HomeMy WebLinkAboutPermit Building 1988-3-11 (2)
ValuE../of Hork: ~
T"3'Soo
Bui16inQ Permit Info: Describe Work(i.e.,
Phon"741~~'~ Familv nesidence With Attached Garaoe}
~--- ~: _:"']2
f.,,~'M~'< -!;.p~ ~
d...Jl (~t:1ef'r''''P
llies.no.)
'-I
1,1
'I
.
.
J INSP.~TION,LINE
726-3/69
CITY Of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
liater Heater
Range
Job Address IQ/ </. IIa y low "Road
Legal Description [~/.'[;c -r;LM,. .J- -11.1..." \
"."".:(~...u> j' ) n -:> f 7
",2?b'i"' A:}~' ....l- ,nA-Ir~...~
Q ror~...1 F'd (h/(,'Aj"'tA.,,,,;J
Address /J c/ Y'.
~<("'" }.'/.~:,v ,1: _"~4'
. ('~+I. tk~,
Construction Linder ^ J
It''it);u?-.<'
Address
UI.:~lliN lEAI'1
(namel
Phone
(addressl
Primary ...---;{A/~&A./-
INFDRlfATlON LINt
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ft9. Other
-1lew __ AddXA 1 ter -,~ep.
__Fence__Demo__Change/Use
__Other
~
;::Xl
C>
RJ
Build Single
-
".tiP!", cL. "-.J ~
, (lj,~~.-L "i~fJP",J"b.~ \
/ I
(~xnires) (ohane no.
Electrical
~JJ .:::::<,O()
~l'l
Structural
Mechanical
CONTRACTORS I name I
Genera I ---rr^/f:./../ J.-
Plumbino Ltll' 0 PIt./I,,6;ut
Electrical ("~,, P<1.../ri rP&~jp:7 _
~'echanical
(address) nice;. nn.)
,;2.300 ()dM"'",.!- "h.,
/
li/!<; .;'A ,//w
I
PLUf.lBING
ELECTRICAL
NO.
FFF fHARr,F ~Jn
~~F I rHARGF NO
~ Each single fixture
;/ 1'.q..-"..e ~+_w__ 7.5C :?2.!"O
Relocated building
(new fix. additional)
Residence of
SQ. FT.
New circuits a1t5.
~ or extensions
'2 = ?;?,,,,,,Re?
SERVICES
:<Z;Si>
S.F. Residence
11 bath}
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
r~.. j <<1f.ncp
multifamily. camm. or
lnduc;trial
Water service
Sewer
Storm Sewer
Of
amps.
L. ~;z> c>.F.o<= JCiX/.o:.7/.,<h"
7- ;S"e:;
CO~~./IND. FEEDERS
Install/alter/relocate
rl;~trih fppnpr~
Of
amps.
(pxnil"'pc:.\
(ohnnp nn l
.I//'5: '171'/
7~ Go - 19..,/
MECHANICAL
t't'L.t.HA.R.(lt
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~n~rp np~tpr ~nrl upnt
./
Appliance vent
sp.oarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.c.
Mechanical exhaust ~~I.
hood i'lnd durt f7'~~ .
\'jood stove/heater I I
I
I
I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
30? ,to TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
ISSIIANC, OF PFRtllT
:<:<- SO TOTAL CHARGES M.....p. /5--=
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the compJeted 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 Oregon pertaining to the work described herein, and that 110 DCCUPAllCY 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 701.055~ used on this ,project.
IlAI-1E(please printlfduAed r2.ihv-'ftUood SIGIIATURJ:::;;:t>-ne<"J ~~ OATE3-/I-&f3
FOP. OFFICE USE DIlLY I
Sq. Ftg. tiain ,Value
Sq: Ftg. Access. x Value
Sq. Ftg. Other /.2t J ----:.c>67'J Value~QC>. -
TOTAL VALUATlOlI
Zone~,..-:'
Type/Const.~~ ~Units
Bedrooms Occy load
Stories / Occy Group
71- ::?
Fire Zone
Flood Plain
7.)
BUILDING PERNIT -----~~~~- Plan Ck. Col11ill.ln'd
Charges anc ~ 65%/Bldo Ppr Fpp
Surcharges ;;?- ~ '3 Plan Ck. Res
3D%/Bldo Per Fee
PLUt~BING PERMIT 3t!) 6i? Fence
Charges and S ---- -:..----
Surcharges /.9:> 00.0
ELECTRICAL PERI~IT _ ___ _~-5:=P:.1?_ 'Sidewalk
Cha rges and
Surcharges ~ / -/.5 AlC Paving
MECHANICAL PERMIT __n/S":.~__ Curb Cut
Charges and
SurCharges LP .75'"
'\<<={'P'P'T .:l:tIlIOL.
, ....." q::z. ../. [Systems Development
""'c.. ~-, ('J)(UCharqe tI.5~)
.;1"
, "
#4
Total Comb. Permit
TOTAL
I
,
II/? -bl
; I
!
.
.
s
.. t .-
/'
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. example- Tax Lot 100, Lane County Map Reference
II OJ 43
2. examele- Lot I. Block 3, 2nd Addition to
,pr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examDle~ heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 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. examole - remodel existing garage into. family room
3. example - 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 TEM1 ANO 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 Electr;cal 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
O. 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.
(I ( 49
3--(Cj /}(f
V. FOR OFFICE USE ONLY
Permit Cl erk
CL-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ?cR/5e: nF~l5R
signatur~?~_
//
-~---
-<?
da te :l"-..(l::? 2? ..8.
'"
-