HomeMy WebLinkAboutPermit Building 1984-12-3
I INSPECTION L WE
726-3769
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INFORflATION liNt
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg, Other
New Add Alter ~ep.
-Fence Demo Change/Use
Other- -
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CITY UF SPRINGFIELD
COHBIIIATION APPLICATION/PERMIT
Job Address 807 N01Hi-/'A" 5.,- S~,,7€ D
Legal Oescription\"l ()~ ~5 1..\2.
aL\~
EilERGWQU~
Heat (-C_ ~ \
Hater Heater
Range
Value of Hark:
Owner I2r,J AK,/) C. (;,.,KNlA IJ
Address 595' ~<-<TI-I (,S-!..h ?lace
<::""
";'?RI.:JE-~/';:LiJ, OJ<<
Construction Lender
Address
DESIGN TlArl
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Phone'l:I'f~_-;7.4'l
Builctinq Permit Info: Descrlbe Work(i.e., Build Single
Familv nesidence With Attached Garaae1
(name)
Phone
(address)
(ohane no. J
(lies. no.)
(exoires)
(namel
(address)
(pxnirpc;\
(ohane no.)
(lies. nQ. \
~(" A1~"iZrH AS." n--- /)
General -r;;.e: WJN~ /Vl",--;;1.UIAJJT
Plumbino ('J.l'S7V/Vl -H.urvi''jj/""b
Electrical J K. ~C""E"'&<:R<E-=
NO.
~ Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
~1echanical
Additional bath
Water service
Sewer
Storm Sewer
~Oi-t 'D s.,
PLUI,IBItIG
MECHANICAL \-:J.~
ELEC'fRICAL
FE, CHARGE NO
s.- \0:::- ~
':EL J:l:IAB.IlE. Nn,
FFL...c.J:iARG..E.
Residence of
furnace/burner to
BTU's
SQ. FT.
\
New circuits alts.
or extensions
Floor furnace
and vent
\6
, ~
(')a::.
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rpc;,idJ>nr.p
mul ti fami ly. cOrmJ. or
Industrial
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and duct
Of
amps.
COMfI./IND, FEEDERS
Install/alter/relocate
di<;.trih. fppdHI:.
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali~ until the
ISSUANCE nF PFRf1lT
TOTAL CHARGES I TOTAL CHARGES
that the Electrical work be done by an"Electrica1 Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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'shal1 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 OCCUPAr~CY 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 basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project.
SI'GtlATURE~ RCf.J
, IlAf.lE(please print) JAMeS K. Co..o~c:, JR
Zone ~
Fire Zone -
Flood Plain -
BUILDING PERMll
Charges an~
Surcharges
PLU'1BlNG PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Cha rges and
Surch~rges
MECHANICAL PERHIl
Charges and
Surcharges
DATE /2- J.lI:4
FOr. orFICE
IISY mn y
V'
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
x
v
lvoe/const\,)-' '\~Units
Bedrooms - Occy load
Stories ? Occy Group?>'?
x
x
Value
Value
Value
101AL VALUAlION
\J""'... CO ' Plan Ck. COIlll1/lnd
__ \ )(..._____ 65%1Rlda J:pr Fee
t.\'" Plan Ck, Res
. U 30%/B1 do Per Fee
__ ,r)_,--.~_ Fence
'-\...) D~R10
___\D.OO 'Sidewalk
1.\0 A/C Paving
~.~
\.) b...
Syste,ms Development
Charoe tl.5~) "
Total Comb. Permit
Curb Cut
~\ ,'2.D
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
- PERMIT VALIDATION
y2. .:/:I- 6 '3 9~ <(
(j d 40/'<1'</
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100. lane County Map Reference
11 U3 43
2. example- Lot 1. Block 3. 2nd Addition to
~prlngfie'd Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinQ!or forced air Qas
2. exa~le- waterheater/eJectrlcal/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. examole - construct single family house with an
attached garage
2. examp.le - 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 TEM1 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 Pl~mbing, 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
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 other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
Pennit Cl erk
D;J
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtICY:
c.mQ'\:'1\.\ '\~\: ~C')C'~\"'(')\_) r-.t::-
-1. \. '\ \ (' \.X '-.. ~ \ ~ F. """ ~ QR.'~~\.l-
~\. Or-;: F. 'X."\ aW~..."-F:9
- -
Permit applicant exempt from registration with the Builder's Board because:
Additicnal Project Infonnation:
PLANS REVIEWED BY:
nam~~)\.\:) -w.r-;\J' Signats;:)..-r. ~ ~d~~e'Q-~-,*u..
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