HomeMy WebLinkAboutPermit Building 1988-7-12
IHFORlIATION LINL
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Range -Fence Demo Change/Use
Va1u€. of flork: ~ Other--
7..~"~:;-Info: Desc~ibe Work(;.,e.. Build Single
Familv nesidence With Attached Garaae)
C:::;;v,;~,-"r..JC7' //~~ ~6"-?
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
.
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IINSPECTIDN LINE
7;l6-3769
Job Address '20// t::.# V)? -fZ ? r,
Legal De;cription /7..,p~-'27'-I'L? ,.i...,.~. '2?"'iO' ~2~
- ---..---------,------" - -
;;>P/c.o t.6&J&rtY /y--"r;;:6
Owner , ~L>""'IL ~~ ~ /....~--'...:..s-
Address?~ ';?.-...' I~ '? Phone
;- (~- ::-'l~ ~;-;;~
5?...c-L-D, _ d/? 97 ~??
(;o"t..et'^" 1.,d('/;;'CW8 ~/~ 1'1'07
Address Phone
.-- ."l)l:~HiN TEAr~ (name) (address)
pr~'ma,'y "7?.%?~AI?_..<7 ~~)P.
Structura;~~ ~/L~~.
. ~ - /' - .
(1 ics. no.)
Electrical
Mechanical
CDNTRACTORS
(name)
(address)
Us.k-.':)~:>/ :;Z;:>__~~-,;...&:~.
.'
(1;(:<;., no.'
Genera lE\;-BI""""- J ~ ~ZltSi
Plumb;nq
, V'7'''b
Electrical
f,lechan; ca 1
PLUJ,lBING
ELECTRICAL
--.BQ."
I FEE I rHARr,F
Nn ,
Residence of
, CE.L '.LI!ARG.E.
1t'
Each single fixture
SQ, FT.
7.9> ~-
IRelocated building
(new fix. additional)
IS.F. Residence
(l bath)
IDuP1ex (1 bath) each
IAdditional bath
/ IWater service
I I Sewer
New circuits alts.
or extensions
SERVICES
15:- "2
/6'...t:>
~.'l>
Storm Sewer
(e)lnirpc:~
~
00
t)
if)
I~
(nhnnp I'In-\
}1~1:l
,1, -') I
(.xn; ..0 \ . ,~hjI'e.~l ,,,....,
M~€.C::- "''1'~- ., ','-l;
4IR~~/
I ~ ~ ~ _ I.LI!ARG.E.
~.-j
7. p.~..9'
I
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~-I.
~.. V 9. se:
~-16.4"
I I
137-1/8....
Vent system apart from I I
heatina or A.C.
I~SOI 7.-
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I Ir.~
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MECHANICAL
N0 I
I ilJrnace/burner to
"" I:r'~- BTU's
7 I.L~~
Floo"r furnace
and vent
Ol
'/
Recessed wall
Sp~rp hp~tpr ~nrl vpnt
~b;~-::l.
1.1;0-/
Apoliance vent
c;po~ratp wA o'!!J
Stationary evap.
cooler
Vent fan with
sinole duct
l
I HAVE CAREFUllY EXAr1INED 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 NO OCCUPAr~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 exemption is noted hereon, and that
only subcontractors ~d employees who are in compliance with OP.S 701.055 will be used jP')this ~roject. , ~,")~
NA!,IE(please print)E.:l.I//(?i1~ G, t!OL:ETr- srr,~_ ~~^t _ :.<-~M DATE?-J 2--~;
. u.>p 1/ t:nCIVVr- - FO~ OFFICE USE orlLV / T-;-
ZoneLM/ ':;UP Tyoe/Const.:zrH.5~ Units So. F.!;I..lf1'ain I"~.!l x Value <jO't~.-
Fire Zone' Bedrooms ' Occy Load ..,95 ~~"i"i9~~f"'''' ::2"''2::<; x Value
Flood Plain Stories I Occ.v Group ~2. / Sq, Ftg, Other~WA<' ,{...<;#~_ Value /Y5': ~ c...
, TOTAL VALUATION 5~,~. 0"
J Temporary Construction
Change in existing
rpc: i rtepcp
Imultifamily, corrm. or I
Tndustrial
I IOf 6c;c amps 17$-
ICO~1./INO. FEEDERS I
I Install/alter/relocate I I
dic:trih. fppdprc;
3 Of ~::?r- amp"I57.5l>I/I;Z.? '1
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I I I ISSUANCE OF PFR!lIT
TOTAL CHARGES ']?j5:'- TOTAL CHARGES -;;?:?%.Sol TOTAL CHARGES gs: ~
WHERE STATE L\lj REQUIRES that the Electrical work be done by an.:Electrical Contractor. the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
&'io/#//~/
~/-:;:-~o ;:>~~F;~;~~s(~~mopment 82So."""
~?~ ~A:5"'....);se ~~_ r
~~!l' .I'~ -I...S..z'9
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BUILDING PERfIIT
Charges and ""\
Surcharges t:I-
/.IQ"... Plan Ck. Corrrn/lnd
I 1.2;;> 65%1Bldo P.. Fe.
---6~1~---- ~6~~Bi~~ ~:~ Fee
___~~_~____I Fence
/6.,~ I D~mo
'::U>Z-SZ> I Sidewalk 23(7"":1
------------
1t!J.13. I A/C Paving. ' '1>1
gs. SO 'I Curb Cut 2. 3''Y.\'I!''
-----'Y-~B--I I
ITotal
I
I TOTAL
PLU!~BING PERMIT
Charges and r'
Surcharges ~
</~ 1>t?
5"36.5't? ,
1~. 'Zc
ELECTRICAL PER!ilT
Cha rges and ~ .1
Surcharges ~ -t,
/lECHANICAL PER'MIT
Charges and
Surcharges
v
~
':?
Mechanical exhaust
hood and dur:t
Wood stove/heater
1~C?~.c.~
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C~omb. Perm; t
~"it 'IC).S7
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/q,6"":< .88
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';, COMBINATION APPLICATION/PERMIT (CAP)
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I. Applicant to furnish
A. Job Address
B. Legal Description .~, .... . ').'_
I, example- Tax Lot 100, Lane'County Map 'Reference
17 oj 43
2. example- Lot I, Block 3, 2nd Addition to
Spnngtield Estates '
'C. Name; etc. of owner and consthk'ti'On lender'
D. .Energy Sources '_' . _ , ~;.' . . \ .... _ . '. . P, \~ .'
1. example":neat/elec"trica1"cei1in...Q/or forced air Qas . "
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- 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. 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
.:' ~. ,S,tru'ctural 'Spe'c{alty Code ., .' ..... ..........
H. . DESlGN 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.atthe Building Division
1. To conser.ve;sp~~e 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
:~','~ CHARGES ON ',THE. SCHEOULES;
"->>:. . . 'D. As noted on'the"CAP: the_: label must be delivered to the
electrical contractor ~or sigrat~re 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
wi 11 prepare a type written copy and return it to the ,_~. ..
applicant at the time the actua,.'pe'rmit is issued for his' ~-"J,
{. . .,' 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. char:ges..are due and
payable when the..permit-is iSsued";" '. '-.' '.-',
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V. FOR OFFICE USE ONLY
",.PROJECT CONDITIONS TO BE S,ATISUED BEFORE OCCUPANCY:
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
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"...Add,itional PI:9j~~,t ,I nfolJ!la):i on.:
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PLANS REVIEWEO BY:
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