HomeMy WebLinkAboutPermit Building 1984-11-30
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CITY UF SPRINGFIELD INFDRllATIDN UNc
COMBINATION APPLICATION/PERMIT 726-3753
~ - EilERGY SOURCES: Sq. Ftg. l'lain-L/~~
Job Addresr.,:;?t::. ~ /'#A-/~ a7J'Y'= e-, Heat ~q. Ftg, Access. .
Legal DescriptlOnj'" -'\.,;,.-.2_.,.._ ~_..,d_~..J.!.:.- !~ater Heater Sq. Ftg. Other
~" "'.J-" _. CJ.>. ~ ....1'EJ~ liew Add Alter Rep.
, I Range, -Fence Demo Change/Use
l..~~\:Iw'k' -Other~b
Owner ~{J --r~ .Jhi;~w.:..~ ~~ 'V-~.$."~ "eNLJ~h'J . .
Address -;>607'. (". II+"- \PhO Ir . BuilGlno Permit ~ Describe. Hork(i'.e.. Build Single
00 <:>U u ne"",7-~2".7 Familv nesidence l'lith Mtached Garaoel
'fU,^-I.Ao'-.L. rJte... 97l{O2. ~R~ r~v.J~ 017'(,:' 'If <13'(/
Construction I.en~r ~. \b-u>17~ ~.....;t'
Phone ~ ~lJ!l () ~ 1:\1.:~ . Zn.,;tJ, .
(address) s r-r{lics. no.) (exoirlsTP- .9l.1hone no.
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TOTAL CHARGES /. '). .. TOTAL CHARGES ~ ' TOTAL CHARGES
WHERE STATE 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 Supervisor and returned to the Building Division
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I INSPECTION LINE
726-3769
.
Address
Uc"GN TEAl.'
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name)
- "'li8-C-O l ~
Genera 1
Plumbino -
Electrical ....
~:?'!~l - r ,WJ\ '1 Lrt~ -
PI.UllBING
NO.
~FF . rIjJHU~F "'i'
3 Each single fixture ~.,c::. 15:."
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
I
J Sewer
/a~
;5:-
yS:-
~Jater service
,
~ Storm Sewer
~
~
IX)
~
\A)
(adrirpc::'S ,
flie<;,no,)
(exoirl'lc:.)
(ahOM nn..)
8VdJ.A\.J..-
()
:?</sI-~'933
ELECTRICAL
MECHANICAL
I-ITL .!lJAIlliL .J!Q
~t:'t:' "'YARG.E.
Residence of
furnace/burner to
BTU's
SQ. FT.
. ~ New circuits alts.
", or extgns;ons
2 ..tli( M6flE
SERVICES
IS"
Floor furnace
and vent
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rp-;:. j ne.nrp
multifamily, camm. or
IndlJ<:.tri.11
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dLJrt
tf.-
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Of
amps.
COI*I./IND. FEEDERS
Install/alter/relocate
rlic;trih. fppnprc;
Wood stove/heater
Of
amps.
ISSUANCE OF PFRtllT
/CfJ. - ~..w,
I HAVE CAREFULLY EXM11NED 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 oerformed 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 1m OCCUPAIlCY 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 701.055 will be used on this project.
t/e;rv /PO! > ///""2/k'L/ SIGIIATURE d- 8~
- ;; .. -ll' FOr. OFFICE USE DilLY
Tyoe/Const.5~~~nits So. Ftg. 11ain~ ~"f'. Va1ueYOt!>SO
Bedrooms . Oecy Load "32 Sq. Ft9. ~ r.a..~~Value ~~ctc:)'O
Stories . I Oeey Groupfi2 Sq. Ftg. ,Other ,,~x Value~~
u . A- " ~ov~.swrO~ VALUATION ~ :rs-c::>
~~~Se$SEJ:>YM:~ ~ eK#q. . ro-_ - 'iLt IDD
. ~:z 60 Plan Ck. Conm/l.n.d . ...,~ 80 Systems Deve opment /"~"J '?,Z'"
_____L__.___~/Bldn Per Fpp .c;v. Charne (L5~) '. ~"'?_ 07
/ ~ Plao Ck. Res
'"OC:) 30%/Bldo Per Fee
~ 0.::. Fence
_____f-k!!.!.___
-:JJ. - D6mo
-___L~ .....1.Sidewalk ~ yo y'
. . 6't:!> A/C Paviog, .,
-___.L~.~-I Curb Cut '3
IWIE(please priot)
Zooe G C
Fire Zone
Flood Plain
BUILDING PERHIT
Charges and
Surcharges
PI.UI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERliIT
Charges and
Su.r~ha rges
11ECHANICAL PERMIT
Charges and
Surcharges
DATE
-:<.". <8
~.-
36,-'::'
Total Comb. rermit
'238. S6
Iliac!. /1
I TOTAL
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.to-
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COMBINATION APPLICATION/PERMIT (CAP)
1. 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
Springtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
"1. example- heat/electrical ceil;n~/or forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. -----
1. examole- 1250 sq. foot house. SOD 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 garoge
2. examole - 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 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
fu 11 schedu 1 es
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
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PERMIT VALIDATION
,Pu
Permit Clerk
PROJECT CONDITIONS TO BE SAHSFIED BEFORE OCCUPANCY: "
Permit applicant exempt'from reg.istration with the Builder's Board because.:
Additional Project Inf.ormation:
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PLANS REVIEWED BY:
;-'na~'e i.&,/Ii'H€ .fl~~ Signature~~~
II!~~~ dateb~~-SY
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