HomeMy WebLinkAboutPermit Building 1985-3-20
Job Address / (J StJ, :10., 1tI A _ rrfl 00 f
Legal Dmription /"'~6~.3.i"- '"2. F'i.,,~o
I IIlSPECTlDlI L1IIE
726-3769
.
Owner
k~R If ~'-I9-(;IM
P~Ii."n..MJ/,)
A.ddress
Construction Lender
Address
OI::.~I(jN TEAr"
(name)
~
,
CITY OF SPRINGFIELD
CDMBIilATlDN APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
\~ater Heater
.
.. J7ne.., Vi
-&'7p,-.--
INFORlIATlDN LJ,'<
726-3753 _
Sq. Ftg. Hain
~q. Ftg, Access.
Sq. Ftg. Other
r~ew Add Alter Rep.
Ranqe Fence_Demo_Change/Use
Valu, of Hork:h ,.:; _Other Cfll
Builcina permit~~~escrlbe Work(i.e., Build Single ~
Famil y l1es idence \-li th .A,ttached r1araae)
ibJIw-or ..1.0"" ~ s, bfw""'-<.!<' ON Sc. ~
IANb!1t!.MJt ~ IA--Tt'H .!JA.s,"- tJ.,UTM'~ I~ '*,,,
$~".~ ~eJk<f p. IA)~ 5ed~ ~ ~.I(",
(lies. no.) (exnires)
Phone
(address)
(ohone no. I
Structural
~/tA1l-1bN b
L--
Primary
Electrical
f1echanical
CONTRACTORS
(name)
A . I ,+s Ik L. ,.
S'AH!.
'$A'M t-
<;,tH L
Genera 1
Plumhinn
Electrical
~1echani ca 1
PLUIIBING
NO.
(address 1
(1 icc:. no.)
(~xnirpc:)
(ohonp nn.
/J1H w ~ l-L
ELECTRICAL
MECHANICAL
Each single fixture
FFF fHARr"f ~I ~~~ rl-lllRGE. NO.
Residence of furnace/burner to
SQ. FT. BTU's
".
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
I I!ater service /~. -
/ Sewer ~<"/"vi<:'t!!f: /~, #0
1'~' Storm Sewer ~~~
/ 7kMA>KA-R~ e:::l'r/<:"'k-
~~p ~W&;:;-
-.f Go6; -==x i!+ ~
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
ITempOrary Construction
IChange in existing
rp~; rlenl'P
Imultifamily, camm. or
lnnlJc:tri~l
App 1 i ance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hood and durt
IOf
amps.
CDM1.I./lND. FEEDERS
Install/alter/relocate
nic;trih. fppnprc:
Wood stove/heater
Of
amps.
/ ~.R:>~"?' o.;;::-...d-
~P.P'-'" ~....
/ J1~v? Vc:::1#"" ISSUANCf OF PFRtllT
TOTAL CHARGES 5~ ..,. . TOTAL CHARGES ~ -. TOTAL CHARGES
WHERE STATE L\l/ REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical rortion of this pernit
shall nOt be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed aprlication for permit, and do hereby 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 Springfield and the Laws of the State of Orel]on pertaining to the work described herein, and that IlO OCCUPAIlCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and emrloyees who are in comoliance with OP.S 7~1.O~1 ~~()r:'<=>'1~~\\Jl)lJL~ .
IlAI-lE(please print) blOR'I -r ~~ SIGrlATURl ~ l..L D~.TE J - ".1 &'
FOP. OFF I CE USE OIIL Y
Sq. Ftg. 110in
Sq. Ft~. Access
15-2 Sq. Ftg. Other~V.lAl<'>
Zone C C
Fi re Zone
Flood Plain
Tyoe/Const.:5'A? ~)l?Units
Bedrooms Occy Load
Stories / Occy Group
I Plan Ck.
65't/Rlda
Plan Ck.
3D%/Bl do
____5,)".~p I Fence
Z .2~ I De.o
-;?t::? "0 I Sidewalk /65'1'
-------~3o-1 A/C Paving
I Curb Cut 2"
I
BUILDING PERMIT
Charges ana
Surcharges
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERInI
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
x Value
x Value
..t)~#~.lue~--"'-'. "'-0
TOTAL VALUATION
Conrn/lnd
P.f~r Fpp
Res
Per Fee
'..ll lJ. 40 ~ 'Systems Development '
.-J.-) Charoe (1.5~)
6-\?r-F\ ((4~1 n
I
I
I
90.<>0
/9.68
.%. .-.
Itf.~~
Irotal Comb. rermit
/tfB,~
238';:'8
TOTAL
.
.
..
..
'Ii
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J, Applicant to furnish
A, Job Address
B. Legal Description
1, example- Tax Lot 100. Lane County Map Reference
17 03 43
2. example- lot 1. Block 3. 2nd Addition ~o
Spnngtield Estates . ,
C. Name. etc. of owner and construction. lender
O. Energy Sources '
1. example- heat/electrical ceiling/or forced air oas
"2. eXdllple- waterheater/electr;callor solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house. 500 sq, foot garage
2. example- if new project. check-new - if addition,'
checl< add. etc.
F. Building pennit information:
I. example - construct single family house with an
attached garage
2, exam~le - 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 TEAM ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE 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 Division Staff
~ill 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.
O(-Ji &</<//!<
fJ
'?/8o/'fJ/
V. FOR OFFICE USE ONLY
Permit Cl erk
N
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
7#€ "'P?I'?~VA-( ,/?>?R
C;O"Rc/ec.r 72:> ~'
/'5F .~ 57??/~/GC:Z>
~. p~~/P#7'?Y
. ;P~Y/5A:::;,IlY:5 &,p
7C>N/~ /~J'>~
'-,,-
Orr/CE ~.I!'-/CL ~
~C:::7/6'A7 /~cP9 ,;1-3
-:::::OPs-" A7'7~~D.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
nameL.::)Jf'H~?L~~. si?natur4",.. .1%~
date ;'-.?~~
.