HomeMy WebLinkAboutPermit Building 1988-7-25
CITY Of SPRINGflELO
CDMBINATIDN APPLICATION/PERMIT
I EIIERGY SDURCES:
Job Address //)2~ ..JL#Rt:./Jw 7;:>. ':!at
L ID .t. ~ I ~ Wa~rHeater
ega escnp lon, '7=.,y--~ ~-<~
Range
\ 1 - D ~ - '2. "2. - (;) 0 - 0 -z. ~ 0 S WjUE of Hark:
Ownerc.A.Q.; D,- I 100.1 ~ c:;;. c..~~1tr2."" \tZ"~' ~ G. a:;. =.C>
. I BuildinQ P'ennit Info: Describe \~ork{;..e.,
(t 4. D Phone Famil V Residence Hith Attached Garaoe 1
l.\II.L D1Z-tr. ~74~C. Q.~ I\",.....r-.l>>\ \:2."'1""
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IINSPECTIDN LINE
726-3769
Address 'P..O
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INFORlIATIDN liNt
726-3753
Sq. Ftq, f.lain
~q. Ftg. Access.
Sq. Ftg. Other _'''3::;>''':5''
-1lew_Addj!(Al ter ~ep.
Fence Demo Change/Use
Other - -
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Build Single
?L ~A .....~L..J\
Construction lender
Address
Ut::::d uN r EAr4
Primary
Structural
Electrical
Mechanical
CONTRACTORS
~'P A..,-....
(name)
Phone
{address)
(exoi res)
(ohone no.\
flies. no.)
\v \,\ ILnt> ~)o.1o.
-z.~~ 1V.l\....\"1..D~ <;i Ac.\\".~l.I"
4(.)..~2:Z.
(n...,)
(addres~;,) (l;~<;. no.)
rt'. 'UQtIlA..l\1l ";.1 '-""'0
'tA..~~. ~A" ';~Do..
(pxnil"'p,,)
(onnnfl nn. )
I C> ~ I e./ 7,1 Ie-to-
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Plumbina
~. C IJ. U" 'l:L."'PH?....
Genera 1
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4"'~D~;"2...
4(,'- Z{.,/ -C
'2..~:r:. ^^ bN 1Z.DW c,r
~O, ~~~ !-H~i> ~\){}tCl.lt1
10/ l/A~
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MECHANICAL
~1echani Cd 1
e>lH LOtr<nt., lEL"-t"L
"1\1....1 ~11_1J PN1'I.1.,)"" _l)'<"
I'UIlIIIIib
7_0 -/.:ZL
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Electrical
ND.
ELECTRICAL
fEf rHARr.F Nn
~~c r~GQr.c NO
ccc rutuu::c
Residence of
furnace/burner to
BTU's
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
Is.F. Residena
(] bath)
IDuplex (1 bath) each
IAdditional bath
I Water service
I Sewer
I Storm Sewer
INew circuits a1t5.
~ or extensions
7.o~ .~~ tE
'SERVICES
I
=.52>
Floor furnace
and vent
;z....
Recessed wa 11
S~~rp hp~tpr ~nrl vpnt
#~~ .a-~~ &;:-y? -_.
I' App 1 i ance vent . I I
seOd ra tp
'Stationary evap. I I
cooler
Vent fan with I
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood and dur:t
I Hood 5 tove/hea ter
I
ITempOrary Construction
IChange in existing
r~"jcjf'.n{'p
Imultifamily, camm. or
Tnduc;trittl
IOf amps.
ICOMfI./IND. FEEDERS
I Install/alter/relocate
di..t.rih. fppclpr..
'.Of amp~1
I
I
I
ISSUANC, nF PFRflIT
TOTAL CHARGES TDTAL CHARGES -:::(";Z-t>e> TOTAL CHARGES ~h. /,c;:' ~
HHERE STATE L'Ili REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
shall not be YdJi1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfUlly ~1INED 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 Derformed 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 UO OCCUPAUCY will be made
of any stru~ture ~thout 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl'07Z!5 will b sed on this project.
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IIAl.1E(please print) L ?li!1E.. P rE'/~f? I'E~ SIr.flATURE '.I? ~_ /L---f .- -1lATE" / Z.S)~ ~
FO~ OFFICE USi'OIlLY .- / ~
,
Tvoe/Const. ~~~.RUnits Sq. Ftg. flain x Value
Bedrooms Occy load Sq. Ft9. Access x Value
Stories/,-.M...-?2 Occ.y Group t'-2 Sq. Ftg. OtherA"F~_~ lC>..",....~ Value~".-:e>.-
TOTAL VALUATION
Zone
c.c
Fire Zone
Flood Plain
BUILDING PERMIT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
-
ELECTRICAL PERfm
Cha rges and
Surcharges
flECHANICAL PERMIT
Charges and
surch!r.g~s
Plan Ck. Comm/Ind
__:3'.~~.~__ 65%/P1~n Po. >00
j, Plan Ck. Res
,/.~;;, 30%/Blda Per Fee
I Fence
------------
I De.o
___2!5:~__lslde...alk
/. /3'; I A/C Pavi ng
-- - ~:ii-- -I Curb Cut
7-l.ft,-n
I (q77 1'1<' 02 syste.ms Development
'1~' /_ Charae (1.5~)
N/?-~
I
I
I
jTotal Comb. Permit .I
I
I
I TOTAL
:275://
-
4~
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.:;1..:} VNJ.1." " l-J
,
COMBIN~TION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description . .._.., ...,,-:i
1 " (".\
1. examp e- Tax Lot 100, Lane 'County Map 'Refer~nce.'
17 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~p,r1ngtjel.<!..Estates ... ' ., ,
C. Name. etc:. of. 'owner and construction&'lender '. '4 ~ "
D. Energy Sources _ " ..
1. examp 1 e- hea tie 1 ectri ca 1 eei,] {n%r forced air Qas
2. exa~le- waterheater/electrical/or solar
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
.~~ttaShed/gar.~ge .' ....~.. .'f,' 1,:' ,";" .
2. . Jexam~le- remodel 'existing 'g"arage"into family room
3. exam~le - convert single family residence into
restaurant (Change of use)
G. Va 1 ue of work as defi ned i n Sectio~1 ~93. (a) .~,f,;~~~:; :
..... Structural,Specialty Code- , :l , ~..... . . ...,.',~
" :. H. OESIGN'TEPJotAND'CONTRACTORS,j .'. .... ".;1,.'. "
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
Rersons'regarding..design information or, job, s;itel/ t~. ...:".)
corrections, efc:" + . - . '" :'::-. '.'
I I, , Abbreviated 'P;l umbing', .Mechani ca 1 ;.& E.lectrical' Soh.dul es. ',' , '
r A. 'Except'where blank spac'es occl,';" i'nt tne desc"riptfon'..'
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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
'.0.. As noted on the.CAP, the label must be delivered to the
. .. efectrical'contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to Sign the electrical label. ---
Ill. 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.
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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" ..PERMI!. VALIDATION
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Permit Clerk
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:,' Pel'f!1it appl i cant~exempt from re~i strati on with the- Bu.! l,<jer,'.s 'Board becaus'e:
Additipnal Project. Infonna~ion:
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PLANS REVIEWED BY:
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name~,~;~R;;;;iijt.~
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signature r ./~
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. date ,e-/.:::-;t;>g
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