HomeMy WebLinkAboutPermit Building 1979-8-16
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'1IllSPECT 1011 LIIIE
726-3769
Job Address 7037 C;;;1r.lc.,'e,J-o
Legal Description ).,I'J-I A rON,v,'e..
CITY OF SPIHi!GFltLO HlFORr1ATlON LItlE II.
COMBINATION APPLICATION/PERMIT 726-3753
IEnergy Sources: Isq.rt. mal" & accsy. bldg.
heat if/a. /t/f/.>. '(5// \ \. \
~ater heater EI",~. Knew _add _d Iter _rep, \.]'J
Iranae E/~~_ fence _demol itian ~
:2D/\ / a 00 change/use _other
,.1 ue of work: ...r(-tf"l/l " ..
3uildinQ permit info.: describe work (Le., build
sinal&' fam. res. with detached aaraoe) _
~Q[~y ahTr)fl
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Owner (name/address/phone) J;o"",/J 'i(, (l.eH'/Sol'/
5121) FrI4Ad.1,'AI i1,I...d.
6JJ....AN J () .. (> .
Construction Lender (name/address/phone)
UI:.SlliN ItAro1
Primary
Structura 1
Electrical
(name)
"
f1echanical
1:0NTRACTORS Inamel
General (I"'d~"A1~ ,<lA~..... iJ..c,..,r,
Plumbino
Electrical
~1echan; ca 1
NO,
Each single fixture
PLUI1BIrlG
Relocated building
(new fix, additional)
~ S.F. Residence
fl bath)
Duplex (1 bath) each
I IAdditional bath
I ~Iater service
I Sewer
I Storm Sewer
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FFF I..QIARr.F
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:JSDD I :?5fJ9
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71(.,-(,,31/
,
(address)
rl ics. no,)
fexoires \
lohonp nn.)
(addrp"" )
(lir:<;. no.)
(pxnirp,,)
(ohnnp M, \
1!!!!!II.e :J., ~ 'tl" t,
plo-b311
MECHANICAL
ELECTRICAL
~JO_
'''-L.IJ:IlABliE:
~~~ rl-/ARGE. J:j[l .
furnace/burner to
?Q........,."",., BTU's
Floor furnace
and vent
Residence of
yo"'" {ldl7 1./ ~r"Ir SQ. FT, ~,'lP .;156
New circuits alts.
or extensions
Recessed wall I
~n~rp hp~tPr ~nn ~pnt
SERVICES
Appliance vent
seoaratp
Stationary evap.
cooler
.2 Vent fan with
..;J sino1e duct
I Vent system apart
heatino or A.C,
I I Mechanical exhaust
hood and duct
I ~lood stove/heater
I
Temporary Construction
Change in existing
rpS.i r!.pnrp
multifamily, comm. or
Inrhl~triil.l
10f
ICO~1,/IND, FEEDERS
I Install/alter/relocate
n;~tr;h fppnpr~
10f
J /) g;>
I
I z!!!? ~Qfl
from
amps.
.3<1.'" ..3 <2P
amps.
New circuits, alts.
....r pyrpn"i....n"
3'29
It. ~O TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
ISSUANCE OF PER'IIT
35' eP TOTAL CHARGES
3S!'!O
that .the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been siqned by an Electrical Supervisor and returned to the Building Division.
I HAVE CAREFULLY EXAMINED 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 don in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work desc i ed here;, that NO OCCUPAtKY will be made
::I'I:n:p:::::t~:~n:;thou the permission of the o/~7<:.iViSiO:;GNATUR kv- OAT'I- ({-J~-/7
~
-
FOR OFFICE USE OIILY o..../:;. ' ,,, 11 It l
Flood Plain .t/Q.. Bdrms ~ Type Const. "=-/\/ Sq Ftg, It!~ S"
Occy Group 1<--3 Stories ^- Units I Sa Fa. Jff//
ACCOUNT sur,'MARY
Plan.Ck, Comm/lnd
65%/Rldo P~r ~pe
Plan Ck. R-es
30%/Bldq Per Fee
___uJ!i1: ""
/"./l~
_ _ _ _ _ _ ,,3,,~...pJ:L Fence
I, L//J Sprinkler System
____u3J;,~gg_ Oemo,
/,4'0 AlC Paving
_u_nLI4",eQJ Curb Cut /8'
.~I./ I Sidewalk 'f() I
3.'D .=
I. ~"~'~I'>
-
34.'1/,Q.oO
3. 7.. (..3;JlO
~~. qt:.'-'!. 7D
Zones [rLF7 U1
Occy Load
BUILDING PERflIT
Charges and
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PER/lIT
Charges and,
Surcha rges
11ECHANICAL PERMIT
Charges and
Surcharges
Value
Value,
'17. In
Storm Sewer Connec.
l~~
Other ,'7:\. ~ ,..
Other
IOCJ.OD
Other
I
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#:.
'$~()~6.e
Total Comb. Permit
1t'A.-O. ~
SOC
(./,1f6
9.00
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 oj 43
2, examole- Lot I, Block 3. 2nd Addition to
~prlngt;eld Estates
C. Name, et'c: of owner and construction lender
D. Energy Sources
1. examyle~ heat/electrical ceilinq/or forced air qas
2. examyle- waterheater/electrical/or sotar
E. Square footage or valuation, etc. -
I. examole- 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
attached garage
2. example - 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 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.
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. BUILOING 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.
V, FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project
Information :~4_-:I
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PLANS REVIEWED BY:
name
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signature
-
PERMIT VALIDATION
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