HomeMy WebLinkAboutPermit Building 1987-8-13
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l INSPECTION LINE CITY OF SPRINijFIElD
726-376g COMBINATION APPLICATION/PERMIT
. - ." EIIERGY SOURCES: ..
Job Address -q~tJS C;',Ar,c-W'Ao/ :.sr'. Heat
legal Description L.",r =f. -:)4'L4^, ~~C/AC Ilater Heater
Range
ValuE of Hark:
::?~tJ,A<'~ cST.
BU1TolnQ Permit Info: Describe Work{i.e.~
Familv nesfdence With Attached Garaael
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Owner' MC.12,NAL 1/-', /:~:lZP
Address 271.N? !V/J:Prpo,o U/A 'Y /~)~eq-7a-?
1JEL.U; VI')":", w...
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Construction Lender'
Address
Ut.~lbN Il:.AH
lname)
Structural
Primary Kj~A= /?,F~S/NoE/T,
,
Electrical
INFORliATlDN LINe
726-3753
Sq. Ftg, 11aln q-;{<I/
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep,
-Fence Demo Change/Use
Other- -
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Build Single
t":"",v-S7:l?Lu:.r &7A'<::1..<i?A'Nr W/7"#
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Phone' 1 :5/7E //yo??ROVc/,??Eh'7S ,
(address) . Jlies. no._) Cexoires), (ohone no.) ,I
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~c-O<rr-::?Ci~, ~"'-""'Y""&".WA~"'.6.;t' . /:;;>~ 82":::>-"'2/=
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Residen~e of
New circuits alts.
or ext.ens ions
I SERVICES '
1
ELECTRICAL
, rijARGELn
'~~
Mechanical
CONTRACTORS {namel (addrp~~l (lic~_ nn.' (pxoirp~' (nhnnp on
General J,IM.eS Ej-'J,o;.u~-?"",,?, T??7. f!~, ~R ZJC4<. ;f1v~, Y.:nv"~ot~ 1../..4, :?.1?3-<;''3!:;S
Plumbino
Electrical
~1echanic,,1
PlUllBI NG
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Each single fixture
7'1
FEF I~ARr,F ~
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1.3<7,""
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17.~
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TOTAL CHARGES :737. 9'=> I TOTAL CHARGES 2:z5:.... .1 TOTAL CHARGES S~. ~l>
WHERE STATE L"l~ REQUIRES that the Electrical Work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
Relocated building
(new fix. additional)
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each I
1
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?f;?7 Storm Sewer 1
1 I/~R/6A7/"W 5"~5T.J..-.-?
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IS,F. Residence
11 bath I
,IDuPlex (1 bath)
IAdditional bath
95' Ha ter servi ce
165' Sewer
Zone /' C.
Fi re Zone
Flood Plain
BUILDING PERNIT
Charges and
Surcharges
PlU!1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERlHT
Charges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
Type/Canst. -s:...J(I
Bedrooms
Stories
/
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1~7.~ I
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I Install/alter/relocate I I I
rli~trih_ f~~d~r~
amp~137.5' 1//2.52t 7
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SQ. FT.
ITempOrary Construction
IChange in existing
rp~ jd_pnl"'~
Imultifamily, comm. or
tnrlll<,;trirll
IOf i?c::I::>
ICOMI-I.(lND. FEEDERS
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I HAVE CAREFULLY EXMlINED the completed application for permit, 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPArKY 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 wh~ are in compliance with OP.S 7nl.055 will be used on t' project.
IlAl.IE(please print) 7)1cj;/l-, 616S'ON SIGIlATUR~
FOP. OfFICE USE OI~lY
S~, Ftg. &in l/3<{/
n:cy //"-'<
Sq. Ft9.~7 , Value :?3',~-
, ~
Sq. Ftg. Other,..".-/:rC "'~t~~~lue_ ~"3,/~.
TOTAL VAlUATlml~<~ ~.oc
5c;a:;;'$?.L U(;8~,/ Systems Development l/G'.,,? 0....
~.::/~ Charqe(I.5~' 77"'~
Units
Occy load j<JO
Occy Group A - 3
Plan Ck. Commllnd
65%/B1d~ Ppr ~~p
Plan Ck. Res
30%IBlda Per Fee
I Fence
____2J:.~_c:.~_
~7. +'0
_~u237. ~c
/~.8S 10-
'"2."25:' - I Sidewalk ij~ ~ '
_n_uj./:,zS:-1 AIC Paving
_~..:_~S:1::..~:::1 Curb Cut '2-5/'
. '2:'95' I ..
am~s.1
MECHANICAL
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furnace/burner to
BTU's
'1;EL1.cIiAB.Ii.E
7.5D )';:? "'" ·
Floor furnace
and vent
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Recessed wall
~n~I"'P hp~tp~ ~n~ wpnt
I Appl iance vent
seoaratp
1 Stationary evap.
cooler
I Vent fan with
sinole duct.
I Vent. system apart from 1 1/./ ~o
heatlno or A.C. 7.~.
1// 1 Mechanical exhaust 1L/.r.J /L;>~,
jr hood ~nd durt ~'~'i:>
I Hood s tove/hea ter I I
kH..../?/..>7~Il'T5 I 1?5'o
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I SSUANCr OF PFRlll T
DATE~
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Value..?v-q""a::> ~
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I 73,7'c I
I /bY. ~O ITotal Comb. rermi t 1701. ~8
"I -" -Z 5', "3C> I I
I I TOTAL b6C::l. 0$
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j. COMBINATION APPLICATION/PERMIT (CAP)
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Applicant to furnish ' , ., '.' ,..'
A. Job Address , ' ."
B. legal Description . ';"'._;
I. example- Tax Lot 100. Lane County Map Reference
II U3 43
2, exam~le' Lot I. Block 3. 2nd Addition to
~prlngfield Estates " '.' I,,~.
C. . Name, etc. of owner and construction lender"
D. Energy Sources :.'. .
'I. exam~le~ heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or sOlar,
E. Square footage or valuation, etc. . "', -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addi~iont
check add. etc.' ,
F. Building pennit information:
1. examole - construct single family house with an
attached garc!lge
2. examp.le - remodel existing garage {nto fa.l!!.ily room
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.
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
i. 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. -
Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible: Building.Oivision 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.
II.
III.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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,'PERMIT ,VALIDATION
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Permit Clerk Cf-"
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name L~iE?Ne ?<EZ;'~
signature ~ 2._
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.., date.,.$-/1.87
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