HomeMy WebLinkAboutPermit Building 1986-10-10
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CITY OF SPRHlGFIELD INFORlIATlON LW,
COMBI:lATlON APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: SQ. FtQ. ',lain
Heat ~q. Ftg. Access.
Water Heater SQ. Ftg. Other
I Ranqe r~ew Add Alter Rep.
I ----------- Fence_Demo_Change/Use
~1S oQCb ~ _Other
Phon~~~,'.)~1, ~~~1~~~~e~I~~~elnf~~ A~~:~~~~eG~~~~~l.e., Build Single
~E\""'\J'C.L '6--,</5T7NC ~('\\\"tn rol~l
('flf'l~\l...~-~Il.INro ~OO~{r~~L-.)b
,j!,A {Is 10 'F\1!,L ~ ~fl \ L.
(address) (lies. no.) (exo;res)
'5\'5 rLO\\\1.e'Si LAC~.
~e-n.~pe.
5i5 'S .~~~S\ ~ c.~ .
11 I) I) jJ
, MECHANICAL
I r~~ ~ furnace/burner to
I I BTU's
I' Floor furnace
~~o and vent
I Recessed wall
~o~~p kp~tpr ~nrl upnt
2 1~rl>Ao??"
I Appliance ve-nt
c;eoarate
I Stationary evap.
cooler
I Vent fan with 1700 I/:z~.
slnnlp (11lCt p...
I Vent system apart from I
heatina or A.C.
I'MeChanical exhaust
hnar! i'lnd dud
I Uood stove/heater
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I HAVE CAREFULlY-EXAtlINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Drenan pertaining to 'the work described herein. and that UO OCCUPAllCY will be made
of any structure without the permission of the 8:;ilding Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by O~S 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontr~ctors and employees who are in com~iiance with ORS 7~1.055 will be used on this project.
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NAlIE(please print) I<'bb~,..-t J... 01H1k~( _ ..SIGNATU~f~J DATEltJ-'/o-B.t:,
FO~ OFF J C5 USE ml'. Y
Sq. Ftg. r1ain
Sq. Ft9, Access x
8-;? SQ. Ftg. OtherRB,"_'-'-"C._"'_ x
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~3--
"I IrlSPECT ION LINE
726-3769
Job Address 3<ffff), ,c: L/T-';",...!ofI-y
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Le9al De5Cription /7-o:l,'7!2.2~ /)/2~
Owner J:f'['Lll)/nr f'?V/.J.FIE:.Ln
Address y\~~ <;;~li~
~l!.-'''-'o~\..D .o~ .
C LJ .
Construction lender
Address
DESIG'l TEAll (namel
Primary f:rrL~Wf ~ ~1:.\W:'1€\S>
, Structural f\{..flY ~~<<:.~
Electrical ~Ar-tfK ~\t;:.~f')~~
..... Mechanical~~~~ ~\C.~~
CONTRACTORS Iname,
Phone
(addressl
(1 ir.<:;. no.l
(pxoirp<:;l
Genera 1
Plumbino
E1 ectri ca 1
f..lechanical
C\ c:J) '\ 4'160
PLUllB ItIG
ELECTRICAL
110.'
f.:H
Residence of
SQ. FT.
Relocated building
(new fix. additional)
. -' INew circu~ts alts,
v or extenslons
'2 ""'ill N>or-J<B
I SERVICES
I
IS.F. Residence
(] bath I
I Duplex (1 bath)
IAdditional bath
I ~!a ter servi ce
each
ITemporary Construction
IChange in existing
rp~ j dF,::nf"":
Imultifamily. comm.
InrilJ<:;tri~l
Sewer .
-, Storm Sewer
Zone t::.c::.
Fi re Zone
Type/Const. :;-;~
Bed rooms
Occy Load
Occy Group
Value
Value'
Valye '7,f=---
TOTAL VALUATION
Un; ts
x
Flood Plain
Stories
I "Yl
BUILDING PERMIT--
Charges ant: ~
Surcharges:
Plan Ck, Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. Res
30%/Blde Per Fee
Fence
-
...,__fi"'C7rO-I'P~ter.1s Development
2~.r~72?C; CharQe (1.5~)
"7 rg ,,",,",'
___;";..d..~_:...___
17'. 3':<
____tZ5.:.?~_
2/0
Demo
PLU'1BING PERMIT /
Charges an~
Surcharges'
~~;~~:;c;.~~PERr~l/ _____~~~_:_ Sidewalk
Surcharges! -.z _ ~&> I A/e Paving
~~;~~~;C~~~PERMIY ____.~~_~J Curb Cut
Sureharges', . 96 I
ITotal Comb. rermit
I '
I TOTAL
(1)."'::'
I
.' <S / '-I. 28-
.~
()
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~
(ohone no..
(I)honp nn"l
~~ L .LHAB!iE.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100. lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springtield Estates
C~ Name, etc. of owner and construction lender
D. Energy Sources
1, examole. heat/electrical ceiling/or forced air Qas
2. examole. waterheater/electrical/or solar
E. Square footage or valuation, etc. -
l. example- l250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check new - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - 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 (aJ of the
Structural Special~y Code
H. DESIGN TEM1 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(sJ 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,
0: 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
wi'll prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
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. '
-1\' B~13;'O
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from res,; stration with the Builder I 5 Board because:
Additional Project Information:
PLANS REVIEWED BY:
i
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name V.C:>PN.:?UC'c:;;;~
signatur
~-~
date /<:?'.<'~'9C