HomeMy WebLinkAboutPermit Building 1984-4-2
I INSPECTION LItlE . CITY Uf SPRINGFIELD
726-3769 CO/lBlUATION APPLICATION/PERMIT
Job Address/80 f &vT/, ''II'' $-f-. ~~~~r,y S~~~
Legal Description 17 -rf)$'::Jt€:: -co. CtO~ Hater Heater
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INFORllATION UNt
726-3753
Sq. Ftq. t.lain
~q. Ftg, Access, 7f1.?'P
S,q, Ftg. Other
~New _Add _Alter -!'.ep.
Fence Demo Change/Use
Other - -
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Range
Valu' of flor"'l.3iotJo
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Phon_J/.,,/.,; /Bullc,ina Permit Info: Descrlbe Ilork(l.e" Build Single
Y"rh/b/I... Fam; 1 y Ilesldence Hi th Attached Garaqe)
971/17' -; ~~~RESS"1f2 LJudJ,AJ,J
tVo. ~P-17- fktr~4&.s1;;;{
&'+0 bltfR. tYN .sltfb.
Dt~IGN TEAM (name) (address) ~l;cs. no.) {exnires)
Primary cThcll ~A.t!JJ/~J {I.LJ~P. /&2Ls. '1l"Srf c--YR.IIJ.,r:;~1l QR.
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Structural ...5u.AAS~~,-.:z:AJc.. cllJA/AI'f5IDt:'. piA.
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Electrical ~
,
Owner D()IAJ eeJl!.^,/IJq CO,eP.
Address /!lo I SCUr# -" ,4'I..r~.
SfA-; w~/~ fQ,e_
Constructlon Len~r
Address
Phone
(l?hone no. I
7~6 761'1
Mechanical
CONTRACTORS
{name)
(address)
W/'Itfd.;cl6J~Y.CG -
nin.. no.)
f Plm;rps)
(n'nnnp nn_)
d:f5/7oo
~"........,,' Url~~i6:
CvO&VlS' #R.
, 1
Plumbino
Electr;caA%ed'eJ2...S' c./eG"'-~/e .J1f6 FiJIWu/'N BllIlt. ,EV9,:Ne.
'lechanical 4f4/#r: MA~~. tat:\,;I(/;tes/ ~"';'F640V~OR'. '
ELECTRICAL
'P" 76f9
9.1,:)..'5Sb'
PLut1BING
MECHANICAL
NO,I
-----lEach single fixture
I Relocated building
(new fix. additional)
IS.F. Residence
11 bath)
Duplex (1 bath) each
SQ. FT.
I....EEL J:liAIlliE.
I
I
I
NO.
rH~
FEF
CHARGE .Jl!l
Res i dence of
furnace/burner to
BTU's
I..E"
I
I
I
I
I
I
I
I New circu~ts alts.
or extensl0ns
I SERVICES
Floor furnace
and vent
I Recessed wall
~n~;p h~~tpr ~nrl ~pnt
Additional bath
I ~!ater service
I Sewer
I Storm Sewer
Temporary Construction
Change in existing
rpe;. i n~.n("p
multifamily, COIIIII. or
TnnlJc;,triill
Of amps.l
CO~1./IND. FEEDERS I
Install/alter/relocate I
rlic;.trih_ fpprlprc;.
Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hoon i\nrl duc-.t.
Wood stove/heater
Of
amps.1
ISSUANC, OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\ll REQUIRES that tile Electrical work be done by an'Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the 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 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 b sis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be ed on this project.
Units
Occy load
Occ,y Group $- '{
liMOS SIGt/^TURE
FOR OFFICE USE O~Y
So. Ftg,
Sq. Ft~.
Sq. Ftg.
~ '~ATE?~.)-tf'~
1lA1-IE(please print)
SVlV4N J).
Zone --.ltJ-.HI
Fire Zone
Flood Plain
Tyoe/Const. 2-1V'
Bedrooms
Stories
t1at
Access
Other
x
Value
value1!Jl'~~
Value
?R~
x
x
TOTAL VALUATIOtl
BUILDING PER~1lT
Charges and
Surcharges
. /___ _ . Plan Ck, Corron!lnd
~ _iiJ 7_ 65%/Rldo Ppr FpFl
--- --;';~-Pian Ck, lies
~ ... 30%/81 dq Per Fee
Fence
I v.:-~-. '1' Pp,syste. ms Development
E.II:.';;U::ott;<r;- Charae (-1,5%)
I ~. ~.s-;
I
5' /<!:;. ctIl:>
PLU'1B ING PERMIT
Charges and
Surcharges
O~mo
Sidewalk
AIC la.vi n9
Curb Cut
"
_ Total Comb: rerm!c~', /YSI. f)f6
I
I iOTAL i ~s-<I. ,,'
ELECTRICP.L PERtllT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
~-
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COMBINATION APPLICATION/PERMIT (CAP)
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
~pringfield Estates
C. Name. etc. of owner and constructfon lender
D. Energy Sources
r.~'~examele- heat/electrical ceil{nqlor forced air oas
2. examole- waterheater/electrlcal/,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.. '. .
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examyle - 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 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.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
port i on of the Meehan i ca 1 and. El ectri ca 1 Schedul es ,
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 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. ---
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.
,
II.
III.
IV,
V, FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY;
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PERMIT VALIOATION
'9
Oel n
~ s\D ;1 0'&
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Permit Clerk
jJ/1 J
Permi t appl i cant exempt from regi strati on with the Buil der' s Board because';
-.") ::1.":.>, . --". .' _.... ...
Additional Project Information:
, (
PLANS REVIEWED BY;
name L.oieA/t:='
~~-~;ii? Signature....4 .2~
, ,.
...- '
/ ').. "
/' ..r..:... ~ . date
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$1-5-8 Y