HomeMy WebLinkAboutPermit Building 1985-3-7
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, INSPECTION LIIIE ( , C'iTY OF SP, ,NGFIELD
i 726-3769 COMBINATION A?!'I..CATION/PERMlT
Job Address 3 Y 2 ? ''$~W1J.AJ --:JhJ1IMRiJM ~ ~~;~r,y ~~ES:
Legal Description /?()~~ 2~ _?~ I~ater Heater
. Ranqe
Owner V~ ~~';;;.IAaJfJ Val~~;;;\~~
Address 0 "/0 ~ Phone '-.('''/ BUllG'na 'P~nl1t Info: Describe Workli.e., Build Single
:J:...e,...." oJ4.. 912,0/ ~";; ~~d;-=1' M~
Construction Lender ::r. lB. 5 ~rtfl. - J' '. ct1.~;JAA ...f/..~
", f ;.' ~/~ (,(7. (tOI) (j
Address /tJ/() WJIS '1h /I? .SOU hu.&,., Phone"J"''(b(
UI:.SlliN rEAr~ warne} (address) flies. no.) (exlJires)
Primary L/"'rd ; f1,Aler. )../ A. j ic:('t4Jr.
Structural ~Aj /I. Vd,"r; Ac,nr
Electrical 'h);/~b'" I'Led ,r""'3/II~t'r..~
Mechanical ~N 1()erum / F/u..nILL..A!>Sb<
CONTRACTORS name)' (address) Clir:c;.. nn ,
&./'n'/<;!rOYld i~. box ~;l) J:u,;"~/L( jj (j.QI)
Plumbina 1'?.i/"j/ i77..e.d 92/J/ SAI./ndprs ijd. .<C<Jrmrllrd) /Jfe ;P.'f(/JA
1'. J ,I 17. a;.
Electrical ~Jo/ //,,:w {"In:, 3L't:t:J ,f,U'tOO' Rc;i ,c,,~~"H~.jjA." 'Jt)-//~r
/ - t/
Genera 1
~1echan;cal
110.
$
Each Single fixture
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INFORl1ATION UNe
726-3753
Sq. Ftq. 1'lain~j'?R'~
~Q. ~tg. Access.
/,Sq. Ftg. Other ':1'1 'IT,tt.
~___Add_A1ter --,~ep. 1)"
__Fence__Oemo__Change/Use
_Other
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(ohane no.)
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fohnnp no \
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PLUI1BING
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ELECTRICAL
MECHANICAL
FEF CHARr" J'n
FCC rH'IRG.!:I~1
I c.E.L1..cHARG.E ,
~-~
Residence of
furnace/burner to
BTU's
SQ. FT.
each
1'New circuits alts.
. or, extensions
'2" diZ~~,c
ISERVICES
1
~.-
I
1
I'
Relocated building
(new fix. additional)
Floor furnace
and vent
/ ,//~ C/H'/r
Appl iance vent
seoaratp
Stationary evap.
cool",r
.., I Vent fan with :::/_1" ce.
, slnale dllct ;.A.~.
I Vent system apart from I I
heating or A.C.
I' I Mechanical exhaust 1 I"/.~'
hood ann duct y.. ~
I ~'Jood stove/heater I 1-
g~;~~~w~_~
/ ~ 1<',".
II - I-I
I
TOTAL CMARGES 75". -I TOTAL CHARGES ,~-I TOTAL CHARGES -::j'ttJ. SO
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penoit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
S.F. Residence
11 bath)
I Duplex (1 bath)
IAdditional bath
I ~/ater service
I Sewer
lstorm Sewer
I
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I
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I
1
1
Recessed wa 11
Soarp hp~tpr illlrl \Ipnt
lTe~porary Construction
IChange in existing
rp'} i qp'.nrp
Imultifamily, CQlTITI. or
lnrlustrial
10f
ICOMM./IND. FEEDERS
Install/alter/relocate 1
n;<;t.rih_ fpp(1l:>rc;.
amps.[
Of
amps.
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1
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J.,SC'1t^m:r Qr nrrUIT
I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information hereon ;s 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPAr~CY 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 ORS 7~1.055 will be used on this project.
Fire Zone
Flood Plain
BUILDING PERmT
Charges and
Surcharges
PLUI~B ING PERMIT
Charges and
Surcharges
ELECTRICP,L PERIHT
Cha rges and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharges
TYDe/Canst.~~1\I
Bedrooms
Stories
SIGIIATURE #, () ~~akwtl A../
FOR OFFICE USE DiU ~ J
Sa. Ftg. f1ain A.PD 929;6x II Value~~.-
1
Sq. Ft~. Access x Value
Sq. Ftg. Other KENk>l:)e~ Value!a,dit:JV.- .
If 0 <.J '3 t;)~. n /1 i g~ TOTAL VALUATION/ ,~_. --
-r _,,-?r-;:;;,O ,JII ')/ Systems Development ~'"').;", _
I D\~' m. Charae t1.5~) D ~.
1 I
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DATE 3-'}-f?L
l
/
Units
Occy Load ~;:>
Occy Group - 8
:fl,/-' - Plan Ck. COllllllInd
t::::"c . . 65%/Rldo Pf'r Ff'P
------,/'-u'D- Plan Ck. Res
/7 . 7_ 30%lBlda Per Fee
_____~ - I Fence
"3.'- D~.o
;(~. ~ Sidewalk
-------~o-I A/C Paving
3<!J. $"l!> I Curb Cut
------/~~-~-I
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I,
I
ITotal Comb. rermit
1>e?/. Bo
loir:9:> ,
I
1 TOTAL
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COMBINATION APPlICAT~ON/PERMIT (CAP)
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I. Applicant to furnish
A. Job Address
B. legal Description
1. example~ Tax Lot 100. Lane County Map Reference
11 U3 43
2. example- lot 1, Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air,qas
2. examDle- waterheater/electrlca(/or solar
E. Square footage or valuation, etc. -
l. example- 1250 sq. foot house, 500 sq. foot garage
2:. exam~le- if new project. check-nfw - if addition,
check add. etc.
F.. Building pennit information:
i. example - construct single family house with an
attached garage
2, examele - remodel existing garage into family room
3, exa~le - 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. Sui lding '. ~
Division Staff must be able to contact appropriate
persons regarding design information or job site . .
corrections. etc,
II, Abbreviated Plumbing, Meehanical, & 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 Electrieal 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. 8UIlDING DIVISION STAFF WIll FIll OUT All FEES AND
.CHARGES ON THE SCHEDULES
D. As noted '0" 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 ~ivision 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 \.5 issued.
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V. FOR OFFICE USE ONLY"
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" PROJECT CONDITIONS TO BE'SATISFIED BEFORE OCCUPANCY:
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'PERMIT VALIDATION
a_A _'L ~ b~J91
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Permit clerk~,A/
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Permit applicant 'exempt from registration with the Builder's Board because:
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Ag~itional Project Information:
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PLANS REVIEWED BY:
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