HomeMy WebLinkAboutPermit Building 1990-4-18
I IrlSPECTIOrl LINE
726-3769
'1
CITY UF SPRINGFIELD'
CmlBIllATIDN APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
-
INFORlIATION LINt I
726-3753 \
Sq, Ftq, Main ~
~q. Ftg. Access. ~
Sq. Ftq. Other
Ilew Add Alter Rep.
Fence_Demo_Change/Use ,,-
_Other ~
Build Single ,lJ\
Job Address / / #// 4- Z€@lY )/ cfJ// _
Legal Descri~tion \ ')()~~..Y~rY) n~::bL
!? f/ f)(?}.f?;I.C'
)!r;DY /V/e./Z
Address 525'~-7 S /p,Ue Jf44.eY')7dYhone ~~~ly~nRe~~~~~eInf~~ A~~~~h~~eG~~~~~1,e"
;..(j);,.uj,-;~, CA. .p 7'5,,)/ (*.$.-:)~...h;,~ ~ /V7""~?S'.r.::>~ ~.".:>)/,.c-?7~ ~
Cc,l,]~l"...H"'R 191:t~a" / .?--.c-_ /--:;;!:.- ~ ... / ~,....".
#':~. . -___ .... ~~ -,/~<; h~-A/~sr' _ /' ~". _"_~ -:;;>~C::-/,e/ r....-r->""/C~
Address B;.rot-~ ~/CL>/~.
UI:.::)ll:iN Tt.Ar4 lnameJ (address) iiies. no. \
Owner
Range
Valu€ of Hark:
""""
/'7""'/<?c7d.
(~xoirp,,)
(nt,nf'l~ nn:-l
Primary
Structural
Electrical
Mechanical
CONTRACTDRS Inamel
General &;.4>:"7?''':;~::P~1"''''''
Plumbino
Electrical t:..rlS F/_~ 1-." I~,
. ~Iechanjcal J?/LL ~6'i&s<f=;b__
(addr~c;,<;'
~(2),1M.})X04JZ3tl M;;:P:;;8?
;)u-I'fL
~"(Y9
/O-{-"Io
I~ -5'-~/
J '1o/-?-:J-} C.
~'f- '436 ~
PLUIIBING
ELECTRICAL
MECHANICAL
2'!.
· F . r ~ 'lBliL -1!0..-
eeL...c.I:iAB.G.E. NO
eee ru~
'!;/
Each single fixture
Residence of
7.2> Z9Z5< )
SQ. FT,
furnace/burner to
/P ..c/~~ BTU's
~; '7-t/K~
Floor furna2e -
and vent
6--~'
Relocated building
(new fix, additional)
~ New circuits alts.
or extensions
"'2. A~. ~'R€
~.S2:
S.F. Residence
II bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
I Water servi ce
I Sewer
Temporary Construction
Change in existing
rp~ i dJIJU'p
multifamily. comm. or
Inrlustrial
"7
Appl iance, vent
Si='oarate
Stationary evap.
cooli='r
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd and duct
~~--
Storm Sewer
~~B/~ ~~"I..;9~
~~E~~'>'Hrm;:>
~D;::>~""'/h~
&~omB///;;;-~~
f
7.u....." ;:?F7.4'~ 9"4 '7~
,
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Wood stove/heater
Of
amps.
I SSUANCf OF PFR/lIT
TOTAL CHARGES ~ ?.<-:9==> TOTAL CHARGES '2"2~SO TOTAL CHARGES Jfg/.-
WHERE STATE L~W 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 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 UO OCCUPAlKY 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 OP~701.0~~ will ~ uS:d on this project.
CaSEI_<Tdc :,:"-~ OI-.;1I'4.n,~;p ,t;/-<pd!e?'7~,/J
IWIE(pIease print)..! ~~G A,D()W\f)SS~, SI(,IIATURE ~/Yftq/.9tr/. /)/" OATE
,. "
f FO~ OFFICE USE miL Y ( /
Zone C L \ Tyoe/Const, 5"~A/ 'Jnits Sq. Ftg, Ilain x Value
Fire Zone Bedrooms Occy Load Sq. Ft9. Access x Value
Flood Plain Stories 2. Occy Group 8~2 Sq, Ftg. Other'<:::"~ ~/ex ~~alue /-z:;~~
-n '7"-_ _ ____ '7.>_ TOTAL VAlUATlm.
n-....., ffcWeW ~ _?~L> 1?6' ~3:."8? k'dZl>: /...~
BUILDING PERMIT ~." ~ Pian Ck. Comm/Ind Systems Development
Charges and __~J~",,7J<::> fi5VRldn Ppr Fop ,<R/, YS ~./.;:<;I tharQe t1.5~)
Surcharges .r-? Plan Ck. Res
;<:9'. "" -' 30%!Blda Per Fee
___~_2~~=:: Fence
{/_,0"?,DelllQ
_L~...::?-:::'f!i~= Sidewalkt~
C- {./3 ~ng,
~jd
.1/~
PLU,jBING PERMIT
Charges and
Surcha rges
-t-
~l
( --
. -
" f!~'f'f"'CC: ~F
, #-A'-~ ~W~
FEe !JOE
Total Comb. rermit
/L?2, ~~
972,&'51
ELECTRICAL PERI~IT
Cha rges and
Surcharges :.
\F
11ECHANICAL PERMIT
Charges and
Surcharges
____&f~~_ Curb Cut
~. t:JS
TOTAL
/t1l71i'. 2Z
e
_.1..__ ..." __
COMBINATION APPLICATION/PERMIT (CAP)
I
1. Applicant to furnish
A, Job Address
B. Legal Oescription
1. example~ Tax Lot 100. Lane County Map Reference
II 03 43
2. .examole- Lot I. Block 3, 2nd Addition to
sprlngfield Estates
C. 'Name. etc. of owner and construction lender
O. Energy Sources
"I. examole- heat/electrical ceilinQ/or forced air qas
2. examyle- water'heater/electrica(/or solar ....
E. Square footage or valuation, etc.
1. exam~le- 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 gan~ge
2. example - remodel existing garage into family room
3. exam~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. OESIGN TEAM ANO 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 schedul es
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
O. 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. ---
Ill. 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
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.
V. fOR OffiCE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
. "
.
PERMIT VALIDATION
slR01 V\ \~~
\ ~flL\ \
Permit
ClerkHvii)
Permit applicant exempt from registration with the Builder's Board because:
Additional Pro~ect Information:
.' .
PLANS REVIEWED BY:
name ~#c ~e~Signatur~~~~.->:>
. (/., '/ - /'
r
date t/-/R- 90
I