HomeMy WebLinkAboutPermit Building 1983-3-29
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j INSPECTION LIIIE
726-3769
Job Address /~ C.<!f'/JITS/JI/JIli('
legal De'cnptlon I'-t:>~ -":i:S-~<,I/
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'-L1TY OF SPRI,IGFIELD
COIIBldATlON APPLICATION/PERMIT
E'IERrV SOORCES
Heat
'/ater Heater
Ranlle
So Ftq IId1n
~C] Ftg Access
Sq Ft9 Other
r~ew Add Alter oep
-Fence Demo Change/Use
Other - -
Valu, of 1I0rk cO
I <; DOn
BUllclnQ Pen111t Info Oescnbe Hork{l e . BUlld Slngle
Farnlv nesldence \l1th Jl.ttached Garaqe)
i) o 11,\()r.! tL r.tm'\ NY\ N.L.~( (J
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Owner
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/ Phone U
Address
Constructlon lender
I NFORIIATlON U Nt
726-3753
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Add res 5 Phone
UcSHiH TEAfl {namel (address) (llCS no) (exolr~$l
Pnmary M.A>I?/S-iPeDP€AI "!' ~~C. /'3/<!> c,..,~~ h. ELr,~~
Structura 1
E1 ectrl ca 1
Mechanlcal
CONTRACTORS (name)
(.Ai1/J I, , (ltrfI <::-I
(address)
{ohane no 1
'3 $I 2. ~,f"//
(l,cs no)
(PXOlres) (ohonp nn ,
/p VA", 'J0R~;v1 C'-'~ENE
ELECTRICAL , MECHANICAL
Nn "" I njAQ~~ Nn "" PlO IU:: [
Resldence of I furnace/burner to
SO FT BTU's
X INew ClrCUlts alts ~s. 01 Floor furnace
or extenS10ns ~ and vent
2 DR Mt>A
I SERVICES I Recessed wall
Sn~rp hp~tpr Ann vpnt
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I
I
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I
I
I
I~""J TOTAL CHARGES
Electrlcal Contractor, the electr1cal port1on of thlS per~1t
Superv1sor and returned to the BU1ld1ng D1vls1on
Genera 1
Plumblno
E1 ectn ca 1
tlechanlcal
PLUllBING
NO
FFF CHARr,E
Each slngle flxture
Relocated bu,ld1ng
(new flX addlt1onal)
Is F Pes 1 dence
(] bath)
Duplex (1 bath) each
Addltlonal bath
I ~Jater serVl ce
Sewer
ITempOrary Constructlon
IChange 1n eX1stlng
rpc;, npnr:p
Imultlfam11y, COI11Tl or
Tnnuc;trli'll
Storm Sewer
Of
amps
COI~ll /IND FEEDERS
I Install/alter/relocate
rl,c;tr,h fpprlprs
IOf
I
amps
TOTAL CHARCES TOTAL CHARGES
WHERE STATE L ~Ij REQUIRES that tile Electncal work be done by an
shall not be vallJ untll the label has been slgned by an Electr1cal
It El'5"'- 1'1/:/
Apol1ance vent
seoa ra tp
Stat10nary evao
cooler
Vent fan Wltl-J
c::,,,,,1,,, rI",:t
I Vent systerl apart from I
heatlno or A C
I Mechan1cal exhaust
hood and duct
Uood stove/heater
ISSUM'Ct OF PFR'llT
I HAVE CAREFUllY EXMlINED t1e completed apnllcat10n for lJer'Tllt, and do hereby certlfy that all lnfomatlon hereon lS true
and correct, and I further certlfy that any and all work oerformed shall be done 1n accordance wlth the Ord1nances of the C1ty
of Spnngfle1d and the laws of the State of Oregon oertalOlng to the work descrlbed hereln. and that IW OCCUPAfKY wl11 be made
of any structure w1thout the permlss10n of the BUlldlng Dlvls10n I further cert1fy that my reqlstratlon ~Ilth the BUllderls
Board 1S 1n full force and effect as requlred by ORS 701 055. that 1f exempt the basls for exemptlon 1S noted hereon. and that
on ly subcontrac tors and eMp 1 oyees who are 1 n como 11 ance Wl th OPS tnl 055 \1111 be used on th 1 S proJec t
I~Ar1E(please pnn~ .n -r ,..,J
,
/'1'e., (, SIr"I~TURFC<:' -
Fon OfF1CE USE orlLV
So Fto
Sq Ft0
Sq Ftg
C..J
Zone G c::.
