HomeMy WebLinkAboutPermit Building 1983-12-8
Owner "l)()", \U_ "- "\ '-\.\-\t"\~
Address \,,?,~ ~(\~\.~ 5~
Phone
INFORllAnON LINt
726-3753
Sq. Ftq. 1,l.in
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Pep.
-Fence Oemo Change/Use
ValuE of );Iork: ~ ti:J Other--
~8!YJ..J. '
BuilrilnQ PermNt Info: Describe Work(i~e., Build Single
Family nesidence With Attached Garaae~
~"""'~\ ~E'C-. '-\...~\.\.
,~~ Q.?\~ - ~
.
~
e-
IINSPEcnON LINE CITY OF SPRINGFIELD
726-3769 COMBlliATION APPLICAnON/PERMlT
I') I:. r:. I:. r. \. EIIERGl:..,SOURCES:
Job Address L.'..-u '.;) \. "':\~~e..\u'\:l,.u Heat ~\.f'('_,"
Legal Description\~ C~ '2_'2. DC \ '2.'2.0-0 l'late~ HeaterF,\Pf''1:
Range (;.~~ C~
"N(.,~'n
I
JJ
U"
rJ
~
ij'/
loJ
Construction Lender(",_~ t>
Address
ut.::dbr. II:.1\11
(name)
Phone
(address)
(lies. no.)
(l:~xoi res)
(PhOM no. I
Primary ~e..'t"n.\.A \J\P~,P......
t')(")'UD\.L'lP",,\\d~~ -~\~
~\.\~-?~
Structural
Electrical
Mechanical
CONTRACTORS Iname) (address)
General \:)()\..) ~\\'I,-D\..\ \. ~~.
Plumbino \)~~ \\C'\
Electrical ~. ~ \~n
~lechanica1 \. 'l\. "Yr--.,- ,",,\~
PLUllBING
nics. no.l
(exoires)
(ohone no. )
ELECTRICAL
MECHANICAL
NO.
FfF r.HARr.F NO
~~~ r~ NO
~~j:' r~'iRGL
SQ. FT.
furnace/burner to
BTU's
"
\~
Each single fixture
o.CI> o.o.~
Residence of
Relocated building
(new fix. additional)
\
New circuits alts.
or extensions
\S~ ~6J
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~nArp hPAtpr'Anrl vpnt
Sewer
Temporary Construction
Change in existing
rpc;j"~nC":p
multifamily, comm. or
Industrial
o
Appliance vent
Sf"Daratf"
Stationary evap.
cooler
Vent fan with
sincle duct
Vent system apart from I
heatina or A,C.
Mechanical exhaust
hood and duC":t
.~t:P q~
Water service
Storm Sewer
Of
amps.
COMfI./IND. FEEDERS
:2. Instan/aHer/re1ocate ,~CI) 1"c.CII
v dit>tl"'ih. fppd~ro; \~-""'\u.
I
I
I
I
TOTAL CHARGES (),()~ TOTAL CHARGES (d'f- TOTAL CHARGES \0, c::o
WHERE STATE L\I~ REQUIRES that tile Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Of
amps.
I
I
I
I
t>. ~""\)'" ~\\I
Wood stove/heater
i()~
ISSUANCE OF PFRtllT
I HAVE CAREFULLY EX~IINED 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 rw 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 and employees who are in compliance with ORS 7~1.055 will be used on this project.
IIAl,IE(please prin~ p/ JI '..N
_ 71
Zone ~ - ~ Type/Const. 'fi- "-l
Fi re ZonE' - Bedrooms
Flood Plain - Stories 7_
/i F.I)Fl./~uJ?.J"
FOP. OFFICE USE miL Y
Units .~ Sq. Ftg.
Occy Load _ Sq. Ft9.
Occy Group~--\ Sq. Ftg.
SIGUATURv:?L < ~~ ~_
DATE J~/'//lk.3
f1ain
Access
Other
x
x
Value
Value
BUILDING PERmT
Charges and
Surcharges
\ C'\ '\ 00 Plan Ck. Conm/lnd
__!_~_.___ ___ ~/Bldc P_pr Fpf"
tJ ~ Plan Ck. Res
'\. 30%lB1 dQ Per Fee
___?!J,Cb
~.<CO
,._ CO 'S1dewa1k
----~:._---
'L. ~O AIC Paving
____lQ~_~__1 Curb Cut
-<10 I.
~ ~. 105
x Value ~_
TOTAL VALUATlOtl_2J:!)/ U ),:'"
Syste~s Development
Charqe (1.5~) ,
PLuP1BING PERMIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
.?\\ot.~. fE'e.
~ ~,CD5
Total. Comb. Permit
/lECHANICAL PERMIT
Charges and
Surcharges
TOTAL
~10. eq
,J
r
.
,.
COMBINATION APPLICATION/PERMIT (CAP)
L Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane ~ounty Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceilinqjor forced air qas
2. examole- waterheaterielectr;cal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new 7 if addition,
check add, etc.
F. Building permit information:
1. exam21e - construct single family house with an
attached garage
2. examFle - 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. DESIGN TEM~ 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
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 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,
PERMIT VALIDATION
. .
'883'
J
~ LDWCb
ut~\U1X
~.
Permit
clerHi{['[U
Permit appl i cant exempt from regi strati on with the Sui.l der I s Board because:
Additional Project Informati'on:
PLANS REVIEWED BY:
I
nameD~\~ ,\ \=)\.\.E,\.\\
Signatu~(".. t"\,,\~"""'~Y--
date\?~-~