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
, .