HomeMy WebLinkAboutPermit Building 1987-8-13 (2)
CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
, Range
,~;qAk . I. 'Va I UE of Hork: \
Owner' M.c.'"5h,NAL. 1:> "\ /:,~;lZP II :29'<::'."*'.::::> e5:r. )
Add /./' Pho. \, BuiTdino Permit Info: Describe Work(;..e,. Build Single
re55 27~ /V/7:P'ThlVP W.4 <;-' /:;q;)~eQ"7~ Familv nesidence I~ith Attached Garaoe'
BELL'; V/..lE/~. ~ r::Lw";'TFLJ.<:.r ~7.&.o;PA'h'r 0//7"#
Construction Lender.' ;iJ,1?/Vt!:- W&'i" IJ-S<::',/-o/ ,AtTcD
Address Phone . :5/TE /M?RC>kc/"??;!Ph 75
UtSIGN TEAr~ (name) (address)' Ilies. no. J (exnires)
Ey~.......c~~.r /"O'5'Y'o.,.y~37hoD"t><:, L )
Primary '"17;P.'APD /?F;?S/hlE/r, '\'.....,?'~::?6"'O> ~L.i"YV~,WAq<;;?"'6</ /:<'<:::K' &.:?::>-"2/~
/'" I I _ .> _ .,
/W'::?cc:. ZJrL~.tfII/E"/ Y:,.,,;;/""/J/~ W.4.
/~~
~/
m r"AO"'!:
I J furnace/burner to
7 BTU's
I
I
/ ITempOrary Construction I, 1$':"" /
IChange in existing I I I'
rps j qPJ'(,~
LlA.'" Imultifamily, COIllll. or I I I
,v Tnrtuc;,trial
~.<= I IOf i?tX> amps.1 1'17.~ /
I 7.~ ICOMH./IND. FEEDERS I II(
I IInstall/alter/relocate I I l
di..trih, fppriprc;,
I :3 IOf -:;'>2 S amps.137.5' IllzszI 7
I I I I I
I I I I I
I I I I
? 3 7. 50 TOTAL CHARGES 2 zs: Of> TOTAL CHARGES ~~. If> 1>
that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the comp 1 eted app 1 i ca t i on for permit, and do hereby cert ify tha tall i nforma t i on hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Oregon perta i oi ng to the work descri bed herei n, 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 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 t' project.
IWIE(please print) 7)lJcj;:1f. 616~;ON SIGN^TUR~
FOr. OFFICE .USE OIJLY -
]
Sq. Ftq. ~in L/3<// x Value?Va,.oa::> -,
Sq. Ftg.~ x Value :?3,,~.-c:.l
Sq, Ftg. Other~/ 7'~ /.MP~~~lue L.,?',/tX>, ~,
TOTAL VALUATlON~:ui~,-'
1 INSPECTION LINE
726-3769
*
.
Job -Addr,.s -q ~ <::'5 6A r; /lVA '?' ""57"'
Legal Oescription L-or::;:, "")<rL...d.,v c:::;."".~C/A'<'
Structural
Electrical
Mechanical
CONTRACTORS (name J (addrp~~ l
General ../.4)14""-5 Er/AU'Ik'> L~h'5;7.: 7~2"Z1 ,(/,2E,
, ,
(lies. no.l
Plumbina
Electrical
flechanical
PLUI1BING
ELECTRICAL
NO.
FEF
r.HARGF
NO.
'2lf
Each single fixture
Residence of
7.S"0 /8tJ. ""
SQ. FT.
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
I SERVICES
I
S. F. Res i dence
(J bath \
Duplex 'I bath)
IAdditional bath
95'IWater service
'65' Sewer
I
each I
I
I
I
'127 Storm Sewer I
I 1;r?;r?'hA;/ON S'~rJw
I
I
I
.1
I
~.'I>
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
Zone /' C.
Fi re Zone
Flood Plain
Type/Const. -S:--j(/
Bedrooms
Units
Occy Load ItJo
Ocey Group A-3
Stories
/
INFOR/1ATlON LINE ..
726-3753
Sq. Ftq. 11aln 4"-;?41 /
~q. Ftg. Access.
Sq. Ftq. Other
Ilew Add A Her Rep.
--Fence Demo Change/Use
Other- -
%
I~
~
\}.l
'-
(ohone no ,~\
2.).s{ LAM
(pxoirpc;,)
(ohnnp nn
::?h'3- o)'''3t;S
MECHANICAL
,<,
r ~ A 1UiI.
Floor furnace
and vent
i$D ,;oa At.
, ,
I
I
Recessed wa 11
~n~r.p hp~tpr ~nrl vpnt
Appliance vent
",poaratp
Stationary evap.
cooler
Vent fan with I
c;,inole duct
Vent system apart from I I/{~,::)
heatina or A.C. 7.~'
Mechanical exhaust 1<<----1 /b~"
hoorl [In('! duct 7'~'l>-
[ \-Iood stove/heater I I
~_'l" /.J07~5.rS I I:? 6"0
I I I
I I I
3l6~
ISSUANcr OF PFR!IIT
DATE~
BUILOING PERfIlT
Charges and ,
Surcharges r
Ii]
I ?//a ob ~lan Ck, conm/l,nd-/15c:a;'$7.L b'&8~r'syste.ms DeveloP'''\5~'
_____7_0____ 65 IRldo Per Fee /,(8?;-:/0 Charoe (1.5~ ''') ,J
Plan Ck. Res
<;7. ~o 30%/Blde Per Fee
Y9ft)<. Co.
PLUI~BING PERMlT~
Charges and
Surcharges
227. ~o I Fence
__n /~8s-1 O~mo
_n_~3~~JSldewalk ij~:<@ 73. ?,c
/'I;~ 'Z:s-I A/C Paving I Ib r. S-o
.~-':n~1,-~.jcurb Cut '7-5)'@.' "25'. "3t:>
2:9:5"1 I
ELECTR I CAL PERIIlT
Charges and "-\
Surcharges
I1ECHANICAL PERMIT,
Cha rges and 1_
Surcharges "p
ITotal Comb. Permit
I'
I TOTAL
/ 701. ~8
66C 3. OS
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A, Job Address
B. Legal Description . ~
1. examDle- Tax Lot 100, Lane County Map Reference
II oj 43
2, example- lot 1. Block 3, 2nd Addition to
. ;jpringfield Estates . . .
C. . Name. etc. of owner and construction 'Iender
D. Energy Sources ". .' .
'1. example--' heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar,
E. Square footage or valuation, etc. .'-
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, ,checkr;ew -.if addition,
check: add. etc. .
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exan.!PTe - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
. Structl;Jral Specialty Code
H: DESIGN TEAM ANO 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 OIVISION 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
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
H' :
.
.
"
.
PERMIT VALIDATION
-)602:0
, <6rI3-~7
Permit Clerk
Lc~
.
Permit applicant exempt from reg'istration with the Builder's' Board because:
Additional Project Information:
PLANS REVIEWED BY:
name LLJiE:N€ ?<CC:;'~
signature~_
r
-,P~
c ',.,.
.,.., date,..g -/1-,8 7