HomeMy WebLinkAboutPermit Building 1988-1-29
Owner M ~ leA Y /)J;} 67 ~'1 (ffJ/
Address 1~'~6& 01:1:. /I.M.'J! Ivll Y
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EflERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of Hork:
A5;.?>~ ~e. CST.
nt. ' Buifc;inq Permit Info: Describe Work(Le., Build Single
Phone'fIf~47A Famil v Res i dence With Il.ttached Garaqe)
, ~4~PC~.4 7C7i'/t:S~ c:=>r V/API!:/"/J~/~/
'5T&R~;:(GXP~/9"-D /#1"'0 r<:::'.~j.;G7?
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11 i cs. no.) (exoi res) (ohone no. )
.
INFORllATION UNt
726-3753
Sq. Ftc). "la in
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
'--Fence Demo Change/Use
--Other -- --
'%
NY
~
6\
IN Af2d\ A ozJ
1- INSPECTION LINE
726-3769
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Job Address
/0 5"0 Ctf1~/I!AJN/A ( r<.U'O.
Description I/',:?], <~."j; y c:?,-::S9~
Legal
Construction Lender
N. ,t:) -
Address
DESIGN TEAI~
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name) (address)
General C);U:>~<c... L6~7.. 'Z~(}(/AK~/Vr~'"
, /
Plumbinq /-JtHi!:Cc> ? Li3c.. .
l1ics. no.)
(exoires)
(ohone nn.)
EV.,t;;Z:-H~ ~~?/~/ ij'~ i/7//
I"
-=<C>"<~FB 6-30 -&'J ~.s-- 7/;1/7".
,
Electrical
~lechani ca 1
PLUl1BI NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF r~ARr,F NO.
SQ. FT.
furnace/burner to
BTU's
FFF r:~AI\r,F
/&
Each single fixture
"2:;0 13~E)b<
Residence of
Relocated building
(new fix. additional)
New circuits alts.
~-or extensions J-
'< 4~. /'77p,r.1 C'
SERVICES
::;>:z ~!:2 ,.
Floor furnace
and vent
IS.F. Residence
(1 bath)
I Duplex (l bath)
Additional bath
each
I
I
I
1
1
Recessed wall
Soace heatpr and vpnt
Sewer
Temporary Construction
Change in existing
residence
Imultifamily, comm. or
Industrial
10f amps.1
ICOMM./IND. FEEDERS I
Install/alter/relocate I
distrib. feeders
Of amp~1
I
I
I. I ISSUANCE OF PFR~lIT
-:::? 2- S-e>j TOTAL CHARGES 2<( --
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
-:z ~P/i"~..s- 4"~ S
Appliance vent
seoarate
Stationary evao.
cooler . .
Vent fan with
sinale duct
I Vent system apart from I
heating or A.C.
Mechanical exhaust
hood and duct
16-f /2.
I
I
I
~Iater servi ce
Storm Sewer
I
I
I
I
I
/3:5. _6 TOTAL CHARGES
. WHERE STATE L}l.l~ REQUIRES that the Electrical work be done by an
shall not be val i,j until the label has been signed by an Electrical
Wood stove/heater
I
I
~.~ p- ~
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1"2
I
IgY~?OH/75 .
I
r
TOTAL CHARGES
I HAVE CAREFULLY EXNlINED 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 NO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further p r ify that my re~'stration with the Builder's
Board is in full force and effect a s required bY.ORS 701.055, th.at if exempt/the basis for exemY;.Jt. 'on \is noted hereon. and .tha. t
only subcontractors and employees who are in compliance with ORS 701.055 wi~l be u on this p~oj c .
"""(pJ"" pdo') 16 Ll iC-H BR I R l). "'''ATURE /. ~\ . OAT'/-'?'f.AJO
FOR OFFICE USE or)L Y
Zone}/.c::.' Type/Const.,.3'-# S)?~ Units Sq. iltg.llain x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories / Occy Group 13'....2 Sq. Ftg. Other5~.d.ocL:~4'?Value ::::;?S/~~""-
TOTAL VALUATION
PLur~B ING PERMIT
Charges and
Surcha rges
/ ~ .c-; Pl an Ck. Comm/I nd
____~~._"::!~_ 65%/Blda Per Fee
~~ Plan Ck. Res
~. ~ ~ 30%/Bldq Per Fee
1-35. ...-- I Fence
------'6.-75--' D~mo
';r:<-sc> I Sidewalk
- --- -- /-.-;~-IA/C Paving
-::2 y- c::oe. .1 Curb Cut
------/~2o-1
//61.~"3
Sys terns Development I
Charqe ("1.5%)
IV~.
BUILDING PER~1IT
Charges and
Surcharges
ELECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
I Surcharges
I
I
I
ITotal Comb. Permit
I TOTAl
369.6/
fgo. ~j4
I
"
tit
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to. furnish
A. Jab Address
B. Legal Descriptian
1. example- Tax Lat 100, Lane Caunty Map ~eference
17 03 43
2. example- Lat 1. Black 3, 2nd Additian to.
Springfield Estates
'C. Name, etc. af awner and canstructian 'lender
D. Energy Saurces
1. 'example- heat/electrical ceilinq/ar farced air qas
2. example- waterheater/electrical/ar salar
E. Squ'are faatage ar valuation, etc. "
1. example- 1250 sq. faat hause, 500 sq. faat garage
2. example- if new praject, check-new - if additian,
check add, etc.
F. Building permit informatian:
1. example - canstruct single family hause with an
attached garage
2. example - remadel existing garage into. family raam
3. example - canvert single family residence into.
restaurant (change af use)
G. Value af wark as defined in Sectian 303 (a) af the
" Structural Specialty Cade
H. DESIGN TEAM AND CONTRACTORS " ,
,,' To. avaid design ar canstructian delays, Building
Divisian Staff must be able to. cantact apprapriate '
persans regarding design infarmatian ar jab site
carrectians, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces accur in the descriptian
partian af the Mechanical and Electrical Schedules,
the applicant need fill-in anly the No.. Baxes adjacent
to. the apprapriate item(s) ta,be installed' ,
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Divisian
I.' To. canserve space an the permit farm the schedules
have been abbreviated
2. If the item(s) to. be installed are nat cavered an
the abbreviated schedules yau shauld cansult the
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As nated an the CAP, the label must be delivered to. the
'electrical cantractar far signature by his electrical
supervisar. The general cantractar is ,nat autharized
to. sign the electrical label. -
Applicant to. sign and date ,
Whenever passible, the initial applicatian will be used as
a warksheet anly. Where passible, Building Divisian Staff
will prepare a type written capy and return it to. the
applicant at the time the actual permit is issued far his
signature.
Fees and Charges
Plan check fees are due and payable'at the time af the
applicatian, 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.
, ..
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IV.
V. FOR OFFICE USE ONLY
Permit Clerk
Cf-/'
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 LeP~A/~ ?:: C:Z;~
signature ~-~~~
/' ~' .;/"
da te /- -:;?& . 88
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