HomeMy WebLinkAboutPermit Building 1985-10-16
CITY OF SPRH/GFIELD
COMBH/ATlON APPLICATION/PERMIT
E!lERGY SOURCES,
Heat
!~ater Heater
Ranqe
Valu€ of Hork: .
1t>'Z./~6.Cf, CD ,I
BuilriinQ Permit rnfo: Describe Work( Le., Build Single
Fa~ilv nesidence With Attached r,araae)
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I IrISPECTIOIl LItlE
726-3769
I
Job Address
/9-11
LaM c::<.../
Legal Description 17.C!I--Z 7./~, t::1Zt;,e>e:J
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Owner !~ 0/ukd 5d-
Address ;f5tiJ /1~d ?~~/7 Phone,~4(Y
~ --//r! /JtJJ %1 IJ '[)
Construct;on render
Address
DlSIGN TEAH
(name)
Phone
(address)
Primary
Structura 1
c.c,k'A#,oT
S T6/.J?/n
Electrical
Mechanical
CONTRACTORS
1?~rth;fM11!il'
\:T~G b.J~
Genera 1
Plumbina
Electrical
~lechanical
PLUllB I NG
ELECTRICAL
....!!Q.,.
FEE
r HIlJlJiL jJn
'9 Each single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
(] bath I
IOuplex (I bath) each
IAdditional bath
1,,'I~later service
~ Sewer
1~~IStorm Sewer
I i:5ew&i'i' "O-J&>
I
I
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Residence of
5"- /!;-
New circuits alts.
or extensions
SERVICES
~.".
~~-
~-/
/0. Of
/
Zone MM
Fire Zone ;:/./1 .
Flood Plain},/4.
BUILDING PERMIT '"7"~ COCO Plan Ck, Comm/lnd
Charges and ____~_!:L'_.__._ 65%/Rldo p.pr Fpp
J.. ..~rsllarqes /" ~Z Plan Ck. Res
"f ~""_-YM__ v." 30%lBldo Per Fee
~~~~:;~Ga~~RMIT _n_4~_~_ Fence
Surcharges ~."" Demo
~~;;~:;C~~/ERlm _n_2~.:.~J Sidewalk I
,Surcharges 2 _ ~,I A/C Paving rL~"",i
11ECHANICAL PERHIT / t:::> 00 I I
Charges and _ _ _ _ J_'_ _: __ _ Curb Cut .
Surcharges . C{e::> I 1
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INFORlIATlON l1~t
726-3753
Sq. Ftq. 1.lain ~~
~q. Ftg. Access,:;>, Y cO
Sq. Ftg. Other '
~lew_Add_Alter -,~ep.
Fence Demo Change/Use
Other- -
I
I
~
I(A
ft
-r~U~/f B-/h~ /lG-C r
E'/Ju/?"'/nE'NT -PA/f'1r ./A/t5-
L./ C)()O S4?_ Ft:." 2~Yd tj1 i:?PCiY
(lies. no.l (exoires) (ohone no.
v-- H./t::.O
(1ic:~_ no..'
4h /)17/
DW - ? pe
d 0- ;:)/!'JC
J:H
r"1lRliE. Nn.
Temporary Construction
Change in existing
, rp'i i ctp.n('p
ImUltifamily> COITlll. or
TndlJ<;trj~l
IOf -,'1~
ICOffi1,/IND. FEEDERS
I Install/alter/relocate
di"trih. fppdprc;
Of 20C amp..1
I
I /
I~~-
I
I
/.).4
j
I
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TOTAL CHARGES ' /l~ tIO TOTAL CHARGES ~4 TOTAL CHARGES)Sz.H. FtGE /.::::>. cot>
WHERE STATE L.\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Sunervisor and returned to the Building Division
. .'. ...., .
I HAVE CAREFULLY EXM1INED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, a~d I further certify that any and all work oerfoDmed shall be done in accordance with the. Ordinances' of the.City
of Springfield and'the taws of the State of OreC]on pertaining to the~ work described herein, and that rm OCCUPArKY 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 exe~Ption is not d hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7nl.055 will be used on this project.
IIAlIE(please print) ;f;;J-IAf I-!YL.-AAI,(J SI";IATURd~4 . DATE)P-/t!-;j5.
FOr. OFF I CE USE.2ffi. Y /?'
Tyoe/Const..3N....S/YUnits #.A. sf Ftg, 'lain f~
Bedrooms AI.A' Occy Load~T__...Sq. Ftg. Access~h:~
Stories 1~,57t.,.,)tIIr.,2ccy GroupJ-/ ,Sq. Ftg. Other v.~ .
, . .' *e:. ~4q{p3- Cc..
DAII1
.....f'(l~Cc.'n,r'~ Systems Development I.'~ ,... U6
~~~ ,;;rr;-GS' Charqe (L5~) <.J 7";>. 7
SQ. FT.
amps.
LI05<(:3<6< :
1../...... - ."
~ !!!:Ii .
'pxoirp~' (~~n~p ~~ \
1J~30--g:h
o ~ 30-:,yh l~
Ij-.:.?Lj- f~~
MECHANICAL
FFF
r~tARG..E..
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
~n~rp hp~tpr ~nrl ~pnt
Appl iance vent
o:;.~oar~tp
Stationary evap.
cooler
I Vent fan with
o:;.inole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hnnd il:nd dur:t
jl'!OOd stove/heater
15.-
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,.t")')UKI~\..r IIr "rr\!l~~
.x /~.t:~ Value~. ~a:>.-
x lIP.... Value ~,~Q:).dlCl
x I. ."~alue ;:j. 5'~<I. ""
TOTAL VALUATlONlbZ.,~"'~, 0"
'PL.f/t/ if.!' If'",-..
F<2' /lzJarnn/9 r -t S"~ ,?o
I
I
~)<. die::> \rotal Comb. rermi t
'I
I TOTAL
15"211. g 2
'2..lrr;r;,B
'1
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COMBINATION APPLICATION/PERMIT (CAP)
,
:PERMIT VALi DATION
I. Applicant to furnish
A, Job Address
B. Legal Description
1. examp'le- Tax lot 100. Lane County Map Reference
II U3 43
2. example- Lot I, Block 3, 2nd Addition to
::iprlngtfeld Estates' '-0 ......
C. Name. etc. of owner and construction lender
D. Energy Sources .
'_-,1. . exame~ e- heat/ e 1 ectri ca 1 ceil i nq/or forced air Qas
..,.... 2. exafI!Ple- waterheater/electrlCal/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cneck. add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - 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 TEAM 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 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 ANO
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 ana charges are due and
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
P'mit Cleek I!!J:iI;r
PROJEq CDND!TIONS TD BE SAfISFIED BEFORE <8W:lPAtl&\' . FdI1V;Wir., I ~ ~CJANC G I
I
/ - LJt1eJR"'-
";ji'- Vd~.rY
67'. ~~~Y~/lqe-,yr ~~~fr?~.H.r l2> h $;,,",
&4>"-"'~-' ,~"'-dee-~"" 7;' If?~ s;,~EP.
~--..... .
Permit applicant exempt from registration with the Builder's Board because:
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.Addi ti ona r "Project. Infonnati on:
l',cn);;;i> ~/
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PLANS REVIEWED BY:
..
I -,...... .~ ':;-:>
.' 'n'ame I ~"VE r>~ 'sig~ature-4~'- .~'l "::0;
da te /&1 "/~ -as'"
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