HomeMy WebLinkAboutPermit Building 1987-4-9
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COMB~N APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
INFORlIATlON liNe
726-3753
Sq. Ftg. I.'ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep. _____
Range Fence_Oemo_Change/Use I~
ValuE of wor;t; If}{)() _Other . ~
Ph BuilGinQ Pennit Info: Describe Work(Le.. Build Single I
on'h88_~141 Familv nesidence liith Attached Garaael
illIYlI/L7 ~A/./ fi Iu ~ /I fI /)4 11 r ~
[~--li, ~--~/31(/t0/~1-r
flies. no. l lexoiresl (ohane no.\
726-6655
I INSPECTION lINE
726-3769
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Job Address 3'360 Game 'Farm Road, 5orinafie.llLOR
legal Omription 11- ()1-l~8.;:::)'--I~- O'd.rxv
Owner
John Mahler
Address c;Ol Oiv i c:;, ion _ Sn_ t;4_
Euopnp
Construction Lender
.Inhn M;::lhlpr"
Address ~hnvp
Ue" uN TEAl1
(name)
Phone
(address)
Primary
Al Towne
50r i nqf i e I d
3192
Structural
Raleiqhwood.
('j.r-J
rY"
Electrical
Mechanical
CONTRACTORS
Genera 1
(name)
Volunteer
(address)
Plumbino
Electrical
"'echanical
PlUIIBI NG
ELECTRICAL
NO. I
J FE: F I rHIlB.G.L _ NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
~ New circuits alts.
or extensions ~~
'2 ~~ ~_€'
\ I SERVICES'
S.F. Residence
() bathl
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rps j ltPJlI"'P
multifamily, comm. or
Indllc:trial
Water $ervice
Sewer
Storm Sewer
IOf
ICOMfl./INO. FEEDERS
I Install/alter/relocate
rli,trih, fPPrlpr,
10f amp~1
amps.
V",
u,V\
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be valid until the
I TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
.
nics. no.)
I i='i='i=' Irl-l~ NO
1z.<..S<:
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220 .se:.1 TOTAL
Y0
c)
(flxoirps1
(ohonf' nn. )
c,
h\0 (All
11 \' ,
./
~ -. /I 0
MECHANICAL
I ~i='i=' I rl-lAR.G..E ~
furnace/burner to
BTU's
Floor fu rnace
and vent
Recessed wall
Snnr.p hp~tpr nnrl vpnt
Appliance vent
seoarate
Stationary evap.
cnolar
Vent fan with
sinole duct
Vent system apart
heatino or A.C.
Mechanical axhaust
hood and dud.
I \.Jood stove/heater
I
I
I
from
I SSUANCf OF pmrllT
CHARGE S
I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPArKV will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 wi'l be used on this project.
HN1E(please print)
John Mahler
ZoneL1Ae~"-I.p
Fire Zone
Flood Plain
Tyoe/Const."::' N
Bedrooms
Stories
Units
Occy load
Occy Group
U5~ C:-6c>e- '6/9
BUILDING PERllIT /7 S<:::;) Plan Ck.
Charges and ~ ______:._____ 65'l/Blrtt:1
Surcharges -7....-., Plan Ck.
. ",. '-' 30S/Blda
\
Conm/l nd
Ppr Fpp
Res
Per Fee
~12$
DATE
~-9-i71
x
Value
/~~ -.0
PlU'~BING PERMIT Fence I I
Charges and ------------
Surcharges OBmO I I
ELECTRICAL PERmT -:2.2 _ s-~ !-sidewalk I I
Charges and ,V\ . ------------ I
Surcharges. -~?> A/C Paving _ITotal. Comb.\Perqlit
MECHANICAL PERMiT . "l- I J
Curb Cut
Charges and ------------ I I TOTAL If I -60
Surcharges I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
Ii 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exa~~le- heat/electrical ceilinqlor forced air Qas
2. examDle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project, check new - if addition.
cheCK add. etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exa~le - 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 abbrevi ated schedu 1 es .you shou 1 d consu 1 t ,the-,
fu 11 schedu 1 es
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES .
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. ---
1!I. Ar~1ic~~t t~ 5ig~ ~~~ Jute
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
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
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.
C&go19
IjJr%J
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V. FOR OFFICE USE ONLY
Permit Clerk
cc---
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
.. . ..-
Additional Proj~ct Inf~~~ti~n:
'.
PLANS REVI EWED BY:
name ~AJP/VtB-
'1? . t ~ ~"-
r,(<F':"~ slgna ure . '--" _ -~
- ,.-'
date 3~27-87
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