HomeMy WebLinkAboutPermit Building 1989-6-20
Owner ;(OliN HYiAN/1
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It CITY Of SPRINGfIELD ~ INFORI1ATION liNe
COMBIIIATlON APPLICATION/PERMIT 726-3753
EIIERr,y SOURCES: Sq. Ftg. 1,Iain
lIeat /J "Nt< ~q. Ftg. Access.
l,later lIe,1ter~l~ Sq. Ftg. Other
flel< Add A 1ter Pep.
Range Alt/AlG Fcncc_Oemo_Changc/Use
Vll~€of\'lork: .ci:J _Other
:r AJc., .1} p.".~ rrn. ' ,
Bulldino ri~,.j;t Info: Describe Work(i-.e.. fluild Single
I'hone Familv Residence Hi th Mtached r.araCle'
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'1lJrr!' y-> [exnires!
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I INSPECTION LINE
726-3769.
Job Address /94/'LAu/?fJ 51.
Legal Demiption \r') t.->-=s ~l) \n(")rllnlt)
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Construction lender
/Ih:>;J ~
AddrC5!" I'hone
UESIGN ItAf~ (name) 'jl' (address'
. l.l~' ,
Primary <:t:.. H:A#/J!iT: S-rEMh'J y WiLL:)
Structural .c::;AmE :AS A./."f,t/vJj
(ohone no.
Electrical
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GeMra 1
Nt/IVE ::.
(name) . ,"
0L,HiJ"
(i\ddress)
{l ies. no. \
{~x[)iresl
(ohone no. )
f1echani ea 1
CONTRACTORS
Electrical
J: )(. G.
J-/Y LoAN/:) uCl/vS7 :J:NC. J9 q I L.,AuK,A ST.
:3 45<6/ CUJ
ELEcT ::1..1,J:; rJ .DPN.~ ~pFL-.o. olf. 7 L/ b 46.!:'t:.
~3 -'}~ LI$l-<6
Plumbinn
~lechanical
PLUIIBING
ELECTRICAL
MECHANICAL
Each single fixture 1,
Relocated buildin9
(new fix. additional)
R~sidence of
SO. FT.
furnace/burner to
BTlI's
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NO,
Ffr
r.Il^Rr,r liO'
_EEL J:IJAIlliE. .JIlL
S.F. Residence
[I bath)
Duplex (I bath) each
-'7-
~.New circu~ts alts.
" or extenSlons ~ ~
'2.-.R ~~"" ~
SERVICES }Z%t(.:lvJ lIP -.;w
~.o }(wAJ zt,ot/:: '2,.5.A~)'s
Floor furnace
and vent
Recessed wa 11
So~rp hp~tpr nnd vrnt
~.i Storm Sewer
3S-r:> /
Temporary Construction
Chan~e in existing
residc>ncl?
multifamily, (oom. or
Innustri.1 . .'5"'~A~;;-
Of J?/C/ amps.1
cm~,1. IIND. FEEDERS
Ins tall lell ter/rel Dei) l.c
rli<d.rih. fppopn.
Appl iance VCI't
seOel r<l te
Stationary evap.
cooler
Vent fan with
~.i1LL,!:>h ~in9le duct
Vent system apart from
~.~ heating or A.C,
Mechanical exhaust
hood ;lnd due t
Hood 50 lovel hea ter
Additional bath
~Ia ter serv i ce
Sewer
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I SSIIANCF or PFRlII T
TOTAL CHARGES
WIIERE STATE L\\/ REQUIRES
shall not be vali1 until the
'5'5-':> TOTAL CIIARr,ES ~s-:~ ~ TOTAL CHARGES
that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supcrvisor and returned to thc Building Division
I HAVE CAREFULLY EXArlINED 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 \'1ork oerfonned shall be donc in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~lOn !",cl'taining to the work described herein, and that Ita OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my re~istration .../ith the Builder's
l3oar.d 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 Or.S 701.055 will be use~ on this rroject.
IWIE(please print)~ Lill/J/vO _SIr;IIATuRt7-../ 0/' 4P I'~A~E b-26-'i"~
FO~ OrFICE lI~EJ()IIL Y. _/
Zone L/Y1'L: Type/Const...s::-N Units S~. Ftg. lI"n ~~ ,oM;?o value:f?I.lOZe:;........
Fire Zone Bedrooms Occy Load /t::> Sq. Fla. Access x Value
Flood Plain Stories I Occy Group 79-2 SI1. Ftg. Other x Value
, I 4 04 ,~~ \0. tD,~qTOTAL VALUATION
,'27-'19 Plan Ck, cOIrmlInJ \A '" (""~ Systems De\elopment /~// /!:},..,
--' ,/, 65%lRlna Per ree '-t\), JT)" Charqe (1.51,) "':'/F-;? DC/'
----'-/.----~r=Piiin Ck. lies ~ - ~ A . 7: -
'$.?'..::> 30%!Blda Per Fee /<;;<""'<O..q..y //~_o...."yC n"",,,,, A''?0-.!!'W'
, ' .-,E::.--e> Fence ( J~A/' "2";{6. 3S' .f:'Ec- p.,E.7- ~/ __ tHr:V4=
---,fj--!~7:?- D!lI'1o' I (;;//,,,urG r/~. 27
I
BUILDING PERMIT
Ch(wges anc
Surcharges
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERIHT
Charges and
Surcharges
....
SIdewalk
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TOTAL
'If5/. ?S
I\J~5\1:'Y7
A/C'Paving
Total Comb. rermit
11ECHANICAL PERMIT
Charges and
Surcharges
ii';
l'i"
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
,PERMIT VALIDATION
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I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
II uj 43
2. example- Lot 1. Block 3. 2nd Addition to
sprlogtield Estates
C. Name. etc. of owner and construction lender '
O. Energy Sources
1. example~ heat/electrical ceilincr./or forced air qas
2. exanple- waterheater/electr;cal/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. exam~le- ITnew project. checknew - if addition.
check. add, etc.
F. Building penn;t information:
1. example - construct single family house with an
attached garl)ge
2. example - 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 3D3 (a) of the
Structural Specialty Code
H. DESIGN TE~1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
correct i ens, etc. '
II. Abbreviated Plumbing. Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the appl icant 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
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 prepar~ 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.
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V. FOR OFFICE USE ONLY
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Permi t
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS ,REVIEWED BY:
name ~;;:...: hcc:;.~ signature /'?~...-7~.:;;~ da~e
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