HomeMy WebLinkAboutPermit Building 1988-7-25 (2)
IINSPECTIOII LINE
726-3769
Job Address 1"'2~~~w ;PI:',
Legal DescriPtion~....~~......,....~ 72,,;t.?~
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Owner LA.Q; D \-' I-J &:0 S. c..~.ll.U\~~r2.'" \ll"~'
Address 'P. Q ?> ~ ~ (,4. n Phone
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CITY OF SPRINGFIELD
COMBJrlATlON APPLICATION/PERMIT
E!lERGY SOURCES:
:!3t
Water Heater
Ran!1e_
INFORltATlON UNl
726-3753
Sq. Ftq. 1.lain -f\
~Q. Ftg. Access. . ~'
Sq. Ftg. Other ~';3::?""~ 100
Ilew Ad~Alter Pep. r-o.
--Fence Demo Change/Use '-J
.1 Other -- - E;"
Build Single -c.
Vl
"diu. of Hark:
~u'50=
BuilciinQ P'ennit info: Describe Hark( Le. I
Familv nesidence Hith .e.ttached Garaael
PL ~.A O:""~~I\
Construction lender
Address
Ul"J~N TEAH
Primary
Structural
Electrical
Mechanical
CONTRACTORS
P IZ /Vy:' ~ "" I.
~'P A.1_
(name)
Phone
(address)
flies. no.)
! I r..-(
9/ J--"\ - G -
~q:\""
(exoi res)
(ohane no.l
1'/')/
,- AO
&;:."1....,(;1
--
"Z.~~ I\.Anl4~Dt:J. <;T ~_\\.".f\{lo.l'"
\\J \"\ '\ \L n"t:::> I-L I-lc::l
(n...,'
(address) _ (1;~c;.. no. \
...",,1'l~,," 011""'"
1t,.Ass'" 'Pt">. ~~>(. '55'/':)0.,
I D '1,,0 I '0/ -z.r /bt>
I I /
(.. ~ ? a.4.4! .
Plumbina
General ~e.., C-.l.l Ua. o...'!2:'I?'"
Electrical l2:ol.H LOt<<nL., 'fi:r "'II
flechanical l..'-Itt...'T....ll.I2..\J ~,h)"~Il.lJft..
l'WtmmS
-1lih '
"2.. ~:z;, ^"' h.~ 17 "''!>l' c...
7.~~~O .
C'-1J, ~~>k l- ,. :; "'-"...."'-.111
ELECTRICAL
. fff 'rHARr.F ..1lfl
4t::l.~(~.
(exnirpc;,)
(ohnnp nn )
"2..0 -/7,G
li.a.;z.Z.
I
'9Uj.A~
'/.JJL/ lo,-l,)
MECHANICAL
4 Il.,tie"';. ,
"!ill' 2&1
CCt..J..tI:iAR.G..EI~ c~~ 1.c.HAR.G.E.
Each single fiature
Residence of
furnace/burner to
SQ. FT. BTU's
IRelocated building
(new fix. additional)
IS.F. Res;d2nu
(J bath)
I Dup 1 ex (1 batll) eoch
IAdditional bath
I ~Ia ter service
I Sewer
I Storm Sewer
I
10f amps.1 I
ICO~1./IND. FEEDERS I
I Install/alter/relocate I I
didrih_ fppdprc;,
IOf amps.1 I
I I
I I
I 1.1 ISSUANCE OF PFRIIIT
I TOTAL CHARGES '=<'72-se:> 1 TOTAL CHARGES ~;y. /.~",.,....
that the Electrical work be done by an''Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
New circuits alts.
~ or extensions
"'2..oJ'llt .h?~r:r.e
=5C
SERVICES
I:~porary Construction
IChange in existing
resjctr:nC"P
Imultifamily. comm. or
Tndustriiil
7
TOTAL CHARGES
WHERf STATE l~ RfQUIRES
shall not be YaJi~ until the
I HAVE CAREfULLY EJJ1.rUNED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein. and that rw OCCUPAIKY will be made
of any stru~ture -ntDout the permission of the Building Oivision. 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 701.052?Will b sed on th~ project.
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llAr-lf(please print) .L ?iE1E. P rE\lIE.f7Ie'L{ ._SIGNATURE _L..4..1 /' ~ .....l~ AATE" / ZS)til
FOr.. OFFICE USir'OiiL Y - I /
Tvoe/Const. -s:.A/,~RUnits Sn. Ftg. 11ain x Value
I
Bedrooms Occy load Sq. Fta. Access x Value
Stories /7'" M~2 Occy Group ~-:2 Sq. Ftg. Other~F/.>7""~ "" .~~ Value~.c;-...:e>.-
;0
,-2..0 -~f \ TOTAL VALUATION
f(C{77 1l.(s-,Cf3 m~~~s(~~~~lopment /,/p?-..
Zone C.c
Fire Zone
Flood Plain
BUILDING PERf1IT
Charges and
Surcharges
PLUtlBING PERMIT
Charges and
Surcharges
ELECTRICAL PERllIT
Cha rges and
Surcharges
MfCHANICAL PERMIT
Charges and
Surcharges
'1-
, Plan Ck. Corrrn/lnd
__3::?..Y-,A'=__....Q2!/Rldo P.l'r F..
Plan Ck. Res
II. ~3 30%/BldQ Per Fee
Fence
---n-----~~1 D~~o
'=?:::?_Se:/'IS1dewalk
___n/~/:'=;;__I A/C Paving
I __../.2;_~_\f1 Curb Cut
I -7S ,.
;L
I' Floor furnace
and vent
1 Recessed wall
~n~rp "P~tp~ ~nrl vpnt
I#~~~_~ &;:..{.?_.
I Appl iance vent . I
s~oariitp
I Stationary evap. I
cooler
I Vent fan with I
sinole duct
I' Vent system apart from I I
heatino or A,C.
1 Mechanical exhaust I I
hood rind duC"t
I \1ood stove/heater j I
I I I
I I I
I 1 I
1
I
ITotal Comb. rermit
I
I TOTAL
Z75://
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,'.
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map. Reference.
17 03 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examJlle- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. exam~le- 1250 sq. foot house, 500 sq, foot garage
2. examp'le- if new project. check new - if addition,
cneck. 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. exam~le - 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 TEAfI 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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
p. 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.
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V. FOR OFFICE USE ONLY
Permit Cl erk
.PROjECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl i cant exempt from reg i strati on wi th the Buil der I s Board because:
. Additional Project Information:
PLANS REVIEWED BY:
name L.~;~R~~
/7 --,;;-,~
signature r /~
/r ",.;
date ,e-/.::'?!i'B