HomeMy WebLinkAboutPermit Building 1982-10-22
CITY OF SPRINGFi~L~'
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Hea t rp l~m
\-later Heater aas
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IINSPECTION LiNE.
726-3769
cfu
INFORtlATION liNt
726-3753
Sq. Ftc). r.la in
~q. Ftg. Access.
Sq. Ftc). Other'
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Job Address
1650 Centennial Boulevard
Legal Description 17-03-25-34
03900
RanCje
Owner
Arden Mayfair
15 Coburg Road
Va 1 UE of \'/ork:
(Miles/McKay} , $13,000.00 ,
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Ph pJl85 2811 tlUl I(;,nq Perhlit Info: Describe Work( i.e.,
on~ - Family Residence With Attached Garaqe)
Build Single
~Change exterior, enclose windows
20'X 8', add 2 new enterance/exit
doors & emeraencv exit
(Jj~~,."rlO.L (exoires)
328 S; Central Ave. Medford
lYJ'VL''? Jt4Ltt
Units'"
Occy Load'
Occy Group B-2
EXTERIOR WORK ONLY
3-N SPR
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2.56
, N/A
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Plan Ck. Comm/Ind
65%/Bldq Per Fpp
Plan Ck. Res
30%/Bldq Per Fee
Fence
Address
Construction Lender
Address
DESIGiITEN-1
Phone
(address)
200 D1Aujou Blvd.
(phone no:)
I
(lics. no. \
. .
(expires)
(phone no. )
Pri ma ry
(name)
, Wi 11 i am Sei bert
MECHANICAL
FEE I CHARGF NO.
FFF fHARGF
Structural
Electrical
r1echani ca 1
CONTRACTORS
Genera 1
(name)
Mayfa i r Markets
furnace/burner 'to
'BTU's
Floor furnace
and vent
Recessed wall
Soace heat~r and vent
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Apoliance vent
seDa ra te
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart fram
heatinq or A.C.
Mechanical, exhaust
hood and duct
\'Jood stove/heater,
ISSUANCE OF PFRf1IT
(address)
. 'ii)i;\L CHARGES TOTAL CHARGES TOTAL CHARGES
. T~HE~E STATE L\H REQUIRES that the Electri.cal work be done by anr"Electrical. Contractor" the .electrical po:rtion"of "this permit f"
,,.'!.,11 not be vali-J until the label has been signed by an Electrical Supervisor .and 'returned to the Building Division
,i~ I l\;\VE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information hereon is true
icjt'~~~~~~ct, and I further certify that any and all work .p~rformed shall be don~ in acco~dance with the Ordinances ?f the City
- IR .~lleld and the Laws of the State of Oregon oertalnlng to the work descrlbed hereln, and that NO OCCUPANCY wlll be made
,~~Y,S,~ucture without the permission of the Building Division. I further certify that my registration with the Builder's
1 ,~~ .n full force and effect as requi~ed by O~S 701.?55, that if exem~t the basis for ~xempt~on is noted hereon, and that
, <ontractors and employees who are ln compllance wlth ORS 701.055 wlll ,be used on thlS proJect.
SIGilATURE .hj./1bc~
FOP. OFFICE USE ONlY
Sq. Ftg: i1ain,
Sq. Ftg.Access
Sq. Ftg. Other
Plumbinq
Electrical
I'echanical
PLUr1B I NG
ELECTRICAL
tW.
FEE CHARGE NO,
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
residence
multifamily. comm. or
Industrial
Hater service
Sewer
Storm Sewer
Of
amps.
COMM./IND. FEEDERS
Install/alter/relocate
distrib, feeders
Of
amps.
D6ffiO
~ -__ ]LIl.__ ___Sidewalk
~-l ' A/C Pavi ng
.---
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t- - - ...: lUJl Curb Cut
I ---:--
)1~~" LPlDA~I(/<y{~jL I
x
Value
Val ue .
Val ue.
x
x
.$13 ,000 .00
Total Comb. Permit
TOTAL
$66.5p
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to, furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
. 17 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. , Name, 'etc. af owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot hause, 50~ sq. foot. garage
2. example- if new project, check-new- if addition,
check add, etc.
F. Building permit infarmation:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family raom
3. examole - convert single family residence into.
restaurant (change of use)
G. Value ~f work as defined in Section 303 (a) of the
Structural Specialty Code
H. DES IGN TEAr" 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 Plumbing, Mechanical, & Electrical Schedules
A. 'Except where blank spaces occur in the description
portion af 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 an the permit farm 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 isnat autharized
to. sign the electrical label. -
III. Applicant to. sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where po~sible, 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
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
applicatian, 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
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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This plan approved for Exterior "Facelift" Work Only. Plans & Permits required for
interior remodel work.
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
signatur
Lorl1~ Pleaer
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date 10...22-82