HomeMy WebLinkAboutPermit Building 1991-2-21
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I INSPECTION L1IIE . CITY OF SPRINGFIELO
726-3769 C0I1BIIIATION APPLICATION/PERMIT
Job Address 971 K~ {).;e ~ f" ' ~~;~r,Y SOURCES:
Legal Oe<cription/7.0~Z2.2 . ~9C>6 Nater Heater
, Ran~e
ValUE of Nork:
I( 170, 'lb.;. ~O
BuilriinQ Permit Info: Descr,be Work(i.e.,
Familv nesidence With Attached G~rao~\
c;,N67Rui!:.. 7" 6:5" 0#/7 .M~rAC
7hI-> MAN~<; ?W/7:,
'mY, .; ~.rE ~~PL;R ~4'i ~~~T
Ul:)Hir~ lEAf.' (name) (address) (lies. no.) lexniresl (ohone no. I
.~ A ~I' hY"TZ'PP';'. A -17
Primary. 'e.HeL./L'U .-'7~GW,.....,r",7.?P<'~ .' Z:>P/N~ /~. ~
Structural
ELECTRICAL MECHANICAL
c" r"Am ..lllL J:'J:'L LUAB.Gf..
Residence of furnace/burner to
SQ. FT, 7'5 BTU's ~:- ~S';.~
,?'v~ t.AN~
New circuits alts. Floor furnace
or extensions and vent
SERVICES Recessed wall
~o~rp hp~tpr a"~ vpnt
Temporary Construction 5 Appliance' vent 3, ~,'5':-
seoa ra te
Change in existing Stationary evap.
res i cte.nce cooler
multifamily. camm. or IIf Vent fan wi th ,- t;7.- .
Induo;tr;al o;;nole dUl':t_
Of amps. Vent syste~ apart from
heatinq or A.C.
COMJ.t./INO. FEEDERS I Mechanical exhaust
hood and durt.
Install/alter/relocate Wood stove/heater
d;"tr;b. fppdpr"
Owner ~-r6R Mbr~U_-<. LorD.
Address 2t:J.5'/ lI/ur.t!Jp f);e \.' A-26 Phone
l<Et?P",N~CA. 9b~2 .
~~;'~;'M"';'/. ~~ m-1?~$
Address
Phone
Electrical
11echanical
CONTRACTORS I name J
Genera1'l?~~/.8U
jaddreso;l
4~r",~~;"~~~'
Plumbina
, El ectri ca1
~'echani ca 1
PLUIIBING
NO.
(~ Each single fixture
Relocated building
(new fix. additional)
FE F CHARGF NO
I~"" 1'I~t!>
S,F, Residence
11 bath)
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
INFORlIATION LINe
726-3753
Sq, Ftg, '.Iain "1/;6.2"1
~q, Ft~~P~1n.
S , Ftg I,"~
2(rlew_Add_A ter_Rep,
Fence Oemo Change/Use
Other- -
.~
.......
\).)
I\l
rP
Build Single
22!-5"rRl
(lies. no.1
(pxo;rp"l
(ohnop no 1
~l
~
Of amps. 8c:SASC>~T~6?,:> ')5'.0' ~,"'<:'\
/J';;R~/Y4',n: Q",c-y.rP'f'P'C, , , ..'
/~~./r-5#A2"""L ;~U~~; 'L._'- :...,,;.~;~~
7J'7 ' HEZT: ?#7/:'.44 c:57f", . ISSUANCF OF PFRIIlT It?.#
TOTAL CHARGES 1~9~N TOTAL CHARGES TOTAL CHARGES S~.''''
.WHERE STATE L~N REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be va1i1 until the label has been signed by an Electrical Supervi<or and returned to the Building Division
I HAVE CAREFUllY EXJ\t1INEO 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 110 OCCUPAIICY 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 .basi;'~ r ex t':Js noted hereon, and that
only subcontractors and employees who are in comp1ian~e.w1th OP.S)Ql:.~~ will b 'used on .hn ~ject.
IlAllE(please print)'y \"IEL cSp...~EtES -......u:I.:.~~=~ "om :::J1':J.llo,l
FOP. OFFICE USE OIILY CJ(EQ," ~~ PaO/YPA77~N -~.~
TYDe/Const.5/~ .:s}llftJn1t<"'?~i~;~~Sq. Ft~, rlain~<-&;7~ ,yA~ Value~Al::>;~,o;'~:
Bedrooms ' Occy Load 2/7 Sq, Fta.~~ ,,~i2z-..-...x~value~&''Z.t!).-
Stories ~ Occ'y Group :l?-I ~", Ftg. Other---'~d~x.L".Ii!> Value 11fr.,,~.~.
.. ~;;,,,...~~ -7' ,TOTAL VALUATlotIW~. 9,,6".~i
".7_CII. P.LPT1?' _.v-~ \. '
I - -} -. Systems Development I
'2~bl).~ Charqe (1.5~) 2"l.5'~~.5'8
I -
I
I
I
I
Zone~~
Fire Zone
Flood Plain
BUILOIIIG PERMIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
_~~!l~-2's:?__ 65%1R1do P!'r Cp.
Plan Ck. Res
30%/B1do Per Fee
I 7~_ "1A.
__~!"f~~~___
"'t'. ~eJ
PLU!iBING PERMIT
Charges and
Surcharges
Fence
OCAlO
ELECTRICAL PERr:1T
Cha rges and
Surcharges
Sidewalk
A/C Paving
MECHANICAL PERMIT
Charges and
Surcharges
___2.~~__ Curb Cut
:26.$0
Total Comb, Permit
s;~ ?g
iOTAL
3~ 7'~7. J6
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\.:.,
:.,
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COMBINATION. APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
'.
I. Applicant to furnish
A, Job Address
B. Legal Oescription., .... ....,.\
I, example- Tax Lot 100, Lane'County Map'Reference
II uj 43
2. example- Lot I. Block 3, 2nd Addition to
'. Sprlngfiel.d .Estittes. .. :' '.
,C. ~,Name. etc. of owner and construction lender.
0, Energy Sources . . '.
,I., exam~le- heat/electricai'ceilinqlor forced air cas
, '. 2. exam~le- waterheater/electrical/or.!Q..!!!.,
'"[. Square footage or valuation, etc. .
I, example.. 1250 sq. foot house, 500 sq. foot garage
2. .examp.le- if new pr:oject; check..!'lew -' if. ,a~dition, .
'cneck add, etc. .' . , .,., .
F, Building permit information:
1. example - construct single family house with an
attacned garage
2, exam~le - remodel existing garage into family room
3. example - 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, & Elect~fcal Schedules
A, Except where blank spaces occur in the description
portion of the Mechanica) 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 Bui.lding Division
I. 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
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 1s 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. jssued,
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,.V. FOR OFFICE-USE ONLy....
k1B
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
.., .,", ." ,l' ,.':
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'.'Additional Project Information:
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PLANS REVIEWED BY:
':riame'~R4~ 72~~ signature4~~_~ date ?~/:z-"'/
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