HomeMy WebLinkAboutPermit Building 1988-1-8
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..,,: f'I'NSPECTION LINE
726-3769
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Job Address l ~ ().:;;,-- ::;:;. v-;q'
Legal De5cription /7 - 0 ~_ '05-?J/
CITY Of SPRINGfIELD
C0I1BINATlON APPLlCATlONfPERMIT
EIIERGY SOURCES:
Heat
t~ater Heater
Range
:iQl~ ~ Work: J/7OfrO
11 ,..-........~~. ,
Builtiinq Permit Info: DescrIbe Work(i.e,.
Familv nesidence With Attached Garaoe)
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INFORt1ATION l1Nt. I
726-3753 \
Sq. Ftq. I,'ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter P.ep.
-Fence Demo Change/Use
Other- -
Dwner~. W add~
Addrm /:)0:> Ale. IT 4Y 'i;~ -'Nt,:),
~ CJ-A...- 9 7 c{7 7
C~n~~ruc~ion Lender
Build Single
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(Jl
B
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I.~ 000
Address
QI:.SHiN II:.Ar~
;jJ1A,,,*- -<,,~ (~-
Lr)~sS;67 t-uddf ~~'"I'J'
(name)
Phone
(address)
4,s-S A"....s IGJ..
v
(l ics. no.)
(exo;res)
(ohone no.,
Primary :::'cl.a... r""s.IY"-vi,~
'1M-4'177
Structural
Electrical
Mechanical
CONTRACTORS (name)
General "_}".,,, Cr,..",<'1.r"-c-{.,~
Plumbino l e~) ~ Plwn...h...i:.. .
J
Electrical ih o<1~-vI. J;;;.,;;{.,.LG
(address)
(1 ir:s. no.
(eXD; ff>S )
(ohane no.)
t&t:" ~ N-S R 1.
;l.'f1.3.~
'7 -~\5-8~
't'ilS''I'n7
LEI'! -/9.3 I
L. 1<1, -/l,:<.f?
~lechanical
---
PLUI1BING
ELECTRICAL
MECHANICAL
~
~ Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
FFF r'1AR(;F Nn
1f9 /5~
'O.E.L nIAilIiE. NO
FH' rI--1~
SQ. FT.
furnace/burner to
BTU's
Hilt
Residence of
,., New circuits alts.
tt-'-f 'or extensions
~
Floor furnace
and vent
SERVICES
Recessed wall
So~~P hp~tpr ~nd vpnt
Storm Sewer
Of
amps,
Appliance vent
~eoa ra tp
Stationary evap,
cooler
Vent fan wHh
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd <'Ind duc:t
Sewer
Temporary Construction
Change in existing
rp'lid~J1C:p
multifamily. comm, or
Tndll<;.tri<'ll
\o-Jater servi ce
COMM.fIND. FEEDERS
Install/alter/relocate
rli<;.trih. fppdpr<;.
Wood stove/heater
Of
amps.
5t1t€~E
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
,'75
'5~c
'/3
/-
ISSUANCE OF PFRrllT
. TOTAL CHARGES . TOTAL CHARGES
that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAr~CY 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 employees who are in compliance with QRS 701.055 will be used on this project.
NAME(please print) ,/'" S D"I. '7) Sc.A.a. V' SIGNATURE Q-~.......~ h.--.. ~
FOP. OFFICE USE oury
, Sq. 'Ftg, ria;n
Sq, Ftg. Access
Sq. Ftg. Other
DmLK .gg>
lone C ~
Fire Zone
TYDefConst.~J\/
Bedrooms
Stories
Units
x
Value
Value
Value
Flood Plain
Occy Load
Occy Group
x
x
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
;"2- t>O I Plan Ck. CornmfInd,.1. ~"'.n Oft?
~ I 65%/Blda Ppr Fpe ~ ~ ~
------------ Pl"an Ck. Res
(,n/3 30%fBldo Per Fee
__.L~~!!..___ Fence
175 D6mo
___2~~~___s1dewalk
/.,.... AfC Paving
---o/A----- Curb Cut
ISystems Development I
Charoe 0.5%)
PLUMBING PERMIT
Charges and
Surcharges
ELECTRICP.L PERrHT
Cha rges and
Surcharges
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
,5/P~.t)(
.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B, Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinqJor forced air Qas
2. examoie- waterheater/eJectrical/or 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,
check add, etc.
~. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examp.le - remodel existing garage into family room
3. exanple - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code r' ' I
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.I. 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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 will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
t 0115
t~g./~1
V, FOR OFFICE USE ONLY
Permi t Cl erk
cu
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
AI"'/"
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,/ p~4a./l.J')r) ~..#..edvA-1"X
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
,
PLANS REVIEWED BY:
name~/) )11~
signature
/p/ M~
,
date_//5V~c.r,
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