Fl re Zone
Flood Pla1n
Tyoe/Const 5.//,I-)f(>. Unlts
Bedrooms
Stan es
Occy Load
OcCY Group_
B-2
BUILDING PERMIT
Charges ane
Surcharges
72 00 Plan Ck
. 65%/Blda
----2:Z8.--- ~6~~Bi~0
I Fence
I Dt;lmo
, Sldewalk
I A/C Pavlng
I Curb Cut
I
Comm/lnd
Per Fpp
Res
Per Fee
c..J ~-rd. omJ"-..:2 '1~ ~.:'
r1a1n x Value
Access x Value
Otherff~4"-x Value
TOTAL VAlUATlON
/5'" &IIPO. -
;.
1ii"6";1"'S 1.~u..r.oISystens Development I
"':1. VO<<t' . "~ICharqe (J 5')
/Y.;/- .
PlU'~B1NG PERMIT
Charges and
Surcha rges
ELECTRIUL PERI'IT
Charges and
Surcharges
_ ___'-'5", -.
.If,C
/1ECHANICAl PEPMlT
Cha rges and
Surcharges
fLAN ~~C"( /7s.. ~;V>~".P
'~sr r.E"e - /S.6(:)
Total Comb rermlt
TOT"" 7$'. 8.8
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COMBINATION APPLICATION/PE~~IT (CAP)
Appllcant to furnlsh
A Job Address
B legal Oescrlptlon
1 examole- Tax Lot 100. Lane County Map Reference
17 03 43
2 examole- Lot 1 Block 3. 2nd Addltlon to
Sprlngfleld Estates
C Name, ete of owner and constructlon lender
o Energy Sources
1 examDle- heat/electrlcal celllnq!or forced 31r oas
2 examole- waterheater/electrlca(/or solar
E Square footage or valuatlon, ete ------
1 examole- 1250 sq foot house. 500 sq foot garage
2 example- If new proJect. check new - ,f addltlon,
check add. ete
F BUlldlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 example - remodel eXlstlng garage lnto famlly room
3 exa~le - convert 51ngle famlly res,dence lnto
restaurant (change of use)
G Value of work as deflned ln Sectlon 303 (a) of the
Structural Speclalty Code
H DESIGN TEAll ANO CONTRACTORS
To aVOld deslgn or constructlon delays, BUlldlng
Olvls1on Staff must be able to contact approprlate
persons regardlng deslgn lnformatlon or Job slte
correctlons. etc
II Abbrevlated Plumblng, Mechanlca', & Electrlcal Schedules
A Except where blank spaces occur 10 the descrlptlon
portlon of the Mechanlcal and Electrlcal Schedules,
the appl1cant need flll~ln only the No Boxes adJacent
to the approprlate ltem(s) to be 1"stalled
B Full Plumblng, Mechanlcal, and Electrlcal Schedules
are avallable at the BUlldlng Dlvlslon
1 To conserve space on the permlt form the schedules
have been abbrevlated
2 If the ltem(s) to be lnstal1ed are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be del1vered to the
electr1cal contractor for slgnature by h1S electr1cal
superv1sor The general contractor 15 not authorlzed
to 51gn the electr1cal label -
III Appllcant to 51g" and date
Whenever posslble, the 1n1t1al appl1cat1on wlll be used as
a worksheet only Where poss1ble, BUlld1ng Olv1s1on Staff
wlll prepare a type wrltten copy and return lt to the
appllcant at the tlme the actual permlt 1S lssued for h15
slgnature
IV Fees and Charges
Plan check fees are due and payable at the t1me of the
,~ appl1cat1on, and no plans w1ll be processed untll these,
fees are pald All other fees and charges are due and
payable when the perm1t 1S lssued
V FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
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PERMIT VALIDATION
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Perml t C1 erk
Permlt app11cant exempt from reglstratlon wlth the BU11der's Board because
Addltlona1 Project Informatlon
PLANS REVIEWED BY
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name Lc~/Y€ R. E'~ F,e.
Slgnatur~...-.........~
,
date 3.2S.~3