HomeMy WebLinkAboutPermit Building 1989-9-25
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CITY UF SPRINGFrE~D
COtIBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
~e9al Oescription /?-<:>3-::??~ =-=..,;?'?~I l'later lIeater
/ . . ' Ran~e
I Valu€ of I-lark:
Owner L/.Al5/0~R~ ~R7''''/'?.-9-7'-=-~. y7"'''''~-''=. ~tS:$7
AdJrcss ~ '/"7 . /t Phone Bui1{\ina Penuit Info: Descr~be Work{i-.e., Build Single
7,-/~? r-;\,p~~A/l/l( / -&: /;"'r/G Family l1esidence IHth Attached Garaoe)
1JH.~~j/~ 7<:"::2'<'/ ~k:'-";:i'C.",,:.r /'2 "'2-;<i'~",.y >>-""A:>V/E
Constr~ct;on ~end~r . T/T~;'r-p /'" ~.;~/-:c ~~l.4--...h"""
^~~ ,ess Phone /'#4(;.<" CbfrJ;VC EX I
OESIGN TEAf.' (name) Jaddress~ - j1;c5. no.) (exnires) (ohone no. I
" 2""""/ /"H~';>7.e>~"""0Z><'-'/7""":..v'" Co.p/<. /.. :-,_
Primary ~#.# #;t:/.:.H/7"-'~ /.JpLL~ 7'2=-..v;,.<;ooc::: 75:::<<:>s;;" 12'S! J?--:2-::<..8Cf9~
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NFORtIATlON
726-3753
Sq. Ftq, 1:la;n~
~q. Ft9.~~~
Sq, Ftg. Other
.4Jlew Add A I ter Pep.
Fence Demo Change/Use
-Other - -
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Job Address '2.JiJSc> ,45'.#~J..vAJ 50-" ,5m":"<.'>-, -
Structura 1
Electrical
11echanical
::::::~TOR~C\{\~~ ~\i\~~d9~gv \~~\A'€(~Xp~~Mu~) \h~\
Plumbino - V\.orlOJ;:u~~M'
('H(lD \tdll-5~
Electrical
~l~sh~ni ca 1
PLUIIB ING
ELECTRICAL
MECHANICA~
;7.?O ~S'~
SQ. FT.
15
furnace/burner to
7/tJ!It?_LU>~ BTU's
"
I FFE I CIIARr,F
7.~ //2.5 ::0
NO.1
Each single fixture
~2
FEE CII^Rr,F
Nr,
EFF
r'.HARr.F NO.
Residence of
Relocated building
(new fix. additional)
~ New circu~ts alts.
v or extenSlons
'2 b? ,/77-.~
SERVICES
:7.7-.'5! '
Floor furnace
and vent
S.F. Residence
!1 bath \
Duplex (1 bath) each
Additional bath
Recessed wall
Snu:p hp.1tpr ilnrl \'pnt
Storm Sewer
/
Temporary Construction
Change in existing
re!j i dgnce
multifamily, conlTl. or
Indus.trial
01 /'2L>0 amps.
CDffi1,/IND. FEEDERS
Install/alter/relocate
distrih. feeders
IS
Z~
Ap!,l iance vent
seoaritte
Stationary evap.
cooler
Vent fan wi th
single duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
~'Iood s tove/hea tcr
~-1S"""
~Ia ter servi ce
Sewer
7 Of
"'5
-:z
/d~
amps. f.<).'" 16'" /5' ~.c"~.~,
S?.9,I/':Z.5!:
~ "1&.""
. -5c. ;z.~
--=?:zs-~
q~A
ISSUANCE OF PfRlllT
TOTAL CHARGES
'1'~ 5':' 0# er TOTAL CHARGES
l./:26.5'0 TOTAL CHARGES
/ b::>. ~:
this perr.lit
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an Electric,'ll Contractor. the electrical ['lortion of
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Guilding Division
I HAVE CAREFULLY EXM1INED the completed application for ~ermit, 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 Spri ngfi e ld and the Laws of the Sta te of Oregon re rta i n i n9 to the work descri bed herei n. and tha t tm OCCUPAUCY wi 11 be made
of any structure without the permission of the Guilding Division. I further certify that illY registration with the Builder's
Goard 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 OP.S 7~1.0557'ill "u~t:;s project.
IIAf.\E(please print) J I!VI --r;;;/..~'{ Srr,IIATURE. .' ~ O~.TE "'-2>--89
EOr. OFFICE UswmlL Y rf: //
Zone /:: r:: Type/const.~./~~nits /<). Ft~, ~{~_ ~ x Value
Fire Zone Bedrooms Occy Load -:2:f3#sq, Ft~,~~/. ~ x Value
Flood Plain Stories /r~2 Oce.v Group A 7, / Sq. Ftq. Other x Value
TOTAL VALUATlDrl2 ~-"~. -,
BUILDING PERmT
Charges an~
Surcharges
t.// ~ <>c> Plan Ck. ConmlInd
___7-'--<2./-.____ .ill/Rldo Per Eee
~ Plan Ck, Res'
-:?C>'9. /:::> 3D%lBldo Per Fee
____!l.k€..~_ Eence
'2::1 7.? Demo
_ ___.7"24?..< ~d 's.tde""2k\. ")\'U b.
~/. '?'3?~,(;C Pavingl 0 ~\1.C'1-'
_~__/~?:~-' Curb Cut
$.zsl
"H'/?T:F/~/
=7.7/9.- &-~
Systems Development "'2/
Cha roe (1. 5~) ---2P._a:>O _ .-<>
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PLur~BrNG PERMIT
Charges and
~ Surcha rges
ELECTR I CAL PERI\IT
Charges and
Surcha rges .
\Y' ; r\) \:l. \ ,
, ~N\\~n ~ot~l Comb,
I
I TOTAL
Permit
J
,
I
11ECHANICAL PERHIT
Charges and
Surcharges
A~ po3.lp5
.
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COMBINATION APPLICATION/PERMIT (CAP)
I.
.'\:;"~~
Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
17 U3 43
2. exa~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 Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. .-
1. example- 1250 sq. foot house, 500 sq. foot garage,
2. . examp 1 e- Tfrlew proj ec't -, chee knew - ; f add i t i on.
. check. add. etc.
F. Building permit information:
1. example - construct single family house with an
a tta-ched garage
2. example - remodel existing garage into family room
3. examjple - 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.' DES I GN TEAI,J 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.
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
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
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.
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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II.
be delivered to the
by his electrical
is not authorized
Ill.
IV.
V.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SAT.ISFIED BEFORE OCCUPANCY:
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"Permit applicant exempt from r.egistr~tion with the Builder's(Board becau~e:
Additional Project Information:
PLANS REVIEWED BY:
-:'~am'e:; :i~~h'E' ?~C?f" signature
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~ date 9./9.,G>9
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