HomeMy WebLinkAboutPermit Building 1988-11-10
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I INSPECTION LINE
726-376g
. CITY Of SPRINGfIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ha ter Ilea ter
::57,
Job Address 6"7t) 5""' O-</-/ ,") 7'
l.e9a1. De,,,ription /7~O'2. - 3'3~o/'S/
l3,,qrOF O/b~/
Owner (J,j .(/("IGj!r6-t.., (....<- c'e..-t;,..
v
Address SI'jD 17<></(/';' ~ /
~.
Construction Lender
Address
DESIGN TEAl.!
(name)
Primary
~/e..,/ t~.
Structural
El ectri ca'l'
f1echan; ca 1
CONTRACTORS
(name)
Genera I' h'l., /tM/ --Is."" .
V
PlumbinQ
Electrical
~1echan; ea 1
PLUIIBING
NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
IAdditional bath
(501 ~Iater servi ce
;=' I Sewer
~ Storm Sewer
I I ~W?' /i71"1/4Yr--/7
:s YSr2F/77
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Ran!']e
ValUE: of l'lork:
11/ ?80
Builciinq Permit Info: Describe \~ork( ; .e.,
Familv nesidence With Attached GaraQe\
Phone
.
INfDRllATION LINe
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. ftg. Other
Ilew Add Alter r.ep.
--Fence Demo Change/Use
Other- -
~
~
I~
"
(lies. no. \
':.EL ..cHARliE. JI.(l
:72-5'0
(').'-
's-: #?
I
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I.
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5"7_50
Build Single
r:;.,.b-vDA-7/~N. C""I/R-'" c;,:::> &rRy-
-i -S::T.<F /.m'~~<:::>VB77E'__rs Tib..e
)fpGJ,Ce/~,,-<f ~.A'.c= L"~//r~.
. nics. no.) (exnires) (nhone no..
Cf)1I~~.
Zone -.LYJPi2
Fi re ZonE'
Flood Plain
Type/Canst. ~ri\r
Bedrooms
Stories
Phone
(address )
{address 1
.57l1o tJi If"'/;!... -
FFF
ELECTRICAL
CHARGF .n
Residence of
SQ, FT.
p'" New circuits alts.
or extensions
-:z 41?'? /?h:>fl ~
SERVICES
/
(
/YJP~/'i' ~v4:"""
2,')"2., ~ qr:v
(exnires)
(onone no.)
Temporary Construction
Change in existing
rp.:;. i denee
multifamily, con~. or
Induc;,tri;d
/5--
~.-
-::?"'-~
?-sP
Of
amps.
In ~6'~,
. \ ;{1
\
MECHANICAL
:.E..L ..cHARliE.
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wa 11
So~rp hp~t~r ~nn vpnt
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
c;,inale duct
Vent system apart
heatinQ or A.C.
Mechanical exhaust
hnorl "nd durt.
Wood stove/heater
from
C0I1I-L IIND. FEEDERS
Install/alter/relocate
didrih. fpprlpr.:;.
ISSUANCF OF PFRt11T
TOTAL CHARGES
WIIEP-E STATE L.'I~ REQUIRES
shall not be vali1 until the
7"2 ~5'C> TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical rortion of this remit
label has been signed by an Electrical Surervisor and returned to the nuilding Division
TOTAL CHARGES
Of
amps.
I HAVE CAREFULLY EXAMINED the comrleted aprlication for permit. and do hereby certify that all information hereon ;s true
and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore!]on pertaining to the work described herein, and that fiC OCCUPAIl(Y 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.S 7f!l.055 \.till be used on this project.
SIGIIATURE(]4?? wi
...,.-; r-c Plan Ck. COIrmlInd
___y'_q._~<;?___~/RldQ Ppr Fpp
-::? 53 Plan Ck. Res
- 30%/Bldo Per Fee
.z:z -~ I Fence
_u -3'~.:iu~~{AtB~ "....1
5-::<-:se:> I Sidewalk 9~'\'1>
_u_--.z~3--1 A/e Paving
IW.IE(please print) :It frtd'f (.
BUILDING PERfllT
Charges aoc "1_
Surcharges r
PLUI1BING PERMIT
Charges and S-
Surcharges
ELECTRICAL PERI~IT
Charges and \j
Surcharges -,
liECHANI CAl PERMIT
Charges and
Surcharges
FO~ OFF I CE USE OIlIX, r ,
Units Sq. ~g. r1ain;Y/'Z?'JcAR?J4/~,/;y~Value ~("'.~--==-
Occy Load Sq. Ft~. Access~n. -r!~~Y Value /j. .~....-
Occy Grou~~~'''Sq. Ftg. Other ~_ '?'~""r~,:::Value i.4?8Z>
* /2 7~ I'D TOTAL VALUAT~-z::? <"Gt?
- _J~ystems Development In.::;')
fJ'-::? JE'3 II'/"'~harqe (1.5~) \.L/b>lsO':. ?e;.
l.w-6-bJ-~),:, #~k.s/>-.;,--.....7'
I.FEE hp. ~ ~G?f"
I~A"''''? -Q ;~5~ /7
I . ~
Irotal Comb. rermi t
I
I TOTAL
Curb Cut I ~'3 y'
)-
r?'?'~4f,'" ~?'2 y'=>
. '2.0
/5-/0
GB.S=
/5'./0
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D~.TE //-,fd-1rl;:,
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II
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PERMIT VALIDATION
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
11 U3 43
2. exan;Ple- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. . example- heat/electrical ceiling/or forced air Qas
2. example~ waterheater/electr;cal/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq. foot house. SOD sq. foot garage
2. example~ if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. examDle - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa"!ple - 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 TEN~ AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab site
corrections, etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except It/here 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. ---
III. 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. .
J~77-3
Permit Clerk
a.~~
1/ - Ire, -:88
V. FOR OFFICE USE ONLY
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
date
signature
name