HomeMy WebLinkAboutPermit Building 1985-4-3
jlllSPECTIDN LINE
726-3769
Job Address ::SO?
legal Description
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CITY Of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
l~ater Heater
RanQe
Owner tILSA-T" fj~oJ '"':R,._..."",
Address </"{"O t!.d:.oL.->t e.L .
Construction Lender
Address
UDlliN II:;:Af"
~o
Phone ~6 7'l1
N} p..
INFORfIATlON UNt
726-3753
Sq, Ft~. I.lain
~q. Ftc). Access.
Sq. Ft9. Other
flew Add A lter ~ep.
-Fence Demo Change/Use
Other- -
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~
N
I~
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ValuE of I"or~:(!lllo I'
/0. f){)t)-
Bui16?nQ Permit Info: Describe Work(;~e," Build Single
Family nes;dence IHth /I,ttached tlaraqe)_
12~ /tAoJ.J . Z Ie ,J,,,;, fi+..: I,~
Ai:>D 70 k.U.,...:! Att-fll>t
Primary
CA,>-..\c.E.. ~~L;;!'
{name}
Phone
{address}
NI..3. L~~II!..J...
:J&97
/oI-W'A1""
7Y/-I'f!Sl:)
Structural
Electrical
Mechanical
CONTRACTORS Inam.'
General {!~c).UI~~t!.
(lies. no.)
(exoires)
(ohone no. I
(addrec:;c:1
~./- (T~~ / 7 7l\~A-f~ ~J
9"2-S~
Electrical
T.~,~
. ero~ ~.." ,'...
"::'/1 _
y As."._
Plumbinn
~1echan; ca 1
....!!Q.,.
6"
Each single fixture
PlU'IBING
ELECTRICAL
1 FFF
I~
I
f1 ic<:;. n_o.'
~91 f..3
(~xl)i rf>~)
(ohonp nn \
MECHANICAL
fHARr.F '.lO.....1
IReSidence of
;25:-' SQ. FT,
.;" INew c;rcu~ts alts.
or extenslons
:2 i!J1i! .M~
SERVICES
. J:HARG.E. ~I
'I furnace/burner to
BTU's
Floor furnace
and vent
~~LJ:liAB.G..E..
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (I bath) each
Additional bath
~Ia tel'" servi ce
Sewer
Storm Sewer
Temporary Construction
Change in existing
rps.i ri~nce
muHifamily. COrTl!1. or
Inrll/strial
Of
FFF
,15:-
Recessed wall
Sna~p hpatpr ann vpnt
:z
Appliance vent
seDarate
Stationary evap.
cooler
\lent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
'I? 'f. sa
.,..- 6.-
amps.
COMM./INO. FEEDERS
Install/alter/relocate
d;<:;trih. feeder.:;
I
Of
I
I
amps.
TOTAL CHARGES
WHERE STATE LAW REOUIRES
shall not be vali1 until the
ISSUANCf OF PFRIHT
:zs:- . TOTAL CHARGES /::;:-. TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor, the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Division
/tP-S"o
this pemit
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 oertaining to the work described herein, and that fJQ OCCUPAr~cY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~ith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt theliS for exemption is noted hereon, and that
only subcontractors and emP10Y~eS who are in comoliance with ORS 7n1.055 I'll bl u d on this project.
IlAI1E(please print) tJ Ill'-=>.... N. fvfe%f~ SIGNATURE (,J UA t OATEffi/~
FO~ OFF I CE USE Ol~L Y
So. Ftg.
Sq, ftg.
Sq. Ftg.
Zone L:.'::::
Fire Zone
Flood Plain
BUILDING PERHlT
Charges anc
Surcharges
PLU'iBING PERMIT
Charges and
Surcharges
ELECTRICAL PERil IT
.Charges and
Surcharges,
MECHANICAL PERMIT
Charges and
Surcharges
Tvoe/Const.
Bedrooms
Stories
S-~N
Units
/
Occy load
Occy Group
Z7
1?:Z
I ~ 40 I Plan Ck. COll111/Ind
J:.,}_~. . 65%/Bldo Ppr FpE'
-- -------- Plan C~. Res
-:z. ~& 30%/Blda Per fee
, ~OC>
--_::?~.
/."'e:>
Fence
DeRlO
7"6 '
_--..t5. - Sidewal~
., ~ A/C Paving
____/~'_~~_ Curb Cut I~;;;?t:)'
. '12 ,
riain x Value
Access x Value
Other.R~.._,~ Value-4~~.......
TOTAL VALUATION
~~:;L~~~~ste, mS Development I .f / '"
':?~.::>....,,~jii:arae (J.5~) /Yf19 .
I
7. ~I)
d.'IO
Total Comb. rermit
TOTAL r /2~.t:l6
.
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. example- lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ce;lin~/or forced air Qas
2. examole- waterheater/electrlCaJ/or Solar
E. Square footage or valuation. etc. ------ ,
1. examole- 1250 sQ. foot house. 500 sq. foot garage'
2. examyle- if new project. check---new - if addition, i
checK add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family roan
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 TE~1 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
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
fu 11 schedul es
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 th
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 possib)e, the initial app)ication 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
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PERMIT VALIDATION
CITY OF SPRINGFIELD
City Han
Springfield, Oregon
Department 01 Public Works
OFFICIAL RECEIPT
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No. B
64527
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Oate Am/L ~_ 19X'c:;:"
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) Rec'd Fromt:::::'aw.!"N/2'I"'<'"r srL>h>;><- c::.-o~_
1775- h'/#//Y17T.
Address L'o7Td4": 6n6YE _ b,A> J
Received For: G,//,.,,; ./iJ=/"UOUEL gS2:"~
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....)'" AUTHORIzED SIGNAT~
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Amount Received
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BUSINESS FORMS,lNC
U'T
Permit Clerk
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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 -.L-&..0./€ d ~ ~
Signature~ ~~~-...,
#' , . ..
date
t/~/6-8;S'