HomeMy WebLinkAboutPermit Building 1985-7-26 (2)
"
.
J~
.'
lIlSPECTION LINE
726-376g
1'/ fl,o
CITY OF SPRINGFIELD
COMBHlATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Nater Heater
Ranqe
Valu. of Work:
" t:!),:::>.o. - ' ,
BUllrilnQ Permit Info: Describe Work i.e,.
Familv nesidence With Attached ~araQel
CcN<-n:?"..J.c?' ~~~X If'~ ~
J/.;r:A/.c~ ;)"72::>P~~ -<-J?~€
-----'Relocated building New circuits alts. I
. (new fix. additional) or extensions
IS, F , Residence ,. I SERVICES ,.,
(] bath) ,
IDuPlex (1 bath) each I I I
IAdditional bath I ITemporary Construction I
IWater service I IChange in existing I
rpc; j qem"p
I Sewer I Imultifamily, camm. or I
TndlJc;.trial
IStorm Spw",,, I IOf amps.1
-----I ...- I 'CO~1,/INO, FEEDERS
I I I Install/alter/relocate
n;~trih_ fppnpr~
I I IOf amps.1
I I I
I I I
I I I ISSUANC, OF PFR!lIT
TOTAL CHARGES J TOTAL CH^RGES I TOTAL CHARGES
WHERE STATE L.\I; REQUIRES that the 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 E~ectr;cal Supervisor and returned to ,the Bu~ld;ng Division
Job Address 't!L7/ /J/-<~KC:; R~:z::>
legal Description /7.~Z-:2$-oO. ~.J:<o.:::.
.
Owner L..AR~~ p. ..:.< r~w.~~~#
Address U<9// ~::iANK <' ~ ~3t,(,Sl
<;l?ip/M<~~ /':>Ae". 9 7'>171:4
Construction Lender '
.Address
Ut~ I uN r E.Ar~
Phone
(address)
(n~1
nics, no,)
Primary
/?f/V.A/ .--Z:>
Structural
Electrical
Mechanical
CONTRACTORS
{namel
r addr~s<; \
(lice;.. nn.'
Genera 1
"""'t;",<"",.-Z?
> -
Plumbino
Electrical
~1~~h~ni r:a 1
PlUllB I NG
ELECTRICAL
.-
NO.
FFF
.1lO......1
Residence of
[HARGF
OL=F
I .
I I
I I
I I
I
I
I
I
I
Each Single fixture
5Q, FT,
NFORltA TI O~ ll, t
726-3753
Sq, Ftg, 1,Iain
~q, ~tg, Access ,j:3 26
Sq, Ftg, Other
Xilew_Add_Alter -,~ep,
Fence Demo Change/Use
Other - -
~
~
~
I~
Build Single
(exo;res)
I
Cohoneno.J
(plCflirpc:\
('lhnnp ""('t,)
MECHANICAL
furnace/burner to
BTU's
ill
I I '
I I I
" I
I I
I
,
I
I
I
I
I
Floor furnace
and vent
Recessed wall
~o~rp hp~tpr ~nrl ~pnt
I App 1 i ante vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hond and duct
I Uood stove/heater
I HAVE CAREFULLY EXM1INED the completed application for permitt and do hereby certify that all information hereon is true"
and correct, and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oref)on pertaining to the work described herein, and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that"my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon. and ~hat
o"nly subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. "_ ,
D, St~'LU'~:<r~I"NATU~E' Y!o;;{J.11M.~~~TE ?~~ 6-'$-
Fon OFFICE USE iiilL Y /,
llAJ.lE(~lease print)_[ a,/, IC... 1/
'-,
Tyoe/Const. ~..~
Bedrooms
Stories
lone M-{I
Fire Zone
Flood Plain
/
Units Sq. Ftg, riain x Value
Occy load Sq, Ftg. Access~~ x Value~~~. OC>
Occy Group B-1 Sq, Ftg. Other x Value-
., ...' , ,'. TOT^L VALUATION
..,
BUIlOING PERHIT
Charges and
Surcharges
PlUf1BING PERMIT
Charges and
Surcha rges
Plan Ck, Comm/lnd
65%/Bldo Ppr Fpp
Plan Ck'. R'es
30~/Bldo Per Fee
I Fence
I De""
L I Sidewalk
r-----------, A/C Paving
L ' -, I Curb Cut
I --------=1
hstems Development
C aroe tl. 5~)
r '-.
I I
I I
I I
I ITotal Comb, Permit
I I
I I TOTAL
, L'2-
---.....:;}~-~----
,2.t:>g
ElECTRICft,l PERI:IT
Cha rges and
Surcharges
11ECHANICAl PERMIT,
Charges and
Surcharges
/50. ...-*
S~.~B
:::z ~'r:-';c.8
I
.
.
I,
f
,I
"
,."',
"
COMBINATION APPLICAT~ON/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B. legal Description .:'
I, example~ Tax Lot 100. Lane County Map Reference
II OJ 43 .,
2, exam~le- Lot I, Block 3, 2nd Addition to
sprlngtield Estates . ,
C. Name. etc. of owner and construction lender
;... D..~ Energy Sources.~. '. "', \
1. example- heat/electrical ceilinQ/or forced air oas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-niw - if addition,
chee k. add. etc.
F. Building pennit information:
1. example - construct single family house with an
attaChed garage
2. example - remodel existing garage into family fOom
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
signa ture.
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.
.
..' . .
'PERMIT VALIDATION
\
I
I
. ,.,
,.0 .....
. ,'. ;,
..'/\
~V\
\.10 \~
~JY b{ },<
.>
,
. (
Ot
~ 6 ~st?1
~
Qy)
1
V. FOR OFFICE USE ONLY
Pennit Cl erk
1,/
PRDJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
IN
-. '
/":.. ..;.>~,,<V~7"'f~.N e.~ A .V&4'/4:: L~ ~7'6R.AIIrrT
~y~~~~p~~~
~~ ~~"'~br> $~ ?HE c::,7'Y~
~DF' -I ~~!"~..,~~~ ~~....~'^"'/~.... .~~----,v.
Pennit applicant exempt from registration with the Builder's Board because:
-rN/~ P4!i.P.JW/T" /..,;: FbP
~3.'~6 F_ &,v..#ne ~~.
~ ,~~~ ~~c.
! -.
.' I.'
Additional Project Infonnation: ~/7;~~AL p~~, i ..p~~./--'"'S
,~tc: ~~&:Y..Y/.>E/? ~liP 7'~3<:",,!-F~. E/;::-~""~''''~<!!f~ O."c.
.' ~., .
M#""~A-~'~L ~~~.~~ 'j:::-'>:'R'- n.;-s """~rJ<:?'U)I/"&.
PLANS REVIEWED BY:
n~me..i-~#e
~~ Signature~~
'"
~~ ..----.d~te
f .... ,-
.
7-<>}' ~S-
,
'-' ....