HomeMy WebLinkAboutPermit Building 1979-9-10
IrISPECTIOrI LIrlE
726-3769 '
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CITY OF SPRIrlGFIELD
COMBlrlATIOrl APPLIC^TIOrl/PE~1IT '
rlFO~I^TIOrl LIrlE I
726-3753 I
-~q. tt, m?'n&ac~ bld9 ~
1<W5. 10
_new._add _a 1 ter __rep,
fence __demolition r\
change/use _other ~
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legal Description
Job Address -, 0 z. s ~} ~CJP yo- D~
('./) n'r\ \.(). subj
La 1- f
Energy Sources: ..L
heat E.le:- G.
/later heater '-f' 0 P c.x-
r~n~e . 0 ~.,_~
...alue of work:
10. n r D\.,.,^' f luilding permit info.: descr be work (i.e" build
Owner (name/address/phone) lC-OY"'d Ln \c:::..o' .AJ;;.....--....,: lI\... sinale fam, res. with detached aaraae) .
6 [ '2. D F"" Y" A-r- \<..... \ m B I uct..... 5 F \'2. e s ') A -t-t f.1.1"l re.
e LlC\ P no€- . De <=1:1 <:\0 ~
Construction Lendor (name/address/phone) '1"2.,0- (0:2, I I
DESIGN TEAI1
Primary
Structural
Electrical
{name)
(address)
(l ics. no.)
(exoiresl
(ohane no. J
, ,
Mechanical I
CONTRACTORS {name 1 (addrpss )
General C-lq12-L'SO lU!- ~a....rf\S
.-"
Plumbino
Electrical
~lechan; ca 1
riO, I
Each single fixture
(l ice;., no.)
(pxnirps) (ohnnp nn)
'2..~ <3 (0 ("
1l...~.("":3(1
J
PLUt,IBIIIG
MECHArlICAL
ELECTRICAL
FfF
I rHARr.F
I
furnace/burner to
BTU's
Relocated building
(new fix, additional)
Floor furnace
and vent
I
I Ri~~~Of
-... 'SQ, FT,
INew circuits alts.
or extensions
ISERVICES
I
rJ-lllQr:~
~
'76,,::>0 Recessed wall I
~ ~n~rp hp~tpr Anrl vpnt
each I. I I
lID KJO Appliance vent I ]TempOrary Con'str-uct;en
T seoarat.~
I I Stationaryevap. I' I IChange in existing
coo 1 er rP5 j dJ'nrp
I I ~ Vent fan with 11. 0,0 I 6e. multifamily, COnJn. or
:;;;J ..inole duct . to Tnrlllc:.tri~l
I I Vent sys tem apa rt from I Of
heatina or A.C,
I I I Mechanical exhaust "" 0<:.3 O' ICOMl1./Ir1D, FEEDERS
hood and durt P. .
I I I IInstall/alter/relocate
Wood stove/heater rli~trih" fpprlpr~
I I IOf amps.
'--I ---, -- Irlew circuits. alts, I
I nr Qvt"pn"inn"
I I I I
I." I .:::i!..06 I
ISSUArlCE OF PER'IIT J
TOTAL CHARGES i:::I.5 c:>O TOTAL CHARGES I 2. 06 TOTAL CHARGES 'l'5 00
WHERE STATE LAW REQUIRES that the Electrical work. be done by an Electrical Contractor. the electrical portion of this permit
shall not be valid until the label has been siqned by an Electrical Supervisor and returned to the Building Division.
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S.F. Residence
II bathl
Duplex (1 bath)
1
Additional bath
~!ater service
Sewer
Storm Sewer
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Nn
.cr
fI-lAI?r.F Nn
...
amps.1
I HAVE CAREFUllY EXAf~INED the completed application for permit, and~O h reby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be 0 e in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work d sc ibed he~einQnd that NO OCCUPArlCY will be made
of any structure without the permission of the BuildinQ Division. r L-
rlAI.IE (please printly1.Al2.R-\H i. 'JAlllotL' SIGrlATURE, I1Jl/l.!1_ 0v7 OATt\ Q-/o-71
Y\ J t :.~ 0 (~ j I
Zones g-I s:-z.
Deey Load
BUILDlrlG PERfIIT
Charges and
Surcharges
PLUI~BIrlG PERMIT
Charges and
Surcharges
ELECTRICP,L PERil IT
Charges and
Surcharges
/1ECHArlICAL PERMIT
Charges and
Surcharges
FOR OFFICE USE OIILY
~l'lst~l>/ r /?,t2..,t..ex:.)
Iq..q..c:; Value _~ ~ q ~ q . ex )
~I Value ::1..'1 fAQ.., ~,
----, - ..-:-,--
Storm Sewer Connec, :;:r1 1,1(0'6. '..."
-- Sd..t'\~ er 166. CC>
m. Flood Plain A.1l> Bdrms ~ Type con~-J....J
Deey Group (2..- ~ Stories.z Units I
Ale [ 0 U N T S II ,., MAR Y
Plan Ck. Commilnd /~
65%/Blda Per Fee
Plan Ck, Res
30%/Bldo Per Fee
Sq Ftg.
So FtlL
I t5}. 00
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L,. 2_~
___~5,_c:'~_
/, q..6
'2- c.. 00
----~..!_----
1 .J:; 0
uL~~g_~___
.~
Ori. 10
Fence
Other
Sprinkler System
Other
Demo.
Total Comb. Permit
~~
I '
4l/p G6
Ale Pavi ng
Curb Cut 18~'
Sidewalk . 41ir
SOC
I J.l.~U
I Q06
I
I 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
17 03 43
2, example- Lot 1, 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. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq, foot house, 500 sq. foot g~rage
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. examole - remodel existing garage into family room
3. examyle - 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. OESIGN TEAI'I 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, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES Oil 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
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Additional Project Information:
(J.e.
PLANS REVIEWED BY:
,
)
name
signature
date
ICSl.OO
Co. 'Z..~
3'3.00
1.40
7..~ 00
}. DO
12..06
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