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HomeMy WebLinkAboutPermit Building 1989-5-3 W~PECT JOrl llilE. 726-3769 . _ Job Addr... lOti/; fv1A1N &7" l.eqa10emiption 1(/(')3 ~S1-1 O4IorY) LIlY uF SPRIlMIELU . COIIBIlIATION APPLICATION/PERMIT E!IERGY SOURCES: Ileat Ua ter Ilea ter Ranl1e NfORIlAT: .:1 Lt.,:. 726-3753 Sa. Ftq. ',lain ~q. Hi): ^ccess. SQ. Ftq. Other lie,., Add fl. I ter ~eD. --rence Demo Change/Use Other -- - Phone I ValUE" of I I L_&Ukb I I 114t~o Ouil(;ino Penult Info: Uescrlbe Hork(i,eo. Fclr.li 1 v nes idence l'lith (t,t tached t'iaraoe) owner~~{~F.1 D ('LfIJ~C-tl dF-71IE ~I ,'''dres> 107;7 MAIN "'5,. ~Nl7f/.E.I f') t1< "{74.77 Construction lender ~€.. ..\ddress UESIGIl !lN' tname) Phone (address) Primary :t12';:'1") L. r~~~e 1~.AI1~1 Structural Electrical !1echanica 1 COil TRACTORS ~l=r ":=;'-/nP'; IN AT::[rt- (1 ics. no.) (exoirps) Bui Id Single 1~.I?o ~~..." glJ Em~NIE ~ Cf74fJ2.. (ohane no.1 \name) (ohane no,) .. ! i I I I \ I Genera 1 L-Mst:. (address) c..8MM(JNr iY 10f I C0I1I.1./1 NO. FEEDERS Ilns ta 11 /a 1 ter/re locate rli~trih_ fppdpr~ 10f amps.1 I I I I I I I TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES WHEr.E STATE Uti REQUlllES that tIle Electrical l'Iork be done by an Electrical Contractor, the electrical nortlon of thls permit shall not be vellH until the label has been signed by an Electrical Surervisor and returned to the Building Division I IIAVE CAHErULLY EXN1lfj[/) U1P. completed ap[llicaLion for f)crruit, and do hereby certify that all information hereon is true ilnd correct, dnd I further certify that any and all l'Iork nerformed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Orenon op.rtaininl1 to t.he work descrihed herein, and that UO OCCl!PAIlCY \'1111 be made of any structure witholJt the nHmission of the nuildill~ nivisinn, I fllrUl(~r cert.ify thi,t Jl1y rel1istration \'Jith the Guilder's noun is in full force and effect as reqllired hy OI!$ 701,O~5. U"lt if eXCIIl!lt the hasis for exelllntion is noted hereon, and that only subcontractors and cr.!r1oyees who are in comoliance with OI~S 701,055 I.lill be used on this nroject. SIr,IIATURE ~~ r~- FO~ OrFICE USE ~V.A v ,- 1 PlumbiOQ Electrical !lech<'lnic<'ll PLUI1RIIIG -...lill.:.. Each single fixture -----IRelocated building (new fix. additional) IS,F. Residence r I b<lth\ -----IOuPlex (1 bath) each IAdditional bath I\-!ater service ISewer I Storm Sel'Jer I -----I I I I I I '-I I I I I I ul I I I I I IWIE(please print)~t:=l"::> 1.. ~/.J..F {.p. ELECTRICAL FrF IrlIARr.F ..1lL' Res idence of sq. FT. ~ -----I New circu!ts alts, I or extenSions /SERVICES -----I ( I ics. no,) (exDire~~ wpnt I-EH I I I I 1-' I I I I I ru~ jTemporary Construction IChanqe in existing rp'j i df'nr~ Imultifamily, conlf!l. or I nrllle;. tr1.~ I ftp F~f>' AI 1t MECHANICAL D~,TE o~~: ,- Zone Fire lone Flood Plain Tyoe/Cons t. Bedrooms Stories BUILOIlIG PERIIIT Charl)CS an'::: Surcharges PLUI1BIIlG PERMIT C~arges and Surcharges . ClECTRIU,L rERI~lT Cha rges and Surcha rges IIEClWIICAL PEP.11IT Charges and Surcharges Units Occy load (kcy Group amps, I ~I~ I I I Recessed wall ~n~rp hp~tpr ~nrl I -----I I I I I , furnace/burner to BTlI's I Floor furnace and vent I' Apoliance vent e;.POAI.~tp I Stationary evap. cooler 'Vent fan with sinolp duct I Vent systeM apart from I heatino or A_c. I Nechanjca 1 exhaust hnorl "lnd durt I Uood stove/heater ISSIIANCF OF prmllT Sf!. Ftq. f1ain SQ. FtlJ. Access Sq. Ft9. Other x COllm/ I nd Ppr Fpp R-es Per Fee x Value Value Value ~_J~~___ ',~~;~B~~~ I C::: Plan Ck. '\ -JD%/B1do I Fence ------------ I Or-mo I x TOTAL VALIIATIOII Syster.ls Development CharQe (1. 5<) I I I I I I I I It~.1S ;, ITotal (omb. Pp.rmit I TOTAL . COMBINATION APPLICATION/PERMIT (CAP) !-.' Applicant to furnish A, . Job Address 8. Legal Description 1. examole- Tax lot 100. lane County Map Reference II 03 43 2. example. lot 1. Block 3. 2nd AddiUon to ~prln9tield [stales C. Name. etc. of owner and' construction lender O. Energy Sources I, examnle- heal/electrical ceilinl)/or forced air Qas 2. examOle- waterheater/electrlcaJ/or solar E. Square footage or valudlion. etc, - 1. examole. J250 sq. foot house. 500 sq. foot garage 2. example. if new project, checkri'ew _ if addition. check add. etc. F. Building permit illformalion: 1. examDle - construct 5inyle family house with an attached 9olr~ge 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. OESIGN TEAl.! ANO COIITRACTORS To avoid design or constr'uction 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 I'Ihere 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. Nechanical, 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. BUllOING OIVISION STAFF Will FIll OUT All FEES AIIO CHARGES 011 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 signature, IV, Fees and Charges Plan check rees are due and payable at the t irne 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 permi t is issued. V. FOR OFFICE USE OlllY ,. 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAnCY: I . .' . PERMIT VALIDATION ~ l3f) 3L. . 5381 Permit. CI ,,' riJif'rA ) 1 Permit applicant exempt from registration with the Builder's Boat-d because: Additional Project Information: PLANS REVIEWED BY: name signa ture - ----.----..-___ _'u_,__ 1 da te , .