HomeMy WebLinkAboutPermit Building 1988-8-15 (2)
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i IrISPECTlON LINE CITY UF SPRINGFIElO
,726-3769 COMBINATION APPllCATION/PERHIT
, / ; I EilERGY SOURCES:
Job Address ~~ AY~ )I ?/...,-~.... " Heat
legal Description /7~3.3S-3/. ~2/0C> Hater Heater
Range
ValuE of Hark.:
f?, 5"9~ (/6
Bullriina Permit Info: Describe Work(Le., Build Single
Familv ~esidence W;t~ Attached Garaael
J?E~""72_~_ l/~ttJc:>F/2:;e .~h7~
..,-'""""~~ ";;a::>~~' &<<:~ ~-'1?T'
Qh'1"~~
f1 ics. no.)
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INFORltATlON liNe
726-37S3
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
F eoce _Demo )s.thange/Use
_Other
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I~
I~
Owner t"'::/To/ c7.1"'" <;z;;q~/'9c:=z.z>
Address ~2~ hi.e '>>'_~
".-- '= =>
rr-L//. L?r>. -r7Y7?
Construction ~nder
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Phone
72v1-:?G~~
.h.Jf,t17 2'....,"/~/4<
Address
Uk.::ll1.iN ll:.Ar.'
lname)
Phone
I address)
(expires)
(ohane no.)
Primary
Structural
'cJ;)~. (~ill')
Electrical
Mechanical
CONTRACTORS Inamel
General.Q'&I~#.::.4;r~/""'r' U,(,/~C:;.
Plumbina
(addre~,,)
(lie". no.)
(exnire,,) (ohnne nn
X...,y ~y~
.4'R7- q<=,/~
Electrical
0../'6
Hechanical
PlUltBI NG
ElECTRI CAl
MECHANICAl
NO_I FFF
~ Each single fixture
/ "17> ~;ti'ffI?;pY,E2 ,
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
Duplex (1 bath) each
rHAR(;F
NO
'"
rI-lAIU~~ NO.
'"
nIARr.:~ ~
Residence of
SQ. FT.
furnace/burner to
BTU's
~ New circuits alts.
or extensions
2 dSl ~~~
ZZ-5'o
Floor furnace
and vent
Stann Sewer
Of
amps.
Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
- /h r&.ti' 72r~..t#r
'(p~iance vent I'
c;p.Drlrrlte
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dllct
[WOOd stove/heater
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SERVICES
Additional bath
Sewer
Temporary Construction
Change in existing
rp~idpn("p
multifamily, COI111l. or
Induc;trial
Water service
CO~1./IND. FEEDERS
Install/alter/relocate
di<:.trih. fpprlpr<;
.Co- ,~
~ _41
Y
Of
amps.
..- - -'~'_.
,'_ ISSUANCE-.OF. .PFR/+1T- _.~ =-_"~.-
TOTAl CHARGES ...-?p/~. 6: -~ TOTAl CHARGES
WHERE STATE l_'\~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
:;::;;'::<'-:5'<==> TOTAl CHARGES ~#. /-5.-
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
1 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 Ore(]on pertaining to the 'Work described hereln, and that no 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 ORS 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.OSS will be used on this pro~~ ~
IWlE(please print) CITY ()!= SR/t)GrF'r(E:.L1) SIGNATUREbq! dMUf!L.. Ii ~DATE
FQr OFFICE USE Oilt:'Y I f~
Sq. Ftg. riain x Value
Sq. Ftl). Access. x Value
Sq. Ftg. Otherd~~ x Value1=? ~~. ~O
TOTAl V ALUA TI Or!
Zone Pt'..
Flood Plain
TYDeIConst.,";::.,y. .$?-?
Bedrooms
Stories
Units
Occy Load
Occy Group
~-2
Fire Zone
n---,
BUIlDING PERNIT Plan Ck. ConmlI nd I~Y'A Shstems Development //#.
Charges ant:: d- __~-2~___ 65%1Rlda Ppr Fpp C aroe (1.5~)
Surcharges Pl an Ck. Res I
/:2. :>8 30%/Bldo Per Fee
PlU'1BING PERMIT /5-~ I Fence I
Charges and S ------------ I Dell10 I
Surcha rges .7S-
ElECTRICP.L PERr:IT ____?32__ Sidewalk
Charges and y
Surcharges /./'3 A/C Paving Total Comb. rermit
f1ECHANICAL PERMn ____/5:"-~__ Curb Cut 07"yOW'~ 160 Tee
Charges and ltJ I TOTAla..~~
Surcharges 7,) I
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, Lane County Map
11 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 ceilinq/or forced air Qas
2. example- waterheater/electrlcal/or ~
E. Square footage or va1uation. 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
attached garage
2. example - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value qf work as defined in Section 303 (al 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.
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
8. 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 1 abe 1 must be de 1 ivered 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 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.
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Reference
II.
III.
V: FOR OFFICE USE ONLY
Permit Clerk
.'"T' .......,..,...-...::-._.;. ::.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
~7?'/V~ ~?2L'J.~Signature~~
r/
/k~~ date g7"'S-&'8
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