HomeMy WebLinkAboutPermit Building 1988-10-13
- .
~
-IINSPEC<ION LINE . CITY UF SPRINGFIE~D
726-3769 COMBINATION APP~ICATION/PERMIT
EIIERGY SOURCES:
~Jb Address //'/1/ e6A1-~~ 4~P Heat
~ega I Oeser; ption /7-v1>1S5~-z.7 ~ .-9~~~ Ilater Heater
; Range
ValuE of Hork:
:<B- :;Jt:>C>, 10
BU11dinQ Permit Info: Describe Work(i~e"
Familv nesidence With Attached Garaae)
.
I NFORlIATlON 11 No
726-3753
Sq. Ftg. 1.lain.
!:q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Rep.
--Fence Demo Change/Use
Other- -
Owner r?;z?Fhl::>N' B~
. ,
Address SI;l/o ~ Y9': MACA'~/77 Phone
~rLrHz;, ~~. 9?:?~
Construction lender
Build Single
C()
IX)
()
\j)
~
73' t. J7.? /2'#~ ::R.F 1/;'5 A!>A'C;-
,
~~_*" ?'..-:~~,PCA7:::?.o12
Address
Ut::i HiN HA11 (name 1
Primary ~E A. ~^""J_/~;,;? ..#/Al.
; ,
Phone
(address) (lies. no.)
~:>~4:./7T+,#~e.
'ZHJR?i(~__7> ~?'>. 97.2'3~
. . "
(pxnirps)
(nhone no
Z' -r 7'- /_>...:....,
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(1 ics. nn.)
(pxoirpc::'
(ohnnp !In. ,
Genera 1
Plumbina
I
"br
c" M()
, Electrical
~lechan;cal
....
",/ ')I
P~UIIBING
E~ECTRICAL
MECHANICAL
NO,
FFF I ~H^Rr,F
Nn I
Residence of
I ~H I rI-4AR(;J:" NO.1
I J:"J:"J:" I rI-4AR(;J:"
/
Each single fixture
-'5~/
Relocated building
(new fix. additional)
~
SQ, F1.
furnace/burner to
BTU's
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
~ or extensions
-:2 &>-;&1 h?"'~ $
SERVICES
~
Floor furnace
and vent
Recessed wall
So~cP hp~tpr ~nrl v~nt
TOTAL CHARGES ~'Y' /::;7"DO TOTAL CHARGES
WHERE STATE l"I~ REQufRES that the Electrical work be done by an
shall .not be valiJ until the label has been signed by an Electrical
I
I
I
Z::?-S&>
Appliance vent
<;'PDi'lratp
Stationary evap.
cooler
Vent fan wi th
sino 1 educt
I Vent sys tern apa rt from I
, heatinq or A.C.
I Mechanical exhaust
hood and dur.t
I Hood stove/heater
I
I
I
~Iater servi ce
Temporary Construction
Change in existing
rpc;, i d_e.nce
Imultifamily, comm. or
Tnrlu<;.trial
Sewer
Storm Sewer
Of
amps.
CO~1,/INO. FEEDERS
I Install/alter/relocate
di<;trih. fppdpr<;.
IOf
I
I
I
amps.
ISSUANCt OF PFRtlIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
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 oerformed 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 fW OCCUPAIKY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IlAI-1E(please print)
Fire Zone
Flood Plain
Stories
"2
Units
Occy load
Occy Group
7;>-'2
(0
COIl111/l ild
Ppr Fpe
Res
Per Fee
SIGIIATURE
FOn OFFICE USE iiiii:Y
Sq. Ftg. Hain x Value
Sq. Ftg. Access_ x Value
'/.2..... _
Sq. Ftg. Other_~D~4 Value~~
,
TOTAL V ALUA TI Ot!
DATE
Zone
/.-"-
Type/Const.-,"'-/~)P
Bedrooms
Curb Cut
~,,?"A>" /~R"
1"'~'8~
.L::27. -("";>
I
I
I
I
I
I
I
syste.ms Development
Chare" tl.5~) -
~/,~
BUILDING PER/lIT
Charges and
Surcharges
do
~ Plan Ck,
nA__..:.~~__....ill:/Blda
= u-=:. Plan Ck.
.' I - ,. </ 3D%/Bldo
..___L'a=~_ Fence
-7.,)
DBOO
I Sidewalk
I A/C Paving
Total Comb. Permit
j
PLur~BING PERMIT
Charges and...... ~
Surcharges :;)
ELECTRICAL PERli91T
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
----~-=?~~.:?-
/-/~
I
I TOTAL
237.3/"
r-::-:::--"~-..-;
. . .' ~
.
.
J
...... .
'.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example. Tax Lot 100. lane County Map Reference
II uj 43
2. exa~le- Lot I, Block 3, 2nd Addition to
sprlngtield Estates
C: Name. etc. of owner and'construction lender
D. Energy Sources
1. exam~le~ heat/electrical ceiling/or forced air Q3S
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check:new - if addition,
cneck alld, etc. .
F. Building permit information:
1. examele. construct single family house with an
attached gar~ge
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 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 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
,.
Permit Cl erk d - \R --.J~
12.105 /1-2 -8.2.
1
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
AdditJonal Project Information:
-'
"
'r
PLANS REVIEWED BY:
. name~.IV"" Fi.=6. Hi:?
Signature~-L....~-:~ date /~-~-.l!S"~