate
rlic;trih_ fpprier"
Hood stove/heater
IOf
I
amps.1
ISSUANCE OF PFR'1tT
I HAVE CAREFUllY EXMlINED the completed ap['llication for !'lermit. and do hereb.v 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 Ore(]on pertaining to the work described herein. and that IJQ OCCUPAIlCY \.,.i11 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 exemntion is noted hereon. arid that
only subcontractors and employees who are in comoliance with OP.S 7nl.055 will be used on this ~roject.
IIAIIE(please print) f?/"I-IAt:':'T':> ~Li,)/.f'p SI('II^TUREAL_~^~' OATE i/:?eY87
/f \ ____- " FO~ OFFICE USE DiJl Y
Zone/ i;C TYDe/con'-t~MY/~ )Units Sn. Ftg. 11ain x Value
. I \ ' / ~ r. '-'" J".J'./. ,1/_ ....,.
Flr~ Zona Bedrooms '---______ Occy load SQ. Ftg. Access/~'EW .~j'/~ Value y~
Flood Plain Stories Occy Group Sq. Ftg. Other C>VtS>?~~ Value~.-
/f..{~;-(:~:.: ,/~z::::~~ ,?5~~"~5<,,~':Z:"J .'::::;~,/ /::~'.f:".' (~;:;V/;;/i::.',::~ (";:.;--:..<:..,.;.;o TOTAL VAlUATIOtl~~""
BUILOIlIG PERIIlT ~~~~R~~~ ~~~~;:d(i) ;;C€?, 9::: ~h;~~~s (~e5Wpmen:) 2. ~. ~
~~~~~;~g:~~ ------------ ~6~~B~~~ ~:~ Fee I
PLU'1BING PERMIT I Fence I
Charges and -----_______
Surcha rges Demo I
ELECTRICP.L PERI:IT
Cha rges and
Surcha rges
11ECHANICAL PERI~IT
Cha rges and
Surcharl)es
q,
I
'1'1. t)"C I
"
/33. 7"3 I
,
,
Sidewalk
------
I A/C Paving
I Curb Cut
--------.----
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'I'I.5'C'
Total Comb. rermit
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xamFle~ Tax Lot 100. Lane County Map Reference
17 03 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 ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. 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. examole - construct single family house with an
a ttached garage
2. examole - 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 303 (a) of the
Structural Specialty Code
H. DESIGN TEAI.I 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. 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 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 scheaules 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 sianature 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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a 01 0 f~
(j /~0
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V, FOR OFFICE USE ONLY
Permit Clerk
CG
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Add.iti ona 1 Project Informati on:
PLANS REVIEWED BY:
? ~ ';')---
name i..&..z?NE rc:c;:;;:g;zp Signatur<.~/~__-",
.
date /-/9-.87