HomeMy WebLinkAboutPermit Building 1983-12-5
'~ .-'.
. .
.j.
'~ '
.t
-,I' INspECTION LINE CITY OF SPRINGFIELD ' INFORI1ATION UNt
, 726-3769 f COMBINATION APPlICATION/PERMIT 726-3753
, \ \ ~ 1[) l \ \--,. ~ I \ . ENERGY SOURCES: Sq. Ftg. r'1~'n,
'Job Address \O'--~. ,-Q.A\)..\)\'\f\\.~ Heat ~ ~q. Ftg. A ess '
I 1 D . t' I .r': V .A~a- Water ate ~ Sq. Ftg. Ot e
_ega escrlp Ion ,?...t)y.<~ -"5 7 A V'~ ~o .. New Add Alter Rep.
, Range' -Fence Demo Change/Use
Valu~ of Work: .....r-, vether-' --=- :.J t
, 55 r(D~ r__\Offi.CO.O\L----'
Buildinq Pe~l1it Info: Descr,be Work(Le., Build Single
Family Residence With Attached Garaqe)
\.,\.9J'\\WA ,_0 I{J m- · 'A\'1.
j6kAf2()- ,
CP
~
;p
ok)'
b
Owner~\'('l""l-tr--> _
Address \ \o~l~ U ffi ~ f\ f\ "- c\VhOne
, ~Q N.\ \CUC)
constructton\Le~~, J - - .
~
Address Phone
DESIGN TEAM (name) (address)'
Primary uJJill~. ,~_cr*' _ '_ ~~~"~d',o_~"_f\
- Structural
, Electrical
J'
(lics. no,) (expires) (phone no.)
~O ~).\ f) _ \ N, .J\.\:f. 1~()(tlll'lf'f1
9~lo-D\i)~~ .
Mechanical
CONTRACTORS (name)
General ~\t' L \ k.)t 9.bt )
13S"."
I
I
I
I
I
I
I
, TOTAL CHARGES 17tP. _0 TOTAL CHARGES IS':':-" TOTAl: 'cHARGES 7Cf. 0"
, WHERE STATE Ul~ REQUIRES that the Electrical work be dane by an, Electrical Contractor, the electrical portion of this permit
shall not be val i1 until the label has been, signed by an Electrical Supervisor and returned to'the Building Division,,' .
I HAVE Cjl.REFULLY EXNlINED the campleted application for permit, and do' hereby certify .that'all. information hereon is'true-'-'
and correct" and I further certi'fy that any and a 11 work performed sha 11 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 OCCUPANCY will be made
,of any structure without the permission of the Building Division. I further certify that my registration ~Iith 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
ooly '"'CO"',""". ,"d ,mpl,y", wh, 'co " com,l1,"" wHh .ORS. 701:055/:ill ''/rd_ ~i"i'P"j,,'.. ... / L
NAf-1E(please print):[J/Ck ,W pSI '. SIGN^TURF~ 1f~ DATE/:2./JIlEL
FOR OFFICE USE ONLY
Sa. Ftg.
Sq. Ftg.
Sq. Ftg.
NO.
.27
Each single fixture
~/N'-I-~~'~/JtlT;
Relacated building
(new fix. additional)
S.F. Residence
(l bath)
I Duplex (l bath)
IAdditional bath
IHater service
'4'-'1 Sewer
I Storm Sewer'
I
I
each I
I
I
I
I
I
I
I
I
'Zone
cC. /fII.R '
,-
(address). (1 i~~1 no.)' ,(expires) (phone no.) "
20~ \:)r) ~I l~ ,,~\-J.\\Jrxt\~rl~ c4P8-RD1"L:
MECHANICAL
FEE CHARGE NO,
~FF rHARGF NO.
FFF rHARGF
Residence of
furnace/burner to
BTU's
:/
. s:-c:oo ,., s:--
~ New circuits alts.
2' ~~e=L;'
SQ. FT.
Floor furnace
and vent .
;s-.
