HomeMy WebLinkAboutPermit Building 1985-7-26
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, IlllsPECTlO1I L1I1E
726- 37 69
Job Address
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legal Description /7-"Z-:2$000. ClO.J:COO
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UlY OF SPR IIjGfI ELO
COMBIlIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
\~ater Heater
Ranqe
ITemporary Construction
IChange in existing
rf'c;id_e,ncp'
Imultifamily, CQmm. or
TndlJ<:trial
10f amps,1
ICOMM./IND, FEEDERS
IInstall/alter/relocate I
rlic;,trih, fppdprc;,
Of amp~l
I HAVE CAREFULLY EXM1INED the completed application for permit, and do hereby certify that all information hereon is true'
and correct. and I further certify that any and'al1 workoerformed shall be done in accordance wi~h the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein. and "that NO OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by O~S 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. .
ST~ LV <;.trfSIGrl^TURE ~ o.",4iJ,1h~ DATE? ~<!- 6-,?-t
FOr. OFFICE USE DillY v ~
Units Sq. Ftg. riain x Value
Sq, Ftg, Access~.t':> x Value~,~~. OC
Sq. Ftg. Other x Value
Owner L.A~~~ V_< 7"€~~ 1
Address U9?/ A!/&''''!4iANK <' ~ ~-6.3Y.!!o.
<~/M<..c-/~~ 7'? A,'iP <;I~~
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Construction lender
Address
Ut~H:iN TEAr~
(name)
Phone
(address)
Primary
/)(,oVu__z;.
Structura 1
Electrical
Hechanical
CONTRACtORS
lnamel
(addrpsc;)
Genera 1
/'.:)~~_Zi?
Plumbino
Electrical
~1echanical
PLU1IBING
NO.
FFF I rHAR~F NO I
Residence of
Each single fixture
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
~Iater service
Sewer
Storm Sewer
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.'l~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
!WiE(please print)
1 aII'll If
,
Tyoe/Const. ~..~
Bedrooms
Stories
11-/
D.
Zone M-#
Fire Zone
Flood Plain
Occy load
Occy Group
I
BUILDING PERHIT
Charges and
Surcharges
L"2 _ Plan Ck, COlll1l!lnd
___.....::J-'-_!...___'_ 65%/81do PJ'r Fpp
Plan Ck. Res
2 ,C>g 30%lBldo Per Fee
I Fence
I D~o
I Sidewalk
I A/C Pavi n9
PLU'~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERrHT
Cha rges and
Surcha rges
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
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INfORllATlON U,'l
726-3753
Sq, Ftq, Hain
~q. Ftg, Access,P326
Sq, Ftq. Other
~lew_Add_Alter -,~ep,
Fence Demo Change/Use
Other- -
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\}
~
~
ValuE of Hork:
/".t:Poa. -.
Builcifnq Pennit Info: Descr be l~ork( Le.,
Familv nesidence With Attached Garaae)
Bui ld Single
r--')N~-n='..,)~ '?' ~",~X '1~ ~
J/~A~~/~ ;)72::>RA6;I"'C ~R~"'"
flics,na.)
(exoires)
{ohane no.,
(1 irc;. no.)
(pxoirpc;.l
(ohnnp nn. \
ELECTRICAL
CCC I r"ARG.J-1'n
I t"t"t" 1 r
MECHANICAL
SQ, FT.
furnace/burner to
BTU's
Floor fu rnace
and vent
Recessed wall
So~rp hp~tpr ~nrl vpnt
Appliance vent
c;.poarate
Stationary evap.
cooler
I Vent fan wi th
sinale rluct
I'Vent system apart from
heating or A.C.
I Mechanical exhaust
hood <lnd dud.
I \'Jood stove/heater
I
I
I
ISSUANCe OF PFR'lIT
TOTAL CHARGES
.Electrical Contractor. the electrical portion of this pe~it
Supervisor and r~turned to.the Bujld~ng Division
TOTAL VALUATION
12lO. - P.o 7-9~Yste. ms Development
~~"~2~~ _ Charqe (L5~)
I ' . .
I
I
I
I
I
I
/.'5";t). ...~
.,-.
fTot"
I
I TOTAL
Comb. rermit
S~. () B
:::z~7':"~8,
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COMBINATION APPLICAT~ON/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II U3 4j , " ,
2. example- Lot I, Block 3, 2nd Addition to
Spnngtield Estates '. ..
C. Name. etc. of owner and construction lender
D.:.. Ener:gy Sources .~ .. "
1. example- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electrical/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 - if addition.
check add, etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exam~le - 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 TEM1 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
O. 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 penmit 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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'PERMIT VALIDATION
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V, FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
I
Additional Project Information: ~/.'?-/~'~#[ PL#~' i ?~~/;O-<;
.~€ A'~0'''y~E7)~iiP ,,~/"J'Whl'~~_ EL~c7"rr/c.......<:. OA;:>
M#'~.JI!U'/"<~L ~<;.'~~~j::.."'->R' 7f'/~ "'5"~r.J~7UA-~.
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PLANS REVIEWED BY:
~~ Signature~~~______date 7-<?:r-SS-
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