HomeMy WebLinkAboutPermit Building 1987-11-23 (2)
rl
.'. .
I HISPECT 1011 LIIIE
726-3769
'"
t
.
(name)
--.. ...
..- CITY OF SPRIilGFIELD IIIFORttATION l,;"
COMBIilATION APPLICATION/PERMIT 726.3753
E!IERGY SOURCES: Sq. Ftq. '.iain
Heat ~q. ~t9. Access.
Hater Heater 50. Ftq. Other
New Add Alter ~ep.
Ranqe -Fence Demo Change/Use.
Val u, of Hark: / {) n1) Other - -
Builiinq Pernlit Info: Describe Work(i~e., Build Single
Family nes; dence Hi th JI..ttached l1araoe)
f7-Vnw ell'.f (/ Ac~
~(A- ,I s:r;L;-~ VI'/?
r:. - - ~
(1/f).-:YLfN-nt7~ ~1.._
(lies. no.) (exniresl
o<J
...:)
~
i~
I~
~
Job Address 35;;;"0 ~~
Legal Description /'7 0 ~ Q..;;;. :::Lvr!lJ()g~
Owner fa.c~ #~):i-1r;;...-)
Address ')/) 'N-w VI C; 9
~c,;~
Construction Lender
Address
Ul:.::>l[ir~ TtAf.l
Primary
Structura 1
Electrical
!1echan;cal
CONTRACTORS
Genera 1
Pl umbi nCl
E1 ectri ca 1
~1echan;cal
Phone
(address)
(ohone no.l
tl~11 ~?"~
.'1 J _ ~
~ 1")"
(name)
IflI..lJ):JJJ /! )
(address)
n ic,,^ no. \..
(pxoi",,,,,,, ,
(ohnnp nn )
Cft, ~ Of 3 :<..
7V(,;- '/d94
,
PLUllBI riG
ELECTRICAL
MECHANICAL
rm.1
~ lEaCh single fixture
-,Relocated building
(new fix. additional)
Is.F. Residence
(1 h,:ltn)
I Dupi~x(1 bath) each
_IAdditional bath
FFF~ r.HAlHiF tm I
Residence of
75' "2':lS'
I IV
I I
I I
I I
I I
Sewer I I
I Storm Sewer 1 I I Of amps, I I
-I I I I CDt1IL/lND. FEEDERS I I
I I I I ~~~;~~~/a~;;~~~~locate I I.
1 I I I 10f amps.1 I I
-I I I II I I
I I I I I I
I I I I I I I ISSUANCr OF PFRmT
TOTAL CHARGES :<':? ~ I TOTAL CHARGES -:::?'2:~S-~ ,I TOTAL CHARGES ~/.......
WHERE STATE L.'II REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED the completed application for ryermit, 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 ' So ring field and the laws of the State of Oref)on pertaining to the work described herein. and that rw OCCllPArKY Ivi11 be made
of any structure without the permission of the Building Division. I further certify that my re9istration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the ba' for. tion is noted hereon, and that
o~subc~ntracto~and employees who a~e in comoliance with qP.S 7Q1.055 will b e on ject.
, *" ~~'e... \""U:';:, l>,;~ ~\.J\.~ '''' ~" 'Q::) ~~
IIAliE(please print) Ru f:>V j')OtVEII SIGIIATURE
FO~ OFFICE USE Oi[v-?"
Sq. Ftg. riain x Value
Sq. Ftg. Acces~Z/.D -:::?B~ 9> __Value---3~c::r.o_"'"
73'- ~ Sq. Ftg. Other ~~'. Value_ 2...::500_,~
TOTAL VALUATlorl~~ -
S/;stems Development..:: 5) t..I'2, _."...
C aroe (l.S~) CZr I
I
I
Comb. Permi t 1
Hater service
Zone ~ C
Fire Zone
Flood Plain
v~
BUILDING PERIIIT
Charges an"~
Surcharges l ~
PLUMBING PERMIT_
Char..ges and ~
Surcharges t :::v
ELECTRICP.L PERI~IT
Charges and ~
Surcharges ~
11ECHANICAL PERMIT
Charges and n
Surcharges ( VJ)
I='rr r~AQ~r - NO I
~I furnace/burner to
/ de... (Ayrr BTU's
I-I -Floor furnace
~4 and vent
I I I Recessed wa 11
S~rlrp hp~tpr ~nrl vpnr
I I
I
I
I
I
I~-
I
I
I
I rrr
rHADr.:r
SQ. FT.
6.-
New circuits a1ts.
or extensions
-... ""R ~t:JRE
I SERVICES
I
ITemporary Construction
------'Change in existing
Iresidpnrp
multifamily, COrml. or
'nnrJo:;t.riill
Appliance vent
<;poaratp
Statio~y evap.
cooler... J ~ :,-.,.~
Vent fan with
$inale durt
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and rlu("t
/
t:#.." / .,-
I
Wood stove/heater
/5-;-=
thi s pernit
<weo.."""L.",-, <J:::5\:) ~
DATE...1( - 2. "3 -i/
Tyoe/Const.
Bedrooms
Stories
'5""-,v
Units
Occy Load
Occ.v Group
/
~o..'" ,_"")
~ \td.~ .Fer
8.~~s
I \~:-'":'~-:z---sz>
f~~;=,Z-3-1 Demo
'-;- J ~ I U1l
?.73~'f~~1 :;:e::~:ng Uf~ '-i'
--_.I~~-,,=:_J Curb Cut
, 7-::> I
PlanCk.
65'X1Bldo
Plan Ck.
3D%/Blda
I Fence
Conm/lnd~,
Ppr Fpp' L
Res ---I'
Per Fee
I
I
I
~O_?OI
]rotal
'?,?("). 2.0
1-&8 V9,
~(, '2.. '2.0
-? 7"'\ 9..5;l
I
I TOTAL
<---
,
t
.,
.
{..;...
.
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
17 03 4j
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 ceilinq/or forced air qas
2. examole. waterheater/electr;cal/or soJa~
E. Square footage or valuation, etc. -
I. example. 1250 SQ. foot house, 500 SQ. foot garage
2. example- if new project. check-new - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. examole - 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 TEA~ AND CONTRACTORS
, I 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 Mechani~al 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 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.
/()SfG
11~~3-:C{ 1
V. FOR OFFICE USE ONLY
Permit Cl erk
c{/
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE ~ey;- ?~/7n~ /;:.:sc..>#-'7c.fE-..
/V6C:: l)
<TE
I~ 7?0/
~~#EP
A~"Y r~~R Tz-,
PP-VE2"c>?~c-.h-T ~~F€/'?7~/'7:r ~T:>
;:; HrC.
?<6?"~/.T" h5&-W~C:~.
~ "
/ ~Z:>//"f#/C::= i
0~n"'E
~~&'",....,...., ?~::?1'#"""" ~-T--' ,;;?,,vnv/~,
, /
~
Permit applicant exempt from registration with the Builder's Board because:
. !
Additional Project 'Information:
PLANS REVIEWED BY:
name / '-~' ~~~Signature~.::?n
~;f~ t I , /r
'Q: _-,,' d~te "7-;:> /-g"?
/---r.; ........ . '
'-