HomeMy WebLinkAboutPermit Building 1986-5-6
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Cl TY Uf SPRINGfiELD . ' ~ IHfDR/1ATION LINt 'I' I
COHBINATION APPLICATIDN/PERHIT 726-3753 cfJ
Job Address ':>"'J 1) C~I70' ,^v L/Jon EIIERGY SOURCES: r!' ~ Sq. ftg. HainAllP~0i'2' ~ i
./ " ,~N I .v Heat1'-G'.::-T: C".-' ~q. ftg. Access. ' I
legal Description \ J O~, ~, ;:) <)0 '6;:;LbOQ Water Heater Gt.&~r. Sq. ftg. Other }I
~ . Ranqe €t.C<~ -.!lew>>dd_Alter-,~ep., ,I I
_fence_Demo_Change/Use V' I
Valu€ of Work: Other -
I~,~". <:>- 1 - CfJ II
Builcilna .Permit Info: Describe Work(i..e., Build Single I
Familv Residence Hit.., J1..ttach~<,i G~raae\
O~,.,~ - r.;lb,::n'<50 ~.,-R-
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-'1 INSPECTION LINE
726-3769
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Address
k, i)&I1...x.....P(Z_ICT, D..'~fJc...
"'7/71 G-AI'C.Wflu LQ
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Phone 7\.11
Owner
Construction lender
0'5",>0
-"
Address Phone
Ut:::-'lliN TEAr1 (n~m~) (address)
Primary ~~'/ STFM2:""..f~. "8MIh6H
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Electrical ~4P E~/N~/~ 299 M~AlTi'oG" ~~~
Hechanical~'5~ W. ~~ ' ' r.
CONTRACTORS -.(n~me) (address) (lies. no,) (px~'
~?"6 LU U'" 1,'1"., \..19 d-"\/
I
Structural
General
C~\'7 .R!Jbrp-\"''''-, G,
Temporary Construction
115.- ~Change in existing
. Ir~~}~"~P
I-.:a.A4M Imultifamily, canm. or
;N". Tnt1lJC:.t..i<ll
'I,."M
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TOTAL CHARGES /1/17. deS TOTAL CHARGES '2<> .SOD TOTAL CHARGES .76. -
WHERE STATE L\li REQUIRES thaf the Electrical work be done by an'Electrical Contractor, the electrical portion of this pernit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
. P1 umbina
Electrical
"'echanical
PlUI1B I NG
~-
....lJ!h.1
~ Each Single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath \
IDuPlex (I bath) each
Additional bath
~ Water service
1281 Sewer
~/IStorm Sewer
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1
10f
ICO~1./IND. fEEDERS
1 Install/alter/relocate
rl;~tr;h ~~~rl~~~
ELECTRICAL
I FFF IJ;JJARr.F
?,Sd ~._
_n '
Residence of
(lies. no.)
Sr.. C',J(iFN6
,
'I
(ohone no. I
(exoires)
"8S-8~g3 i
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;'S'2-~S~~
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, FFF 'rlJARG.J ..0
HECHANICAL
. "-E.L
~.New circu~ts alts.
or extenSlons .,~
'2 "" /ftI7"Rc:
SERVICES
Of
SQ. fT.
furnace/burner to
BTU's
2:Z.J'"
Floor furnace
and vent
amps.1
Recessed wall
<;ns}rp hP;1tPt. ;!Inrl vpnt
~ lIe~ ?bMP
I' App 1 {ance vent
S~Dar""tp
I S-tationary evap.
r.ooler
-., I Vent fan with
4 c;inole duct
1 Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood and dur-t
I I \'Iood stove/heater I I
1'3. ~G>~':~~ ~""V&
I' - I I
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amps.
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ISSUANCE OF PFR'UT
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and 1 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 110 OCCUPAllCY 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 7Q1.055 will b~ used on this project.
, SIr.IlATUREd~ A"o ~ DATE 5-t - J".6
FO~ OFFICE USE DIlL V ~.MlfII>.r-="e-c /{At'CI&" -:z..~ 206
Units Sq. ftg. l1ain~;;: f16 Value r:18: 2/-.1
Occy Load~ Sq. ftg..'.::' 72S' /it!lP Value g;,;ZCO
Occy Group ~-2 Sq. ftg. Other x Value I?- 2t::''7
t36b'?1l1 ~c1 'j-b:<;<,,TOTAL VALUATIOIIL9~J B2/
35LJ, b '-'- ~h~;~;s t~~~~lopment "215(, Z. ~Z
1lAf.1E(please print) G<</-::.!1: !f6tfe~1:!; Co, ,'... <..,
Zone
G{ c..-
Type/Const.~..J\,f
Bedrooms
r~/ ~ Plan Ck. conm/I,nd
____::?i?r:rz.L___ 65%{Rldo Pi'''' ~......
-?~ ill) Plan Ck, Res
~ .71 30'%/Bldo Per ~~~
___!!f'2=-~__ fence
5: ~() DURIO
____~?.:?~Jsldewalk "?(;ai I
. 9~' I A/C Paving'''UJ7
____.3~_._~J Curb Cut Z-3Y'
/.~'II I
Fire Zone
flood Plain
Stories
BUILDING PERNIT
Charges and
In.~"lI!M
PlU'lBING PERHIT
Charges and
Surcharges
ELECTRICAL PERtHT
Charges and
Surcharges
MECHANICAL PERHIT
Charges and
Surcharges
/
I
If?/)V L.~ J:'.rG
~."~ ~);~7'h1~'"
I '2$, 5'~ !rotal Comb. Permit I
'':It:;. "201
I TOTAL
26,26
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3e;Z7./6
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. examole- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
n Energy Sources
1. example. heat/electrical ceilinq/or forced air oas
2. example- waterheater/electrical/or SOlar
E. Square footage or valuation. etc. ------ .
1. examole- 1250 sq. foot house. SOD sq. foot garage
2. examole- if new project, checklruew.- if addition,
check add, etc.
F. Building permit information:
1. example. construct single family house with an
a ttached garage . .
2. examole - remodel existing garage into family room
3. examole - 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 TEA/I 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 '
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 b~ 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.
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V. FOR OFFICE USE ONLY
Permit
Clerk ~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
name Lo,/? IY~
PLANS REVIEWED BY:
n~~Si9nature~~~da~e
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