HomeMy WebLinkAboutPermit Building 1985-7-1
,~
r3\.JI.~
.
IlNSPECTlllJil L l!l'I
726-3769
Job Address 33 <65' oJl-~~ ~ + .
Leg.l De5cription 17'~7.<:JO.3vlI. ~
~ 'l~-,,"J~
,~:zgc; ~n/j'j"-"'t:.;, ~hOne?;;_"v.
??6-'5$11
Owner
Address
Construction Lender
Address
Ut~lliN TEAf.1
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
{namel
Plumbina
-~
(name)
Electrical
"'echa ni ca 1
NO.
-~-
PLUltBI NG
Each single fixture
Reloc.ted building
(new fix. additional)
S.F. Residence
(] b.th I
IDuplex (1 b.th) e.ch
IAdditional bath
I ~Jater service
I S,ewer
~1Storm Sewer
CITY Uf SPRINGFIELD
COMBIilAT10N APPLICATION/PERMIT
EilERGY SOURCES:
He.t
t~ater Heater
Ranqe
ValuE. of Work:
;$/0 MY 0
Builtiin6 Permit Info:
Familv nesidence With
INFORllATlON UNe
726-3753
Sq. Ftg. M.in~'"
~q. ~t9. Access.
Sq. Ftg. Other
){!lew__Add__Alter~~ep.
Fence Demo Ch.nge/Use
Other - --
Describe Work(i~e.,
Attached Garaae)
(1- ~(JA~ t: /17
~ <).[) i t'
Bui ld Single I ,
~
g)
~
(ohane no. \
~u.;,LJ,~;O
Phone
(address)
(lies. no.)
lexnires)
(addr~ss)
(lics. no.)
(p'.lCOirpc;)
(ohnnp nn \
ELECTRICAL
I MECHANICAL
<<LI~I
I furn;tr'p/hllrner to
/ BTU's
I Floor furnace
and vent
I Recessed wall
<:r'li>r'P ~P"""'" ".,rl 1/1""'''
I
6.-
FEF
rHARr.F
Nn
t't:'t:' ru~
Residence of
SQ. FT.
,/
New circuits alts.
OL extens ions
:z dR .1Vi6Rt#;
SERVICES
IS'"
I
I
I
I~..). / Of -..? CO .mps.1 -<<.I.;' /
I I COMIL/I NO. FEEDERS I I I
I I Install/alter/relocate I I
rlic:;trih fpprlprc:;
I Of .mp~1 I
I I
I ~I I
I I I
"2'!!>.- TOTAL CHARGES y~ -.1 TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical l1ortion of
label has been signed by an Electrical ,Supervisor and returned to the Building Division
ITemporary Construction
IChange in existing
rp}jrjl.i:nr'P
multifamily, COlT1T1. or
Tnduc;.trial
I Appl iance vent
<;~oariltp
I Stationary evap.
cooler
I Vent fan wi th
s.inole duct
Vent system apart from I
heatino or A.L
Mechanical exhaust
hood rind du("t
I
I
I~SC
I
Wood stove/heater
1('('''MlrE:' nr
r~:u .
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be valiJ until the
I HAVE CAREFUllY EXAr1INED the completed application for permit, and do hereby certify that all information hereon is true
and correct; and I further certify that any and all work oerf9rmed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project.
IIAIIE(ple.se print)~, !5-fee n b /6c.k SIr.llATURE ~ At7-P A?/J..-wL OATE ,JI / J,<,--
FO~ OFFICE USE mllY - 1 1-
Units Sq. Ftg. f1ain x Value t
Occy load Sq. Ft9. Access x Val ue
Occ.Y GroupH....~~ Sq. Ftg. Other /,~.x V.lue~~.-
. ~ ~.(' TOTAL VALUATION
(u" - , 2" :.._ Systems Development / .ro. _
1.~ --"":::) 77,..... Ch.rae (1.5~) U C
Zone.Lt? All
Fi re Zone
Flood Plain
BU!LOING PERIIIT
Charges and
Surcharges
PLU'~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERIIIT
Charges. and
SurCharges
MECHANICAL PERMIT
Charges and
Surcharges
/t'. So
thi s pernit
Bedrooms
Tyoe/Const. 5.,N
. ,
, .r::'2. _ . Pl.n Ck. Conm/lnd
___L__,____._ 65%/Blda Per Fee
C)~ PI.n Ck. Res
::if. 30%/Blda Per Fee
2r". - I Fence
-----~~~-I D~o
~e:!/. o~ I Sidewalk
---- - ;~~--I A/C P.ving/r~z
____/~.%~__I Curb Cut
.'fZ I
Stories
I
I
I
I
/6. - ITot.l Comb. rermit
I
I TOTAL
/YB.~
:?~Z'.-'I~
~
.
~
COMBINATION APPLICAT!ON/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot lOa. lane County Map Re~erence
II uj 43
2. example- Lot 1. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check-new - if addition,
check. add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exam~le - 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. DESIGN TEAfI ANa 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. BUILOING 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
signa ture.
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.
. .
PERMIT VALIDATION
t"g~
n....\
(.) (p~ q 19
~
PROJECT CONDITIONS TO BE'SATISFIED BEFORE OCCUPANCY:
,~\D
Permit Cl erk (YjJt
/ ,
"
V. FOR OFFICE USE ONLY
Permit appliGant exempt from registration with the Builder's Board because:
Additional Project Information:
,
I
PLANS REVIEWED BY:
name Lt:>R~?~~S'ignature4., ~.-: ~
,,- ,,-
date t;'26.8C