HomeMy WebLinkAboutPermit Building 1985-11-7
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726-3753
Sq. Ftg. r'la i n f91. zS"
~q. Ftg. Access.
Sq. Ftg. Other
--1~ew)lAdd__Alter~~ep.
Fence Demo Change/Use
--Other -- --
I ~~~~~~r~ON LINE Cor18I N~H6N orp~rn~~iM7~ERMIT
Job Address IZ90 CE,lV7 CNN /4L LSLI/D ~~~~GY 1:9JJ.J~
. . . /_ r=;i<2'Sr ~.a,cun.f)-o..' Hater Heater a.!:t:!-r-
Lega 1 Descr! pt 1 onLoJ-' ~~ ,&/ t?C.K- / - TV , feaUbl/,4 ~/c:.
T Range ~~~~
T/9-..>L LtJ7 /7t:?3 Z7 31-/02'7/ q ValuE of Hark:
Owner CE#'7CN ;<j/AL U/VT4L .-9JJ'()C. Zpj 000 ,
Address /2/::'/J /'..r::. /~ I Ph '7JJ./ "'7/7'"lBuildino Permit Info: Describe l~ork(i-.e.. Build Single
/v LC/,-// c;<../^///.l-L one/"7~/v,J(./Family l1esidence l~ith Jl.ttached Garaoe)
-'::;Pr::D CnIL-t.-ti::; -k/f}tK"5oN) '41th dJ if ,:jOO/77t?~ 7?J G,fTJtV<)
d~L- -/>R:}tC"eJ5)CJ/f//}l- tJ,CF7CtL -
Construction Lender
Address
DESIGN TEAr.,
Primary
Structura 1
Electrical
Phone
(name) (address)
Cr/A-)?'L~5 (A(H~LLL3?
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<T"-
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(lics. no.) (exnires) (ohone no.)
66/ t'OIVrR/1cr /6/&/ '7/&t
Mechanical
CONTRACTORS (name) (address)
General I'J.J/-Jelef H/ ?-?-be- ~ I5Ox~t?L .6-1f
Plumbino .eRFtl> <...5~/77~/ PLU/Yl/S/A/C;
/
ElectricalRRL/NC/ /~N EL.EC~/(
:~lechanical C4K/BAV #E477Nb
S.F. Residence
(1 bath)
I Duplex (l bath)
IAdditional bath
1~later service
I Sewer
IStorm Sewer
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ELECTRICAL
Residence of
SQ. FT.
New circuits alts.
or extensions
-:z ~.~ M6~G
SERVICES
(] ics. no.)
(exoires)
/t;3I'13J
@,."
(ohone no. )
-:gq-j 13/.37
I Recessed wall
Soace heatpr and vpnt
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II
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I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart from
heating or A.C.
I Mechanical exhaust
hood and duct
I Hood stove/heater
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PLUl18 I NG
NO. FEE I CHARGE. NO
3 Each single fixture 'SiN /5~
Relocated building X
(new fix. additional)
MECHANICAL
I 1'1'1'
n-lARr::1'
NO I
fU~~burner to
/ IH~~P
Floor fu rnace
and vent
1'1'1'
I rf-lARr::1'
'.t:O
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TOTAL CHARGES /5: Dal TOTAL CHARGES 1501> . TOTAL CHARGES '~H. /t::>. If>O
WHERE STATE L'1,H REQUIRES that the' Electrical work be done by an, Electrical Contractor, the electrical portion of this permit ,
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division .
I HAVE CAREFULLY EXAMINED 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 oertaining 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 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 comoliance with ORS 701.055 will be used on this project.
"""(,]",, ,,,,,) C::1I/-7a~S H4 &[ f?/--- sr'''ATUR~~ W ~OATE ( nJ/;~
FO~ OFFICE USE ONLY
Sq. Ftg. f1ain x Value
Sq. Ftg. .. -e~s X Value aSs-
Sq. Ftg. Other.4lP ~'f.~r Value 27./ <is-
TOT^L VALUATION -:zJJ:~."
-=?A\O -B"S~Cf7 '
I ~? <j(. (,5 Isystems Development I r / ~
\(z)-"l.I- ~S Charge 0.5%) '. /Y.//".
I IH." ~7'/~"t ~ St:? Ff:
I W~q~~~'
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I 9, 00 ITotal Comb. Permi t I
: I TOTAl
Zone R- f"
Fire Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICfl.L PERr~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
each
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Of
amps.1
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COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.1
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Tyoe/Const. ~-t1I
Bedrooms
Stories~_
Units
Occy Load
Occy GroupT-;Z
1 4t:Itt:J Plan Ck.
___ _':?.I..._____ 65%/Bldo
L~ U Plan Ck.
"7. ,87 30%/Bl do
'____L~_~~_I Fence
. ~t> I D6mo
_ ___.IS:.e> I Sidewalk
. 6() I A/C paving8S51/J
.LIP. #/)1> I Curb Cut
---- ---.~~-I
Comm/Ind
Per Fee
Res
Per Fee
ISSUANCE OF PFRMIT
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13.CO:
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/ 76. '1'1
I 76: '1y
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp 1 e- Tax Lot roo', Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources ,
1. example- heat/electrical ceilingjor 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 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 TEAM 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 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
fu 11 schedu 1 es
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. -
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
signa ture.
Fees and Charges .
Plan check fees are due and payable at the time of th~
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.
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V. FOR OFFICE USE ONLY \
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl icant exempt from regi strati on with the Buil der I s Board because:
Additlonal Project Information:
PLANS REVIEWED BY:
name LORNe neG~
signature ~~~._~~
'/' - ,
"
dateJI.. ~5
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