HomeMy WebLinkAboutPermit Building 1988-1-29 (2)
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'1' INS~~CTION LlN~
726- 37 69
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Job Address
/6 s-o CR1NJ/elvNIA( (<.,l-tIO~
Legal Description /7'6>'}."< S" 3Y, O)~9~
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
Water Heater
Range_
INFORI1ATION llNe
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other-- --
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Owner M ~ leA Y /}J tJe>TM(f1v;
Address ?~ 36t$) e;J',4k../lAO/Jl' tvIJ jI
El4r;a;F
(1.
ValUE of Work:
:A5t?>C>C>. -e,. c-sr.
Phon ,;. ---//7};' Buirdinq Permit Info: Descr.be Work(i.e., Build Single
ec./J'7-r /;'1 Famil y Res idence \~i th Jl.ttached Garaqe)
'&./~/!?c~.h? 7'C?F/t!$.A c>r J/</APt;r/J~/..o
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~7.4!>R~;:fGXPd#~' //Y rt:::> , rc:::5~GK'
Phone . ~.7;t!~""'~Ut9~ ~C)I?tE: ~<'...G )
(address) . (lics. no.) (exoires) (ohone nO.l
Construction Lender,
tI ~-
Address
DES I GN TEAt~
(name)
Primary
Mechanical
CONTRACTORS (name) (address)
General UP<:"<L L6~7.. "Z,3()t>.t?AK~/Y7 LtM",
, /
Plumbinq ~NCC.<:> l' c.~c. .
. )
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,
~ ;}/., ~/ft50
~}.J\
Structural
Electrical
, !~~(t~;
"~.:'':.
(lics. no.)
(exoires)
(ohone no. )
EV,&;Z:-H~ 6'i? ~.?/o/ //~ ~ 7//
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~C>"'~&PR 6-3~ -&? ~.s-- s.?/'7'~
,
El ectri ca 1
- ~1echanical
PLUt1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF rHARhF NO.
FFF rHARhF;
1&
Each single fixture
Residence of
7f)Ci 13~Db-
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
~or extensians ~
'".< 4~ /';?p,q =-
SERVICES
<z~9. >
Floor fu rnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
Sewer
ITemparary Construction
IChange in existing
residence
Imultifamily, comm. or
Industrial
Of
amps.1
I
I
Recessed wa 11
Soace hentpr nnn vpnt
'< ~P/?~.$" o/~ S
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct '
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
6 --, /2.oe=f
~Jater servi ce
Storm Sewer
TOTAL CHARGES
, WHERE STATE LAW REQUIRES
shall not be valid until the
I
I
I
I
I
I
/ ~ _A TOTAL CHARGES -:::?:?_ SC> TOTAL CHARGES 2?:- -
that the El ectrica 1 work be done by an El ectri ca 1 Contractor" theel ectri ca 1 portian af thi s permit
label has been signed by an Electrical Supervisor and returned to the Building Division
COMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeders
10f
I
Wood stove/heater
amps.
'2
g-y~? t:.J/Y /75.
G. C?> p_--
ISSUANCE OF PFRMIT
Zone.~L:~
Fire Zone
I HAVE CAREFULLY EXAt1INED 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 dane in accordance with the Ordinances of the City
of Spri ngfi e ld and the Laws of the State of Oregon pertai ning to. the work descri bed herei n, and that NO OCCUPArKY will be made
of any structure without the permission of the Building Divisian. I further cer ify that my re~'stration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt/the basis for exemr;;.on ~s noted hereon, and that
only subcontractors and employees who are in camDliance with ORS 7nr.055 wi~l be u on this 0 oj c .
/
NAt'1E(please print) ~l)ICJ-i BR I R b SIGNATURE ~ DATE/~?~'1i&
FOR OFFICE USE or Y
Sq. iltg.
Sq. Ftg.
Sq. Ftg.
Type/Const.,p.,.1l S?r:f> Uni ts
Bedroams Occy Load
Stori es / Occy Group
BUILDING PWlIT
Charges and '"
Surcharges ~
I ?~. S~ Plan Ck.
____________ 65%/Bldq
~~ Plan Ck.
~. ~ ~ 30%/Bldq
/'35. ..>.... I Fence
------6.-75'-1 Demo'
-;;r:;z - ~ ISidewal k
-----~,1-.-/9-1 A/C Paving
-:2 y_ -e.. " rcurb Cut
------/~2o-1
13""'2
't) ,
Comm/Ind Q, '
Per F~~ //c1..,g '3
Res
Per Fee
r1ain x Value
Access x Value
bther~,./~.oe~~;):4'C?Value2--"5/~&e=>. ~
TOTAL VALUATION
Flood Plain
'Systems Development '
Charge 0.5%), ' , ',_
ij'~.
PLW~BING PERMIT
Charges and, t'-
Surcharges ~
MECHANICAL PERMIT
Charges and
Surcharges
to
I
~ _4 ... I .' Total Comb. Permit 369.6/
~ I : TOTAL I
]/.80. ~jL
I
ELECTRICAL PERMIT
Charges and Ll
Surcharges -:\.
"'....-
~~
,...
,
COMBINATION APPLICATION/PERMIT (CAP)
. P5RMI.T VAUDAJION
I. Applicant to. furnish
A. Job Address
B. Legal Description . ", " '--..
1. examp 1 e- Tax Lot' roo, Lane Couh'ty Ma'p .~eference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
, Springfield Estates. .
-to 'Name, etc.' of owner and construction lender'
D. Energy Saurces .
'J' :,:. P. l:'example-:' heat/electrical ceiling/or forced air qas
2., example- waterheater/eJectrical/or solar
E. Square f60tage br ~aluation, etc.- "
1. example- 1250 sq. foot hause, 500 sq. faat 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 raom
3. example - convert single family residence into.
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
, ~~ructural Specialty Gode . . . '.
'.' . H. DESIGN TEA~1 AND CONTRACTORS ' ,
<. ,1 .. ;.\ ,To a,vo.ip ,.d.esign ar cons,tr\lction cjelays, Building
Division Staff must'be able to -contact appropriate
persons regarding design information or job site
carrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces accur 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 Divisian
1. To. conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to. be installed are not covered an
the abbreviated schedul~s you should co~sult.th~
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 author.ized
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 capy and return it to. the
applicant at the time the actual permit is issued for his
signa ture.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be pracessed 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
Permit Clerk
C-~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder'sBoard because:
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-;' t\d,dit1.ona 1 Px:oject In.forma.t:j,~n:
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PLANS REVIEWED BY:
. .
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name LeP;e;;A/~ ?:: C:Z;...::" '7
signature ~~~~~
'j/ -./' - "
date /':"""7& '88
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