HomeMy WebLinkAboutPermit Building 1988-2-17
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; 1726-3769
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CITY Uf SPRINGFIELD INFORlIATlDN LINt 'I
COMB illATION APPLICATION/PERMIT 726-37S3
A EilERGY SOURCES: Sq. Ftq, I"ain ~
Job Address '/ ,{ , , ,~7
/02 .tYc:>R rAt j Heat ~q, Ftg, Access,
Le9al Description /7~'" ",,"",_0</..,. _~__ Hater Heater Sq, Ftg. Other 'C) I
~~~,)' ~~ - ~~~ ~ew Add Alter Rep. ~
Ranqe --Fence Demo Change/Use
Val UE of Work: Other - - I C()
/$.9(;;3. ~ 'II
BuildinQ Permit Info: Descrlbe Work(l.e.. BUlld Single \U
Familv nes;dence With Attached Garaoe' 1\J
?,4V//'r0 f C;;/,~ 4M1bV&'/<-7//~
.t;;R ~c;..>/-a:> ~5~'7- L:..sr.. I
I~, ~, ~
(ohone no.\
Owner ~tA-JIlr<=h'ce ,--:)C# ,c~r-:-;;;;:>
Address l?- C> _ 7? c:> ,I(: R-;;. Phone
."'>7PPr_;'. /cy~ ? V/-;r~OS-
Construction lender
Address
UDlliN TI:.AI1
(name)
Phone
(address 1
(l ics. no.)
(exn ires)
Primary
fN/c 7//-5~
El.ctric.1
C}()( _ r 'l. 'DO
- ,
_ ~\"l.
,; .
Structural
Mechanical
CONTRACTORS (name I
General W;~R/S#
(address)
(1 ;(':5. nn.'
(exoi rp<;)
(ohonp nn.)
'/8S-/?C>O
Plumbina
Electrical ~T;:q /c ~~.
~1echan;cal
l'tlJlll!lJrl6
ELECTRICAL
MECHANICAL
NO. I
. FEE I [HAR:GF Nn
I ~I='~ l r1-lARr.F NO I
I FJ:"~ I rHARr.1='
SQ, FT.
furnace/burner to
BTU's
Each single fixt~re
Residence of
Relocated bul1din~
(new fix. additional)
S. F. Residel:lce
(l bath \
Duplex (1 bath) each
Additional bath
~ew circuits alts.
~ or extensions
!"')IYE L/,;;::"C,,-,/.r
SERVICES
/5:";
Floor furnace
and vent
Recessed wall
~n~~p hp~tpr ~nrl vpnt
>,
ISo' Storm Sewe~
:;0,-
Of
amps,
Appliance vent
c;eoara.t~
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
hea t; no or A _ C.
Mechanical exhaust
hood and rlurt
I Hood stove/heater
Sewer
Temporary Construction
Change in existing
re'i i npnce
multifamily, conm. or
Tnrluc;trial
~Iater senice
CO~1,/IND, FEEDERS
Install/alter/relocate
r1ic;,trih_ fpprlpl"'l
Of
'imps.
TOTAL CHARGES
WHERE STATE l~ REQUIRES
shall not be valij until the
I SSUANCf OF PFR!lIT
6" a,...... TOTAL CHARGES /5'. <<>.... 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 EXM1INED 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 UO OCCUPAHCY will be made
of any structure _ithout the permission of the Building Division. I further certify that my registration with the Builder1s
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 7nl.055 will be used on this project.
IW,'E(please print)
RlDO V ICTol< 6Fllorr ISIr,!IATURFtZ1lt.I..t.~j,t;t;t:
FO~ OFFICE
USE mIL Y
Sq. Ftg. riai" x Value
Sq. Ftn. Access x Value
Sq, Ft~, Other~/""""","'~/h'~aIUe
TOTAL VALUATION
DATE{E.-/7-K'Z'
j
Zone C"-:
Fi re Zone
Flood Plain
Tvoe/Const.ll1..v/~__
,
Bedrooms
'Stories
Units
Occy Load
Occy Group
/~~~ -~
BUILDING PERI'UT
Charges an~
Surcharges
Plan Ck,
65%/Bldo
------------ Plan Ck..
30%/Bldo
Conm/lnd
Ppr Fpp
Res
Per Fee
e1.2.r;
I
i
I
I
cry I
/?'I~'Ii
I
Systems Development
Charoe (1.5%)
~
(~
'2&'2. 9'-S~ ,
PLUI~B lUG PERMIT <:"" to. --
Charges and r -----~!:.~----
Surcharges:> '2. 50 Demo
ELECTRICAL PER!m /."" - Sidewalk
Charges and \..1 _____:.U.~____
Surcharges.....' . 75 Ale Paving.
MECHANICAL PERMIT c~/b"fut~
Charges and ____________
Surcharges
Fence
/3'1. $"0
%./0
ITota,
I
I TOTAL
538. 01J
Comb. Permit
'2 '3&.86:"
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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
II 03 43
2. examole- lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C, Name, etc, of owner and construction ,lender
O. Energy Sources
1. example-, heat/electrical cei1in~Q/or forced air Qas
2. examole- waterheater/etectrical/or solar
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 room
3. examole - convert single family residence into
restaurant (change of use)
G. Value of work as deflned in Section 303 (a) of the
Structural Specialty Code
H. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding deslgn information or job site
carrections~ 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
8. Full Plumbing. Mechanical, and tlectrical 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. ---
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 ather fees and charges are due and
payable when the permit is issued.
,
(6 17q t
'J-(1/2
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V, FOR OFFICE USE ONLY
Permit Clerk
Cr/-
PROJECT CONDITIONS TO BE SATISFIED BEFORE eGGUPIINCY:-:- P~~M/T 1':5~CJ.4'-,.yC<S
-::;;"'::::;"v'c/.? Z/,.==y,..c-LO.v?/7,-c:-"';'-:;7 ~~/-=2e::-,/77~.T <~hc ,g~-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~RHE fi~G'T'
Signature/2.____ _ ~--"'">
/ / . /../C./ .
date //4<4;1'-8?
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