HomeMy WebLinkAboutPermit Building 1989-2-22
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1rI~I'lC r lUll L "'l .
726-37V9 . __
Job Addl'e5S ~"03 .0;. '1'fJ' '1 sr.
I.e~.l De<cription \ Y ~ () ~ c;lS4 I
LIlY tJI SI'RIrIGf IlLU
CDrIBIIIATION APPLICATION/PERMIT .
I E!IERGY SOURCES:
- f' rI'~ He.t
U"\.l_l) " l'later lIeater
Ranl'1e
J ValuE" of Hark:
I 9.;J0t) qg
I tluill.ino Pernl1t Info: Oescnbe l~orkli.e" Build Single
F' "r.ll 1 v l"lP.5 i dence \lith I\t tached C';araoe)
1#.A'<l!/~ tEJL~,J", ~'{?4~o,.
tJ ,.ee I. c.~ wJ;. 3 '8' e;-A>' ~sc;
Owner -c;,-",AOr. (/s-4
,'<idress qaJ A/V Sr P~H.A.J< Jf'~
~IJ"'Q ~:<. 97:'-/0
Construction Lender
,hldress
Il All name
Primary -?~-K &cKU. a.
Structur.1 ~&J<!!."t!. ,! ,Jt:.JE<!LI't.>~
Electrical
!1echanical
CONTRACTORS (l1ilrne)
Gener.l kl4f,c: d&:!n..c. (J.
,
Plumbino
Electrical
nf!r.hanicitl
PLurIB IIIG
...lill..:.
Phone
['hone
address I ics. no.
-Z3t?~.it/." 4H 81!lt/AAJO ~~
ot.9o SiJJ &tUCebf+ Jk H,.,AJIJcR-
(address)
.::23r/sd ~H
4;~:~
ELECTRICAL
_ -liL. CHMGl JlI1...
Each sinqle fixture
SQ. FT.
-IRelOC-atedb~'i j'd i;g"
(new fix. additional)
I'S.F. r.esldence
(I bathl
-----IOuple' (1 b.th) each
jAdditlonal bath
~!a ter serv i ce
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,
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II
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n__ I --I
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Se....er
I Storm Se\'ler
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Residence of
-Ef.L1J:!lI\JlG
~INew clrcu~ts alts.
or extenSlons
~ dR NI,.""",
/SERVICES
-,
ITemporary Construction
IChan'1e in existing
,residence
/multifamily, conl!l. or
Indu<;.triid
IOf
I COI.lIl. /I ND. FEEDERS
Ilnstall/alter/relocate
di c;.tritL fpprler<;
IOf .mp~1
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amps.1
TOTAL CHARGES TOTAL CHARGES
HI/ERE STATE L.'\U REQUIRES that the Electrical work be done by an
shall not be vali'J until the label has been signed by an Electrical
Zone
Fire lone
Flood Plain
Tyoe/Cons t.
Bedrooms
Stories
BUILDI1lG PERHIT
Char')es an~
SurCharges
-r.~3
PLU'IBING PERMIT
Charges and
SurCha rges
. ELECTRICf..L Plm:IT
CharQes and
Surcharges
rlECHMIICAl PEP.r1IT
Charges dnd
Surchar!)es
\0'0\'0
<'2- ~C>
Electricdl Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
Units
'lain
Access
OthcrC ::,:..~ - i
Occy load
Occy f,roup
t4fORtIAT: ~:I ll..:..
726-3753
So. Ftq. "iain
~q. ftl). Access.
SQ. Ftg. Other
rleh' Add JI.l ter ~eD.
--rence Oemo Change/Use
Other -- -
exnlres
5~;'
! '
---s;::>i
i~1
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(ohone no. J
..2.~-<';;5t/.r
2.:2 </- (} sz, Cl
(exoiresl
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.ohonp nn _I
..;:113& S'3 <II
/1/l-
MECHANICAL
furnace/burner to
BTti's
I Floor furnace
and vent
" I Recessed wa 11
~n~rp hp~tp~ ~nrl
,-
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I TOTAL CHARGES
Apol iance vent
~po..H'atP
I Stationary evap.
cooler
I Vent fan with
..inole duct
I Vent system apart from I
heatino or A.C.
I' Nechan ica I exhaust
hood and rturt
I Uood stove/heater
ISSUArICr OF PFP.lUT
)C Value
x Vdlue
'L:y1';~~ ~ L~"':- Va 1 ue
TOTAL VALUATIDrI
.;J'd;;;2-'i1 (j;.O ~9o 4
c- ..., 33 13'2"D Syste~s Development
~~, ,~ Ch.rQe (1.5<)
#4
A/C Pavinq
!rotal
I TOTAL
I HAVE CAREFULLY EXAflltlEO t,e completed apfllication for ~ermlt. 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 Sor i n9 fi e 1 d and the LdWS 0 f the S ta te 0 f Ore~on pe rta 1 n i n9 to the work descri bed here in. and tha t fie OCCl!PAIlCY \"i 11 be made
of any structure without the permission of the Buildin9 Division. I further certify that Ply renistration \ol1th the Builder's
lloard is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemntion is noted hereon. and that
only subcontrdctors and cr.lployees who are in comnliance with Or.S 7l'H.OS5 ,.till be used on this nroject.
?a~; +- ~.)<I''' /-kN1 SE.e.lJfCES /) .' f)
1lMIE(please pri:;:OAde.- t{fA1lHF..f _ SIr.;IATlmE .A/t:1P4.~.__...Y
FO~ OrFICE USE O;ilY
Sf!. rtn.
SQ. Fl9.
Sg. Ftg.
~__ PI.n Ck. Comm/lnd
----~2q::_ 65!/llldo Ppr Fpe
Plan 0. Res
30t/Rldn Per F~p
I Fe~ce ---"-
---------~--, Dp.mo
-.:<' ;(' ~5Z>-1 Sidewa lk
------------
/.~
Curb Cut
3/2-
(amb. Permi t
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example. Tax lot JOO. lane County Map Reference
II oj _3
'2. 'examole- Lot 1. Block 3. 2nd Addition to
Sprlngtield [states
C. Name. etc. of owner clnd construction lender
D. Energy Sources
1. example- heat/electrica.Ll:eJJjn~lor forced air Qas
.2. examole- waterheater/eH~(;(I"lCn liar solar
L' Square footage or valuation, etc. -
1. examole- J250 sq. foot house. 500 sQ. foot garage
2. example- if new project. checkl1ew _ jf addition,
check add. etc.
F. Building permit information:
1. examole - construct sinyle family house with an
at lached garage
2. examole - remodel existing garage into family room
3. exanmle - 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 TEN! AND COIITRACTOIIS
To avoiiJ dcsi911 01' constnlCtioll iJCl.IYS. ULJiliJillY
Division Staff must be able to contact appropridte
persons regarding design infonmation or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except l'lhere 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. ff 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 ArlO
CHARGES ON TIlE SCHEOULES
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.
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building ~ivision 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.
~~33B
V, FOR OFFICE USE ONLY
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permitCler~ ~J:l.gX7i )
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
J
Permit applicant exempt from registration with ,the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
1
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date 3'~-8"'7
name ~ 6-h"'#~~~~ignature
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