HomeMy WebLinkAboutPermit Building 1985-8-5 (2)
I I'15PECTION LINE CITY Of SPRINGfIELD
726-3769 COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Job Address ~/,.,l.j ~PU'G.J \ . ~,\rt; I'lL' Heat
Legal Description m ll!Itti'lt." cl _ Ijater Heater
Ranqe
/1- 03 27 -z...0 '2-10 I ValUE of Work:
Ownerdt1Ww<;, ~. l-IthWlC'. ,1''{', 11 7.sfH.J.
. , BuilGinQ Permit Info: Describe Work{i.e.. Build Single
Address 1'1")?tJy Q(),3 Phone Familv ~esidence Ijith A.ttached Garaoel
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Construction i:Jnder A'.' _"
(name)
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Electri'cal ~.f~
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PLUr1B I NG
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NO.
,\' Each single fixture
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-!."J Relocated bui lding
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.ti S.F. Residence
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.,.. (1 bath)
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,.4' Duplex (I bath) each
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-'"N.. Additional bath.
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~K". I/ater service
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}t - Sewer
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" Storm Sewer
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Address
UtSl!iN TEAI4
Primary
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Structural
Electrical
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Mechanical
CONTRACTORS
Genera 1
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ELECTRICAL
FFF I rHARr.F
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Residence of
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furnace/burner to
SQ. FT. BTU's
o,....-'.ftew circuits alts.
or extensions r
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SERVICES
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Temporary Construction
Change in existing
rp',i:jrte>nC'P
multifamily, comm. or
lnduc;.tri",l
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amps,
COffi1./INO. FEEDERS
Install/alter/relocate
rlidl"ih fppdprc;.
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INfORllATlON ll~c
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Fence_Demo _Change/Use
_Other
(exo;res)
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(ohane
(pxoirpc;.l
(ohnnp nn. l
MECHANICAL
I...E.ELJ
Floor furnace
and vent
Recessed wall
So~~p kp~tpr ~nrl vpnt
App 1 i ance vent
seoar",tp
Stationary evap.
cooler
Vent fan with
sinole-duct
Vent system apart
heat;no or A.C.
I' Mechani ca 1 exhaust
hood and duct
I \'lood stove/heater
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from
ISSUANCF OF PFRllIT
'. ~ ,.
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be vali1 until the
/{/. - TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of.this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
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.1 HAVE CAREFUllY EXMllNED the completed appl i cati on for permit, and do hereby cert ify that all informati on hereon is true
and correct, and J 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 rm OCCUPArKY will be made
.1 of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
'~., Doard is in full force and effect as required by ons 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 7nl.055 will be used on this project.
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SiGrl.';TURE ~ ~QLJf.).;L'J:0
--FORorFICE USE DIlLY /
Sq. Ftg.' f1ain x Value
Sq. Ft9. Access~~~~ Value
Sq. Ftg. Other ~~~ x Value
TOTAL VALUATION
rWIE(piease print) I< ,-Wl
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Zone
Fi re Zone
Flood Plain
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BUILDING PERMIT
Charges and
Surcharges
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PLU'4BING PERMIT
Charges and
Surcharges
ELECTR ICAL PERI~IT
Cha rges and
Surcharges
r1ECHANICAL PERHIT
Charges and '
Surcharges
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
. /(!;> __ Plan Ck.
----t!..--"----.- 65X/Bldo
~~ Plan Ck.
. , ~. 30X/Bld"
/~ (SO Fence
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- YO 0_
---_j&_._~J Sidewalk
,60. I AlC Paving
~_____~_~_~'_:curb Cut
CommlInd
PJ'r Fp~
Res
Per Fp~
b.SC>
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DATE
3~5 -B"'i
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Systems Development
CharQe (l.5~)
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ITotal Comb. rermit
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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 03 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check--,;ew - if addition, .
check add. etc.
F. Building permit information:
1. example - construct Single family house with an
attached garage
2. examele - 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 TE~l 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 ANO
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. ---
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.
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Pennit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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EXHIBIT "A"
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Beginning at.a point 333.80 feet North 89 49' 20" East of the
Southeast corner of the A. C. Stevens Donation Land Claim No.
45, Township 17 South, Range 3 West of the Willamette Meridian,
t.. and run thence North 0 04' West 78 . 06 feet ; thence South
~::. 89 49' 20" West 18.00 feet; thence North 0 04'. West 78.06 feet;
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',' thence South 89 49' 20" West 18.00 feet; thence North 0.04' West
J;; "',,73.89 feet thence North 89 45' 20" East 100.00 feet to a point
7~.on the West right of way line of Gateway Street; thence South
',,,,' 0 04' East 124.80 feet; thence along the arc of a 1869.86 foot
radius curve to the right, the long chord of which bears South
o 21' 10" West 27.37 feet; thence South 89 49' 20" West 81.80
!eet to the Point of Beginning, in Lane County, Oregon.
Together with the right to install and maintain necessary
utilities, including but not limited to sewers, storm sewers and
use of the untraveled portion for car parking purposes, over and
along the following; Also a right of joint access for ingress
and egress over and along the follow Beginning at the Southeast
corner of the A. C. Stevens' Donation Land Claim No. 45 in
Township 17 South, Range 3 West of the Wi11arnette Meridian, and
run thence porth 89 49' 20" East 220 feet; thence North 0 04'
West 151.95 feet to the true point of beginning; thence North
89 45' 20" East 195.80 feet to a point on the West right of way
line of Gateway Street; thence North 0 04' West along said right
of' way line ,30.00 feet; thence South 89 45' 20" West 195.80
feet; thence South 0 94' East 30.00 feet to the point of
beginning, in Lane County, Oregon.
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