I
I
I
I
I
6.-C~
~ERVICES
I Recessed wall I
Soace heater and vent
-I~t}"~ .zt,c~
I App 1 i ance vent I
seoarate ,
I Stationary evap. I
cooler
I'vent fan with I
sinale duct
I Vent system apart from
heating or A.t. '
Mechanical exhaust
hood and duct
Wood stove/heater
ITempOrary Construction
!Change in existing
residence
Imultifamily, comm. or
Industrial
10f
ICOMM~/IND. F[EDERS
I Install/alter/relocate
distrib. feeders
10f amp~1
,
. amps.1
I
I
I
I
I
I
I
I I
'114CClM;M6S5CtR ~ \~)b 1'<)<ClII:
'1 ~mE.1~ 3~?: I st~--'
I ' I I
~~~UI-\I\Lt. \If PFRt1IT c'
Fire Zone
Type/Const~J1f ~~.Unit~
Bedrooms . Occy Load~St::J.J!:
Stories Occy Group, .15'- 2,
~1ain x .Value
Access x Value
Other Xit=~Di:~ x Value ~S':t::Jt!>O...
,
TOTAL VALUATION
~"8e;;= ~,,: 1\'\'
'BUILDING PER~1IT "/2fl!f~~:9.~..:,1 Pl?n Ck. CommlInd
Charges and _ _ :'~''-''''-'7''?''3.-''--,:''',- 65%fBl do Per Fee
Surcharges "1'/' '~~'- Plan Ck. Res
" _ .!..'" ." 30%/Bl dq Per Fee
170. -- Fence
------6-:,iO-' D6mo'.
_ _':,. _ .I L ~~ _3; dewal k ,
~CJ A/C Paving'
7 ~ ...." I Curb Cut
------~-.~~-I,
Flood Plain
PLur~BING PERMIT
Charges and
Surcharges'
ELECTRICJl.LPERrm
Cha rges and
Surcharges
MECHANICAL ,PERMIT
Charges and
Surcharges
\
f/./!.
ITatal Comb.
I '
I TOTAL
Permit
$~~"?~- ,I
.""1111...........1. ...... ...,_....\..: I'
/A. -
,i~
'\
&,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Black 3, '2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/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 single family house with an
attached garage
2. example - remodel existing garage into family raom
3. example - convert single family residence into
restaurant (chan'ge af 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 canstruction delays, Building
Divisian Staff must be able to contact appropriate
persons regarding design information or job site
corrections, 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. 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 an
the abbreviated schedules yau should consult the
full schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As rioted on th~ CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisar. The general cantractor is not ,authorized
to. sign the electrical label.
Applicant to. sign and date
Whenever passible, the initial application will be used as
a worksheet only. Where possible, Building Divisinn Staff
will prepare a type written capy 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 af the
application, and no plans will be processed until these
fees, are. paid. All other fees and charges are due and
payable'when the-perinit is issued.
:'
II.
III.
IV.
, V. FOR OFFI'CE USE. ONLY .
.
, \
"
,
, '
,PERMIT VAL~DAJION
~ 6)1q55
t\= lD ~ () fl ,~
"", - ~ ."~ I
..~
~ ~-
'.
~ ~;;
It;:
'1'
-;;; -~
1
.... '. .t ~
i
.'
. ~
~ .-
-i
i
'1
f:
.,
i~ .
~ '. l~
I,
: j
--
--
. ..
i-
Permit Clerk~~
,
I
PROJECT CONDITIONS TO BE SATISfIED BEFORE OCCUPANCY:
ZJ" AJV.~AL c::;. S ;/ 6 <:::4 r ~
W4JPAt' ,/4) ~ ~~,," -.."=;J!:;>
S~8M/r ~py ~r: ~.s
~~ #-'p/N~ p,.", $/C5t1'iL
Fu/<.r
kr/IV~N
Permit appl i cant exempt from regi strati on with the Buil der I s Board because:
:.- ...
; ,AQditional Project Informa~Jor:
PLANS REVIEWED BY:
-"
~ I;
.. :,..
~.-da~e
, ..,..,-?
name ~~ ~..,.............5 i gna ture ~r .....,.'
,
. ,
/~.. $'-8 ~ '