HomeMy WebLinkAboutPermit Building 1982-9-16
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726=''-/69 .
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Job Address
J LIlY UF SPRIrlGFIELU
COtIBiIlATION APPliCATION/PERMIT
/-'/L/ F {tUn../ I ~~;~GY SOURCES:
/f/tJ3 30.30l C:Jr2CjfJD J !later Heater
Ra nrTe
NFORI1AT: ~':{ Ll:.:;,
726-3753
Sa. Ftq. I-iain
~q. ~tg. Access.
SQ. Fto. Other
rIel... Add ft.l ter P.eo.
-Fence Demo Change/Use
-Other- -
Describe Hork( i.e.. Sui Id Single
I\ttached (iaraael
Otzt'1LPI,p )
/1-) cd.Jl
Legal Description
Owner 1- <(r s: tlk1~ j
Address flI'/7J/1'7 1lla<.4r /
Phone tJ 1 tJ
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Guih;ina Permit Info:
Far:\;lv nesidence Hith
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Construction Lender
Address
Phone
address
U
II
II
name
()IuYlIl AJ
1 ics. no.
eXOl res
Primary
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C41
11~1
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1~1
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hone no.
Structural
1'5\/0
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Electrical
~1echanica 1
CONTRACTORS
(name' _,_
(address )
( 1 ics. no. l
lexoires)
Genera 1
Plumbina
Electrical
"echanical
PLUIIBIIIG
ELECTRICAL
MECHANICAL
--Lill.:..1
'--EJ;L.' CHARGE
.I~sidence of SQ. FT.
'/New c;rcu~ts' alts.
I or extenSlons
ISERVICES
I
I Floor furnace
and vent
I Recessed wa 11
~n~~o ho~~ vpnt
-I
I Apo] iance vent
o;eOrlT"i1tp
1 Sta-tionary evap.
cooler
I Vent fan \'Jith
sinole duct.
I Vent systeM apart from
heatino or A.C.
I ~lechanica I exhaust
hood ;,od duct
I Hood stove/heater
I
I
I
II.
Each Single fixture
furnace/burner 'to
BTlI's
Relocated building
(new fix. additional)
"S,F. Residence
(I hathl
IOuPlex (1 bath)
jAdditional bath
Hater service
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,-+--1
/ I I 10f
I I IICOI1l.I.IINO. FEEDERS
I I I IInstall/alter/relocate
rli~trih_ fppdpr~
I I Of amps./
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1\~1) I I I
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each
Sewer
ITemporary Construction
IChange in existing
rpsidenrp
Imultifamily, camm. or
Induc;.tr;al
IStorm Se...'er
amps.!
(chane no.-)
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TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCf OF PFRlII T I
TOTAL CHARGES "'
Contractor, the electrical portion of this permit
and returned to the Building Division
I HAVE CAREFULLY EXMlINED be completed ap!11icat"ion for bermit, -and do hereby certify that all information hereon is true
and correct, and I further certify that any and all wQrk oerformed shall be done in accordance with the Ordinances of the City
of Sari ng f; e 1 d and the Laws of the S ta te of OreC)on pe rta i n i ng to the work descri bed here in, and tha t rw OCCUPAHCY will be made
of any structure without the permission of the ~u;lding Division. I further certify that my reqistration with the Builder's
~oard is in full force and effect as required by ons 701.055, that if exempt the basis for exemDtion is noted hereon, and that
00', ,"'CO",,,,,,,, 'M ,~,."" .. 'co " ~"'"" .", '"' '''..~" "', ".""
IIAIIE(please print) D Au [ Tfl N70fIJ SIr.IIATUR~~~ OATE~/t:::..,p?
FO~ lJttll!:. USE~~~"- - - ~
Sq. Ftg. f1ain
SQ. FtlJ. Access
So. Ft9. Other
Is,7.~
TOTAL CHARGES
loIHERE STATE L..\U REQUIRES
shall not be val H unti 1 the
Electrical
Surervi sor
Zone
Type/Cons t.
Bedrooms
Units
Fire Zone
x
Value
Value
Oeey Load
.acc,Y Group
x
Value
Flood Plain
Stories
x
BUILOIIIG PERI.IIT
Charges an::: ""\
Surcharges d-
TOTAL VALUATION
IS 0[) 'Plan Ck.
. ~----.!:'_..!___I 65t!BldQ
75 I Plan Ck.
. 30%/BldQ
Fence
Comm/lnd
Per Fee
Res
Per Fee
Syster:1S Development I
CharQe (1. 5')
PLUI1BING PERMIT
Charges and
Surcharges
------------
Demo
- - -
Total COlTlb. rermi t I
TOTAL
. ELECTR ICP.L PERlIIT
CharQes and
Surcliarges
Sidewalk
------------
A/C Paving
IIECHANICAL PERI11T
Charges and
Surcharges
------------
Curb Cut
~
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100. lane County Map Reference
17 03 43
2. examole- lot 1. Block 3, 2nd Addition to
~pringfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/eleccrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exampJe- if new project, check-new _ if addition,
check add, etc.
f. Building permit information':
.1. example - construct single family house with an
attaChed gar~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 1n Section 303 (a) of the
Structural SpeCialty Code
H. DESIGN TEAM 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, Mechanical, & 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 schedules 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 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 fees are due and payable at the time of the
application, and no plans \.1i11 be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
j
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Cl erk
CC-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
I
date