HomeMy WebLinkAboutPermit Building 1984-10-8
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'J1l't'Adoress -;;;>0 -;::jO E::::'Jo~,,uOLl U'), Heat
Legal Oescription \'1 () ~ ?? ?f'\ I ()~ I/ater Heater
Range
lNfORlIATlON L1NL
, 726-3753
Sq. Ftg, I-lain
~q. Ftg. Access.
Sq. Ftg, Other
Ilew Add A 1ter Pep.
-Fence Demo Change/Use
, ;; n //// /J.- ~ - V./1~' lJ Val~ of Hork: ~ Other--
Owner~ \J.AA~"4JVu.PAf:'fY U'Lf:Au."r 1'v.,Ji. ~ 7. t?r;70. _
-r;-- h Bui1C11nQ Permit Info: Descnbe \~ork.(i.e.. Build Single
Address ~O -30 I'{AI7. tJ/iA) Phone 7</1- Familv Residence IHth Attached Gara.a~)
SI~/&>dl/tG--O 'a~Os atf~ /Sb-?,dJ
(~~;z.f, 97Y'o~
Mechanical
CONTRACTORS (p.ame) (addrp.ss) (lies. no.)
Genera I '--J-'J4 ,jjk_;-?}f~ A< a../.." 1;).(rO ~y. e2ft?...JI
Plumbino ~
Electrical~1xf11t _ ?t/: ~ 1::7A1!~
~'echanical;1. AHQh.J1'""tllJ.LA, 3/SS'-<.l~ Cv.o/~L
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Constructi~n render
Address
UL:lIGN TEAl,'
~,
~
1
/t
Primary
Structural
Electrical
NO.
.
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c\J
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(J
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()o
(name)
Phone
(address)
"ba..lfL-
. f "
~~Q'~
VI [IV
(lies. no.)
(exn; res)
(ohone no.
(~xoirps'
------TOhoneno l
( bJ(q-~'?9.r-
!OW- 4'7...1&
-::SYS" -027, /C/
PLUlIBING
ELECTRICAL
MECHANICAL
FEE rHARGF
FFF IJ:H.Il.RG.E. NO
I
f'lrn~eLil!Jrner to
~\.~r> BTll's
NO
FFLJ:H.Il.RG.E.
S~ :0-
Residence of
Each single fixture
\
{g
<0-: Co~
SQ, FT.
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be val;~ until the
Hater service
Sewer
Storm Sewer
New circuits a1t5.
or extensions
SERVICES
Recessed wall
Sll~rp hpiltpl" :mti lIont
Temporary Construction
Change in existing
rps- i rlJ'nrp'
multifamily, camm. or
TndlJ<;.tr;al
Appl iance vent
seoa ra tf>
Stationary evap.
cooler
Vent fan wit~....., _
sinole duct Gll,'~ ~
Vent system apart from I
heatina or A.C.
Mechanical exhaust I
hond and durt
I
I
(....CD
I
I
'2..
I
I
I
I
I
I
I
~,o::> TOTAL CHARGES /.s09- TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Division
Of
amps.
COI*l./IND, FEEDERS
I Install/alter/relocate
dic;trih. fppdprc;
IOf
I
I
I
Wood stove/heater
amps.
ISSUANCF OF PFRllIT
V2.~
thi s permit
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 Ore[lon pertaining to the work described herein. and that NO OCCUPAHCY 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 7nl.055 will be used on this project.
D.
A4.E,vc;ES SIGII^TURE d#~",-f' /..J C#fP>-<o,_
FO~ OFFICE USE 0111. l"- V /
Sq. Ftg. f1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
TOTAL VALUATION r;') '1. rT Y'",
IW,'E(please print) ~/&#MI!.
Zone C (
Fi re Zone '""-
Flood Plain ___
BUILDING PERIIIT
Charges and
Surcharges
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
DATE /0-8-,%;..-
Tyoe/Const. \.)-\. '\
Bedrooms
Stories
Units
Occy Load
Occy Grou~ r'2.
?
_ _L~\.co..~
5.C\'2,
___20-#~__ Fence
\ 'GoO
)s- cro I Sidewalk
----- -.-~b--I A/C Paving
\f(,. c::c> I Curb Cut
------~u.~---I
~ c,~(pO ~ 1);.1
0/ a 0 n,,,1. ,,/ Slsteos Development
/". rra 7/0/-1/, ~rQe tI. 5~)
555.-
Plan Ck,
65%/Blda
Plan Ck.
30%/Bldn
Co","/! nd
Per Fee
Res
Per Fee
Demo
I
I
8'ffiffi
Total Comb. Permit
a\'C)\\\."('",\
I
I TOTAL
~~
7~~, -
~
.
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rx L( () 0 '2 <-/
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. example- lot 1, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinqlor forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc,
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~Je - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ 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
signa ture.
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
--
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PERMIT VALIDATION
fJ# (Pl~6g
f,j IC!v'~y M
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Permi t Cl erk 4J>I.
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~L \;).E.a\ 'l\~,~ \~~r\.\C')\ \~ \l"\~, Cl""I ""Y<.1~\.1:;'C'\ ~\. '\l"I
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name..\. )~~ rl ~')\
SignatuQu...l\.~_' ~ date\()-~~~lt
.
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F ~te>~
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OCCUPANCYNAMEj::'C,rrI'hrU;c:-Ir,'1<'<; (1, U,
AOORESS ,::SO~O r;~A+' Loo.-o
,
FIRE DEPARTMENT INSPECTION
CLASS
BUILDING OWNER
PHONE
BUS, PHONE
OCCUP. NAME
HOME PH.
ADDRESS
I CODE SECTION
VIOLATIONS
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YOU ARE HEREBY NOTIFIED TO CORRECT THE ABOVE VIOLATIONS WITHIN
S]GNED:
]NSPECTOR ,....,b1u Ul 's- S k~
DAYS,
VIOLAT]ONS: Noted
-
co,
OATE ,;{ -:U-fr5-- ABATED
NUMBER