HomeMy WebLinkAboutPermit Building 1987-12-4 (2)
CITY OF SPRIN~UELD INFORllATION UNt:.
COMBINATION APPLICA}10N/PERMIT 726-3753
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e:-c:-/. /. I/J_,,^- ()/J -i . L-~!IERGY SOURCES: Sq. Ftq. l'lain
V J ?f-./b.L.-{. r..??1/t14'7f'1./c. Heat ~q. Ftg. Access.
DescriPtiOnj",..".Ao:z..::"7_' ''''. ""~. ~--...-.. 'Hater Heater Sq. Ftq. Other
, v;;.... ~., IV' ~~ ~ flew Add Alter Rep.
./;' q -Fence Demo Change/Use
(;,. . - ::,: "Y'',JeJ, JffO Oth,,--
Buill;inq tWermit In10: Describe \~ork(Le., Build Single
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&1ics. no.) (exoires)
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Iij~PECTION LINE
.726-3769
Job Address
Legal
Owner
Address
Construction lender
Address
DESIGN TEN!
, Primary
Structural
Electrical
Mechanical
CONTRACTORS ~n~~e)
General ~
Phone ~yf 5"
~/2-
(na~)
Phone
(address)
IlJUt? ~,r~, S~8 '3t::>J?N<:-C:;;;;>.a.y~ ~~,
Plumbinq _
Electric,al :r-~' ~~ /
~'echanicalj?~..c:::.,~~H ~~~~/.n-1C./
NO.
/
Each single fixture
(address)
PlUI11lU rtG
ELECTRICAL
i! fEE
CHARGE
Nn
Residence of
7... 5"'0
SQ. FT.
Relocated buildin~
(new fix. a~iticnal)
S. F. Residence
II bath)
Duplex (1 bath) each
IAdditiOBal bath
I ~later service
I Sewer
Storm Sewe....
ITempOrary Construction
IChange in existing
residence " "
I Imultifamily, comm. or
Industrial
I 10f amps.1
I ICOMM./IND. FEEDERS I
I IInstall/alter/relocate I
distrib. feeders
I 10f amps.!
I I I
I I I
I I I I I
/:;;-:....-.J. I TOTAL CHARGES -:..c( ~ --S--P TOTAL CHARGES "~/y' pf):- v
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
~ New circu~ts alts.
or extenslons
-:? ~-r.? ~~
I SER'VICES -
I
TOTAL CHARGES ~/J<~.
WHERE STATE LtlDREQUIRES
shall not be vali1 until the
1'1'1'
(1 ics. no.)
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09
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--.::t
GJ
(ohone no.)
q;)..t I (,~c)
(exoires)
~;;_n~~/I
3:::>:::>b
~&?I-'2 "X>9
MECHANICAL
rHAR(;1'
rHARrtEJ
NO
1'1'1'
furnace/burner to
BTU's
~~
Floor furnace
and vent
Recessed wall
Soacp heater ~nrl vent
t/' ~T~ -a./'::'~?,?/A' 6.
Appliance vent
seoarate
Stationary evap.
cooler
/ Vent fan with
sinole duct
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I Uood stove/heater
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I?,
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I
I
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ISSUANCE OF PFRrlIT
I HAVE CAREfUllY EXArlINED the completed aprlication 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 OCCUPArlCY will be made
of any struct~re ~jthaut the permission of the Building Division. I further certify that my registration with the Builder's
Board is in (u11 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.
fW1E(please print) l/hIlL,# {?#/~4/'"",
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Zone c:: Co
Fire Zone
Flood Plain
BUILDING PERf-liT
Charges an:: '"'\
Surcharges ~
PLU/~B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges ~
SIGN!\TURE~4.d;I" ~~~
". /
DATE ~ ..2~p 6,/
j
FOR OFFICE USE ONLY
Sq. Ftg. rlain x Value
Occy Load .5q. Fto. Access x Value
Occy Group 13.:-2... Sq. Ft~. Other ~~.c:y;:;::>~c Value ::42/?>"-"":'"
\ 10:]31" TOTAL VALUATION
19f/a 1/-/2/-sf~h~~~~s(~:5~Jopment //..~ ~
,-
I
I
I
I
I
I
TyoelCons t.
Bedrooms
Stories
5'-/Y
Units
I
$
Ie ~~ I Plan Ck.
_-'...&2_;Z:~~:::::_ 65%/Bldo
, Plan Ck.
~. f6? 30%/Bldq
___-'.5- e>7!!:>1 Fence
~ 7 s-I D~mo
-:?:< ---S""C> I. S 1 dewa 1 k
------;~/3~1 AlC Paving
____/~:-::--' Curb Cut
. 7~--1
Comm/Ind
Per Fee
Res
Per Fee
y
I
I
I
ITotal Comb. Permit
J
TOTAL
:2/5". 46
'i;' ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT,. VAll DATION
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.
Springfield Estate~
C. Name, etc. of owner and construction lender
D. Energy Sources .
1~ example- heat/electrical ceiling/or.forced air qas
2. example- waterheater/electrical/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 singl~ family house with an
attached garage
2, example - remodel existing garage into family room
3. example - 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.
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
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 Hem(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
_ DO' As noted on the CAP, the label must be delivered to the
;"<'. ,.,.... el'ectrical 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 'prepa re a type wri tte'n 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 other fees and charges are due and
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
&c/p;
Permit Clerk
/0&>2 S
c1J~'
__ PROJECT CONDITIONS TO BE SAT~SFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project. Information:
PLANS REVIEWED BY:
~/7~C;;- aC.;;.~Signature'~.....;~ ~~ date //..../&-&::>
. ''/ Co'...r..
name
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