HomeMy WebLinkAboutPermit Building 1985-5-8
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11rISPECTlON LINE ,., CTTY OF SPRrNGFIElD
726-3769 COMBINATION APPlICATION/PERMIT
Job Address :<. t q' J77 ~ "Ill 5 r. ~~~~GYdO~C!S:
legal Description t=IOf{/2,IT -1 ( A-~HP}:J) liater Heater t:.A (
Ranqe b A .>
11<()1'~S"~2 "tJ~ol ~S~c:1(7 ./
, ValUE of Work: ";) 0
Owner f- A(";' 1--/ In e J 'tv l ,,) ,dO.r;
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Address ?2X.'O aJ.I/f"/./I/P.
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Construction lender
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Address
Ut.:)lGN TtAr..,
Primary
Structural
r~I'p
Electrical
Mechanical
CONTRACTORS Inamel
Genera I .\Je)[y\.
Plumbina
Electrical
~techanical
NO.
Each s1ngle fixture
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IHFORliATIOH lINt
726-3753
Sq. Ftq. 1.lain I,) 0 (I
~q. ftg. Access.
Sq. Ftg. Other -,/05'
~ew Add Alter Rep.
-Fence Demo Change/Use
Other- -
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BuilriinQ Pennit Info: Describe Work(Le., Build Single
F"milv nll:$idence I~ith i\tt,'lchf'd f';araopl .
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nics."no.) (exoire{) (ohoneno.
Phone
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(name)
Phone '
(address)
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'7//) '7 _ Iv / / /itvr:. efie_ ~~rel}t: ~ :'SlLi I: (:.. -IF- 20 2. VACiJtML, nR
Sakn1 t7Y1-1i/1 CJiJk c, ::; " cJ
~-th /I r31A+m I' _-IrnF
(address)
Ross:. ( 1:.~ ~L.ls..e... Qf1'\o\.4-tlLc..h~)
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PLUrlBING
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EEL.I CHARGr r; I
600
ELECTRICAl
MECHANICAl
FEF
rHAR:r.F
Ij(l
. ICE.L.I
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new f1x. additional)
S.F. Residence
_.II bath\
Duplex (I bath) each
Temporary Construction
Change in existing
I"j:I~jrlJl'.J'Irp
,/ Sewer MpP/F/~7/ ~H /C?-- ~~~~;:~~~~y. COllin. or I
0/ Storm Sewer CX~lV4Y 10. -- ~ Of amps, 'I
CO~1./INO. FEEDERS
I Install/alter/relocate I
_ .d.i..s.:t..r..ih_ fpp(jpl"C:
I Of amp~ I
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I I I I SSUANCf OF PFRHIT
TOTAl CHARGES ~ TOTAl CHARGES J S. pb .1 TOTAl CHARGES /11/8. /tCl. -
WHERE STATE L\li REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical ~ortion of this permit
shall not be vali1 until the label has been signed by.an Electrical Supervisor and returned to the Building Division
Additional bath
Water service
~ New circuits alts.
or extensions
7. <!pR JVJOTr",c
SERVICES
Recessed wall
_ _ _ ~hp.ltpr .::Inri vpnt
ISoe:
Floor furnace
and vent
-1--
Appliance vent
'>.eoaratp
Stationary evap.
cooler
Vent fan with
sinolp duct.
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond and dlJr"t
Wood stove/heater
I HAVE CAREFULLY EXAMINED 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 Derformed 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 flO 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
~nly subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
HM1E(please print)
Zone' CC
Fire, Zone
Flood Plain
BUIlDING PERI1lT
Charges and
Surcharges
PlU!~BING PERMIT
Charges and
Surcharges
ElECTRICAl PERIHT
Charges and
Surcharges
.
MECHANICAl PERMIT
Charges and
Surcharges
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j/e",. n/ e-- /p t/.> 5
SIGIIATURE._~ ~.tfF tfX24/.
FOr. OfFICE USE olllr-
Sq. Ftg. lla1n
Sq. Ftg. Access
Sq. Ftg. Other #.lJP/..r/~h
3'.o,~ -
OATF
If;/Y/I65' " .
\
Type/Canst. ~~
Bedrooms
Stories
Uni ts
Occy load 75'"
Occy Group~'~
x Value
x Value
.x $"-" Sf Va I ue
TOTAl VAlUATION
/
/2? <:>0 Plan Ck. Conm/lnd
_______..:.___"_ 65%/Bldo P.rr fpp
~ ~c:> Plan Ck. Res
;;? . C> 30%/Bldo Per Fee
?c:P. ""'". Fence
--n---.-80-, DORIO
L:2:. ...... I Sidewalk
---- - ~~-I AIC Paving
,1~. ~ I Curb Cut
--n-n~-fp-I
Systems Development
CharQe (1.5~)
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ITotal Comb. Permit.
I ?B. 83
7,11.93
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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
17 OJ 4J
2. examele- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinqlor forced air oas
2. examCle. waterneater/electrlcalJor SOlar
E. Square footage or valuation, etc. - .
I. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project, check new - if addition,
cneck add. etc.
F. Building pennit information:
1. exam~le - construct single family,house with an
attached garage
2. examele - 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, & 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 Dfvision
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
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
Permit Clerk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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date c.~ i-~s
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name Le:>~HE n.~~ signature
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PARCEL I:
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. . Lot 1, Block 39, SPRINGFIELD, as platted and recorded in Book I, Page 1,
Lane County Oregon Plat Records, in Lane County, Oregon, Lane County Oregon
Deed Records.
PARCEL I I:
The East 56 feet of Lot 2, Block 39, SPRINGFIELD, as platted and recorded at
Page 1 of Volume I, Lane County Oregon Deed Records, in Lane County, Oregon.
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