HomeMy WebLinkAboutPermit Building 1989-6-12
.j lil~I'(CllOlI llill
726-3709
'~Ob Address 13:X' ~
I..gdl Oe<cription 1703354/ OO:;(O,;;J...
no 3?:>(O 3:;'0300/ .
own.r~. ((~o~tUu
Address /_1(J() ~~ ",')-f-V 1 ' 61.\
constructift:J::L- Oficf-7)
,\Jdress
OESIGIl Ill\/I
Primary
Structural
Electrical
!1echan i ca I
CONTRACTOR>
LIlY 1)1 >!'RIIIGIIELU
CorlBII/AlION APPLICATION/PERMIT
E!iERr,y SOURCES:
Ileat
Uater Ileater
Ranflc
IflfOllllAT: .:1 Ll.,:.
726-3753
Sa. Ftq. ":310
~q. ftc]. Access.
SQ. Fto. Oth.r
fle\1 . Add ~.l ter ~.eD.
--rence Oemo Change/Use
Other -- --
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Valur of Hark.: ~
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Uui It;ino Perm; t Info: Descrlbe I.Jorkll.e" Gui Id Single
f,'m1el1i~;Hi~C~:~ j h A /'
1/ 11
{nameJ
Phone
\address)
Genera 1
r;g() 'rri1Jtu.. ~
Plumbino
E I.c t r i c d 11I?;i ..Jtlvrrir71
tlp-chanica1
18lJ ~ Viw; WffiAu
,.
PLUI1BIIlG
ELECTRICAL
i:U.1
-----I EdCh singl. fixture
-1"Relocated building
(new fix. additional)
I'S.F. r.esidence
_ {I b"hl
IOuPI.x (1 bdth) .dch
jAdditional bath
~!a ter serv i ce
Sewer
IStorm
I
Sewer
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lon.-C- .c..
Fire 70ne
F'lood Plain
BUILOlIlG PERIIIT
Charl]es an~
Surcharges
PLU'1BING PERMIT
C~arges and
SurCharges
. ELCCTRICf..L rERr:1T
CharQCS and
Surcharges
!1WIANICAL PCP.!1IT
Charges and
Surcharl'}es
'-ITL
I
CI/ARGE
JiLl
'Residence of
SO. FT.
1----- New circuits alts.
or extensions
{ /SERVICES
TlD.=.r:
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.Ye-G.'.'-O .Jp:>
Construction'
,
conf!l. or I
I T empora ry
IChanlJe in existinl]
r('~id{'nr~
ImUI t i fami ly,
lndu",triill
IOf
I cor~1. /I NO. FEEDERS
Install/alter/relocate
distrib f~~pr"
amr>s.1
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amps.l
,
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Of
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I TOTAL
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"'-let - f(PN I
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B:.L_CIlAlllif..
(I ics. no. I
(emirf's)
(ohonc no. J
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Electrical Con'tractor, the electrical rorUon of this perr.lit
SUflervlsor <lnd returned to the Building Division
Tyne/Const;
Bedrooms
.s--A/ '
tlni ts
( IIAVE CA/!ErULLY EXN1H1CI) t~lC completed apnlic.ltion for 'lermit, .HHI do herebv certify that all information hereon is true
and correct, and I further certify that any and all ',"ark oerformed shall be done' in accordance with the Ordinances of the City
of Soringfield and the laws of the Stilte of Drenan oertaining to the work described hel'ein, and th.H flO OCCl!PAIlCY ,,,i 11 be made
of any structure without the permission of the lluildin<1 Oivision. I further certify that mv re<1istration "lith the Ouilder's
Goard is in full force ,1nd effect as re(IIJired by O/:S 701.055, that if c~the baSIS for exernntion IS noted hereon. and that
only subcontractors and employees \~ho are In comnliance with OI'S 701.D 5 \11 1 be used on thlS project. .
"MIE(pl.... Prlnt)~ljQli..~ S'r k'^"~t SIr.IIATURE - ~~qL~Dm Cr-f'L-
~
FO~ Off I CE lISE 0/11. Y
S~. ft9. /lain
SQ. rt~.
Occ.y Group 7<:- 2 So.
Ocey load
Stories
-;::>= Pldn Ck.
~ C>_~~ 6S%/Blrln
------------ PTdn Ck.
/. "55 JO%/Bldn
I Fence
------------
I D~mo
:5C>_-=. I Sid.walk
------;=-s=0-:-, A/C Pavin~
____________, Curb Cut. I
~e9~? ~
Corrm/lnd
Ppr Fp~
ffes
Per Fer
t:(?>.-
I -;? 7.::>0
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II/I. 9"3
I /!('7'. ~ 3'
Q.
Ii
L/t./-;:).tJ.7
~0{J
n .
ex ir
/.o-;}.tI-"'-c.
il, J f(q
,-
flECIlAN I CAL
-ElL J:J1ARGl.
furnace/burner to
BW's
I Floor furnace
and vent
I .r.....~.cess.d wdll
,I,). l ",,("p h,."tpr "nn v~nt
/S'-'!
I I APDI iance vent
Sfloal.atp
I 1 Stationary evap.
cooler
I I'Vent fan with
<; inolr> r1uct
I I Vent syster.l apart from I
heatinq or A.C.
I I Nechanical exhaust
hnrll1 .lnn r1urt.
I Hood stove/healer
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ISSIJA/lCf nr -fmllT
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TOTAL CI/ARGES
x
ystccs Development
CharQ. (1.5")
ITotal (amb. rermlt
I TOTAL
g"
. 7
,
c-- --
--=r"" b_
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
,A. Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
II oj 43
2. example- lot I:'Olock 3, 2nd Addition to
~prlngfjeld (states
I; "C. Name, etc. of owner and construction lender
O. Energy Sources
1. examnle- heat/electrical ceilinq/or forced a,ir qas
2. examole- waterheater/electrlCnl/or solar
E. Square footage or valuation. elc. -
1. examole. 1250 sQ. foot house, 500 SQ. foot garage
2. exalllole- T"f'"F1ew project, checknew - if addition.
check add. etc.
F. Building pemit information:
I. example - construct sfnyle family house with an
attached gclr4ge
2. examole - r~nodel existing garage into family room
3. examole. COllvert single family residence into
restaurant (change of use)
G. Value of \'lork as defined in Section 3D3 (a) of the
Structural Specialty Code
H. DESIGN TEN.I AND COI/TRACTORS
To dvoid design or canstl'uclian 'delays, OuihJing
Division Stdff must be able La conlact appropriate
persons reg a rd i ng des i gn in forma t i on 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, Nechanical, and Electrical Schedules
are available at the Building Division
1. To conserve spdce 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. BUILDING DIVISION STAFF lllll FIll OUT All FEES AllO
CHARGES 011 TilE SCIIEOUlES
O. 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.
IH. Applicant to sign and dilte
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wi 11 prepa re a type wr it ten copy and re turn it to the
applicant at the time the actual permit is issued for his
signdture.
IV. fees and Charges
Plan check fees are due and payable at the time of the
dpplication, and no plans \.dl1 be processed until these
fees are paid. All other fees anLl charges are due ilnd
payable when the permit is issued.
V. FOR OFFICE USE DrilY
PROJECT CONDITIONS TO BE sAnSFJIP BEFORE DCCUPAtICY:
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PERMIT VALIDATION
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\4,20
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Permit.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signa ture
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da te