HomeMy WebLinkAboutPermit Building 1983-9-12
Ll TV 01- SPRliH.iF I ELD
C0I1BHIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat ~' .
Hater Heater /fJ.d
r]
Ranqe
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IItISPECTIOII LlllE
726-3769
Job Address
'J} .'
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1s'17
legal Description /111AP. lAy., L,.,T ""
n-03-3C, -'3d..-
~II ,7~ /llL,.~olJ
.<;"1'), '.<:I " 57
So.
0)1001
Owner
Address
Phone )'/)_~~?
J r"J ,
Construction lender
A/lfJ./C
Address
Ut~lliN Tl:.Nl
(name)
Phone
(addressl
Primary
,
/
~ (}?, ~~(fA~ jl-J
J
Q OI..!ST.
Structural
Electrical
f1echanical
CONTRACTORS
(namel
(.) .! 'I k.'.\J.~' I:~,
'\J:.-IJClIH,Hn" ,~.J,".
If)d.()E
OAU€ K ; 01) ne.T.
NoiJ t;
(addrpss)
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General
Plumbina
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INFORf1ATION Ul'1t
726-3753
Sq. Ftg. 1,Iain ,/.:JOO
~q. Ftg. Access.
Sq. Ftg. Other
~lew__Add__Alter~~ep.
Fence Demo Change/Use
Other- -
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1<::>
IUJ
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va;, of Hark:
/0.000
BuilGinQ Permit Info: Descr be Work{ Le.,
FamilY nesidence With Attached Garaoe)
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/.:;, 0-0 a;;; /1
flics.no.l
(1ir:s.no.)
Electrical
~rt( s: ?f"T"'...-r
t.lechani ca 1
PLU1IB ItIG
NO.
ELECTRICAL
Build Single
/'-I'/.b<A;f~ ""~
Otl {/
(exoiresl
(ohone 00.\
(p)(oirpc;)
(ohnnp nn_)
~_ -/.P:f?<I '/y}-,]'P'lc,
?<()-3'I'l
.,
MECHANICAL
Each single fixture
FEE CHARr.r: NO H~ rI-lARC:::~ NO
Residence of furnace/burner to
SQ. FT. BTU's
~~~ rI-lAQr.1='
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Install/alter/relocate I c Il"-Il~ OQ
ni,'rih. feener, \;)" " ~
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II
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I TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Oiv;s;on
Temporary Construction
Change in existing
rp<;id~ncE'
multifamily. comm. or
lnrlllc;tri<ll
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 oerformed 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 NO OCCUPArKY 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 ORS 701.055 will be used on this project.
SIGIIATURE~ C JrM- ~.LOATE_2:./.'2 -Pj
FO~ OFFICE USE Q;IL Y
So. Ftg. Hain
Sg. Ftg. Access \ ?.c-t:)
Sq. Ft9. Other
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
ISERVICES
I
S.F. Residence
(1 bath 1
I Duplex (1 bath)
IAdditional bath
~Ia ter servi ce
each
Sewer
Storm Sewer
Of
COffi1./IND. FEEDERS
IOf
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TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\I/ REQUIRES that the Electrical work be done by an
sha1l not be valii until the label has been signed by an Electrical
IWIE(please print)~1ff
CaNsT
Zone_c.C .
Tyoe/Cons L\l' ~
Bedrooms -------
Stories \
Units \
Occy Load
Occy GroupQ..- \
Fire Zone -
Flood Plain -
BUILDING PERfIIT
Charges anc
Surcharges
__.5.2,-~__u_ :~~;B~~~
? 08 Plan Ck,
, 30%/Bl do
Fence
CommlI nd
Per Fpp
Res
Per Fee
PLUI1BING PERMIT
Charges and
Surcharges
I Demo
I Sidewalk
I A/e Paving
Curb Cut
ELECTRIC~,l PERI~IT
Cha rges and
Surcharges
- -- ]:!;),'-~- ---
\. '2.0
11ECHANICAL PERMIT
Charges and
Surcharges
1.'Zt/~-d'5 <01(j)7~Syste. os Development I
, =>,?\ s::>.r, -,Charae (1.51,) .
'1 l Ui9" tlnrm
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t~'" \S~
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amps.1
amps.l
Floor fu rnace
and vent
Recessed wall
Sn<l~p hp<ltpr <lnrl vpnt
I App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
<;,inole rluct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood and duct
I Hood stove/heater
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from
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ISSUANCE OF PFRlllT
x
Value _
Value [().(W
,."
x
x
Value
TOTAL VALUATION
I~().OO
ITotal
I
I TOTAL
Comb. rermit
85.2'l>
235. 2e
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II
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
II.
t. Applicant to furnish
A. Job Address
8. legal Description
1. example- Tax lot 100. Lane County Map Reference
1/ 63 43
2, .xa~l.- Lot 1. Block 3. 2nd Addition to
~prlngtjeld Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/elec!~ical ceilinq/or forced air QdS
2. example- waterheaterjelectrlcal/or ~
E. Square footage or valuation. etc.
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition,
check. add. etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family raam
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 TEM1 ANO CONTRACTORS
To avoid design or construction delays, Building
Oivision Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
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 AND
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. ---
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.
Fees and Charges
Plan check fees are due and pay~ble 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.
(9c~. ~ /qB3
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III.
IV.
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V. FOR OFFICE USE ONLY
Permi t
Cl erk0ARLYJ.J
.,
.
PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt 'from registration with the Builder's 80ard because:
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Additional Project Information:
PLANS REVIEWED BY:
name~)\\)~ \?\')F"-1\
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signatur~ \, )lA-C'- ") "-<')':-A.J'r
1
date a. ,. ?~l. Ch.~