HomeMy WebLinkAboutPermit Building 1988-10-21
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IINSPt:GTrON LINE
726-3769
Job Address oJJ 41 u.."Z.~~ M"Lc L/L:
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Legal Description 1'7 /),::1, ;:) 7 4-"3. O~'irO()
INFORf1ATION UN~
726-3753
Sq. Ftq. t,1a in
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Range -Fence Demo Change/Use
V:Ju~~;O~:I/CJ -Other- -
Buildina Permit Info: Describe Work(i,e., Build Single
Family Residence With Attached Garaae)
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Owner ~~ I~ )_~.b.A""',Jf'''''_~-''
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Address S-J3 V~~ Phone.l't1.il1.8
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Construction Lender 0 J
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Address
DESIGN TEAt~
(name)
Phone
(address)
,;
Cs.~~A~"'~
(lics. no.)
(exoires)
(phone no.")
~~
Structural ~
Electrical ~
11echanical ~
CONTRACTORS (name) (address) (l i cs. no.)
j General ~ ~ ~ ?,(.f" V 2.~ ~~ '(S""~J"
. Plumbina ~.(..--
: Electrical ~ ~ 19'.() ~~..l y.a ~ ~ .lO-$"Oc.. /~r
'~1echanical ~~ rJ.-~. ~ ..1''-18'11 12-~y.:
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PLUt1BING ELECTRICAL MECHANICAL
Primary
1""1 J.
.c;?x;l()
(expires)
(phone no.)
7"87.
..]'tJ-]I'IJ
7"1 'N.U3
7"~ "~J/)b
NO.
FEE . CHARGE NO.
,
FFF rHARGF NO.
FFF rf-lARGF
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
each
~-New circuits alts.
or extensions .~
'"2. ~7.:< /Y)G5~c::.
ISERVICES -
I
-z?S;:;
Floor fu rnace
and vent
ITempOrary Construction
IChange in existing
residence .
Imultifamily, comm. or
Industrial
10f amps~
ICOMM./IND. F~EDERS I
IInstall/alter/relocate I
distrib. feeders
10f amp~1
I k. /\ I
I \ rf )I\:{J I
1 .1 I I ISSUANCE OFPFRMIT
TOTAL CHARGES TOTAL CHARGES . . -:::;?2..s-~ I TOTAL CHARGES fr/~' . /S <=-;9
WHERE STATE L\W REQUIRES that tile Electrical work be done by an:Electr;cal Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Superv1sor and returned to the Building Division
S.F. Residence
(l bath)
Duplex (1 bath)
IAdditional bath
I Ha ter servi ce
I Sewer
I Recessed wall
Soace heater and vent
I .---- ;k / e=;-;' ~~~rk.C"""':
I I'~~ance ~eht I' f
separate
Storm Sewer
I Stationary evap. I
cooler
I Vent fan wi th I
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechan i ca 1 exhaust
hood and duct
I Wood stove/heater
I
I
I
I HAVE CAREFULLY EXA~1INED the completed application for permit, and do hereby certify that all information hereon is true
land 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 oertaining to the work described herein, and that NO OCCUPAr~CY will be made
of any structure without the permission of the [luilding Division. I further certify that my registration ~Iith the Builder's
IBoard 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 ORS 701.055 will be used on this project.
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NAME(please print) ~
A""AtIV/
SIGNATURE &~ ~
FOR OFFICE USE ONLY
DATE_/p...}./.~
Zone /'" c:::::::
Fire Zone
Flood Plain
Type/Cons t. 9-)$/ Units Sq. Ftg.
Bedrooms Occy Load Sq. Ftg.
Stori es / Occy Group 3'--2 Sq. Ftg.
BUILDING PER~1IT
Charges and "
Surcharges cJ..
LLVt5t::/
____J~~,_____
-:::(, '23'
1Z~d... ..p lo:')~'1'-~~
Plan Ck. Comm/Ind
65%/Bl do Per Fee c!:28 . q .3
Plan Ck. Res ~
30%/Bldq Per Fee ~I
I
~1ain x Value //
Access x Value /c.--
Other~p~x Value/~.?S,Ot"':/~--,~
TOTAL VALUATION
L...k' Je-
PLU/~B ING PERMIT
Charges and
. Surcha rges
Fence
Systems Development I
Charge (1.5%) ...
I
I
I
I
.1
.Comb. Permit
ELECTRICJl,L PERtHT
Cha rges and
Surcharg~s ~,
MECHANICAL PERMIT
Charges and
Surcharges t.P
I D6RlO
_ _ _ 2~ ~~ _1.Sidewal k
1-/5 lAIC Paving
____L'~~~_l Curb Cut
h/zl
c' I~otal
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALLDATION
" #:.
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 Additiorr to
Spri ngf,i e 1 d Es ta tes _
C. Name; etc. of owner and construction lender
D. fnergy Sources
1. example- heat/electrical ceiling/or forced air gas
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 single family house with an
attached garage
2. .example - remodel existing garage into family room
3. example - convert single family residence into
restaurant (chan'ge of use) "
.G. Value of wor,k as defined in Section 303 (a) of the
Structura'l '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 sHe '
correcti&ns, 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. FulJ Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedul es
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
app1'ication, and no plans w.i.ll be processed until these
fees are paid. All .other 'fees and charges are due and
payab 1 e .when the permit is issued.
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V. FOR OFFICE USE DNLY
Permi t Cl erk lu
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt .f'rom-reg,ist'ration with the Builder"s,Boardbecause:
Additional Project Information:
PLANS REVIEWED BY:
nameL-o;?8g-/i-c6ij-~ s. ignaturea--e....-,~~"-'-. _ d~~e /tf) <0/-8'8
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