HomeMy WebLinkAboutPermit Building 1984-10-16 (2)
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I IrISPECTION LINE CITY OF SPRINGFIELD
720-0' oJ-. ,COMBINATION APPLICATION/PERMIT
Job Address '?,,z')'Q. f{mA..J../'A' \l+
Legal OmriPtion\\-] n?':'f) (j,() - ?\F/)
owner'-711::b~11j}p1 JIlt jlJL u) d,AJ
Addre,; -;z, 5\ 6' d }jiij:J /uri' ~ \f- Phone 74/-
S.,J1.!.. t1 /<2 qzl./ 7 7 ;),4 'It!
Constructlon lender
INFORlIATION liNe
726-3753
Sq, Ftcj, ',lain
~q. ~tg. Acce~~. ____
Sq, Ftg, Othek-1,~\
New Add Alter Rep,
Range __ -Fence Demo Change/Use
Va 1f} of I'lork: 0-0. Other - -
n 7., (l'f'70. -
Builoina ~ermit Info: Describe Work(;~e," Build Single
Familv np-sidenc~ ~ith Attached Garaop.'
, ~~~ /JJ.i.JLO }JLtJ 6' q II
.
EIIERGY SOURCES: _-
Heat _,\t.....,......\
Hater Meaterf--,~' - '
-s
(}
1'-.9
Ie
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it
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1
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Address
ue>l{iN TEAl1
(name)
Phone
(address)
(lies. no.)
(exo;res)
(ohone no.~ l
Primary
~.
':~
Structural
Electrical
Mechanical
CONTRACTOR" I Game) 1 '
General ~&dg., 'jp/!;AALA
Plumbina
(address)..... (lir:s. nn.)
O--!O.(j} "7/3 flM.&L,;I..Ii s~""'%d
(Pf~;;;/<fl/
(ohnnp nn.)
~-d C?/c J
Electrical
~ (;P.e~.1
iJo/ 7/1.o..'.~ - P,;.dqr h~
~a :; 0 0
/~/<)Al.l
J?9S" - ag~r/
f..lechanical
PLUllBING
ELECTRICAL
MECHANICAL
NO,
FFF
r.HARr.F
NO
I ~j:'r
Ir"T1
furnace/burner to
BTU's
Floor furnace
and vent
I !:'rL 1J:HARG.f.
Each single fixture
Residence of
SQ, FT,
Relocated building
(new fix, additio~al)
S.F. Residence __,
(1 bath)
, ,
Ouplex (l'bath)'each'
Additional bath
New circuits alts.
or extensions
SERVICES
Recessed wall
So~cP hPAtpr And vpnt
,
.I
Storm Sewer
Of
amps.
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnc:l and dud.
~Ia ter serv; ce
Temporary Construction
Change in existing
fPS ~ rlJIJlrp
multifamily, COI11T1. or
Tndu"t.rii'll
Sewer
COMM,/INO, FEEOERS
Install/alter/relocate
di"trih_ fppnpr"
Wood stove/heater
IOf
I
I
I
amps.!
1 SSUANC, OF PFRt1lT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an "Electrical Contractor, the electrical portion of this perr.!it
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 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 110 OCCUPAI~CY 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 exemotion is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Zone '0.. \",
Fire Zone -
Flood Plain '---
Tyoe/Const~ 1.\ ~\-
Bedrooms
Stories \
Unit, \
Occy Load
Occy Grou~ \~_ II.
SIr,rIATURE
FO~ OFF I CE USE Oill, Y
Sa, Ftg,
Sq, Fta,
Sq, Ftg, Other
~ 9kn/iN ~N
Jt '" cK) 11, "(, ( Sys tems Oeve I opment
fI',,",u>, lR'o?"1o Charoe tL5~)
DATE /0 ~ It. -l"S'
llAf.IE(please prin~9 "e-tJ 'Ros s
,
1Iains..':i\<;:;'\
Access
x Value
x Value
x Va 1 ue
TOTAL VALUATION ~ ,C"'!"'x"')
BUILOING PER~tlT
Charges and
Surcharges
"\D ()(:> Plan Ck, Comm/Ind
______ ...:.____ 65UBldo P.fr Fpp
W Plan Ck, Res
\ , 30%IBldo Per Fee
\\,~
PLUl1BING PERMIT
Charges and
Surcharges
Fence
HECTRICH PERr:IT
Cha rges and
Surcharges
OeRlo
I Sldewa 1 k
I A/C Pavi ng
I Curb Cut
I
ITotal
I
I TOTAL
k.\ \-~c;b
Comb. rermi t
I1ECMANICAL PERMIT
Charges and
Surcharges
~L/ 00 fly
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
II oj 4J
2. exa~le- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation. etc. ------
I, example- 1250 sq. foot house, 500 sq, foot garage
2. examole- if new project. check new - if addition,
checK add, etc.
F. Building permit information:
1. 'example - construct single family house with an
attached garage
2. exam~le - 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 (al 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
fu 11 schedu I es
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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.
V, FOR OFFICE USE ONLY
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Permit Clerk
M\\N1
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PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'~ C'r--,"\0..... \')';. -\, 'AC, q,Y(-'("\"'-L \\.'\~-c\(",'\)<;'.., -.\t='M\\.JC'~ Q~\>~
\('\ ,\?-,r-, '1;::\ ,<;) \. w:;:,\~ ~ ~ ?-,~ \\ ,(,~~F(" (?( ,",l'_ ~\, ,\~,""\ '\ ~o;;>
'~~P(.""')\."'~l ~'Q~(,,)\.l ~ ~C\ 'Vp.,\..'(-...,.
, Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: E\ FC',"\)\("~ ~F"Q>~,\\ \.-\c'\\
\\. Y l \ \\J:-,\. '") \. \ ')1 ,\~\S- ~~~,\ - ~'V-r t==t ~C\'?.\C" \.() a~\.\..)
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\=JF\.>~,'I.\ o;C'.....j"v .....,~y-,,.'?V ~. I. ~,F\(. V)~\~ -(rn'i2~"'M,\t:::..""E
\\"\':\""0...,\' -:.....,\ "IN --;:)T-r)... .~.. (~ ! \';-A,B. e ';-\,r::r\~\ \ \ \1 (\'\"'1' ~ ~~\\ \S,w,
PLANS REVIEWED BY:
name\..::::> \>.).~~~ ') "" '( \.~ \. "
SignatuJ......r\..~~\ _
da tN""r\()-~\...\.
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