HomeMy WebLinkAboutPermit Building 1984-4-2
CITY OF SPRINGFIELD INFORlIATION liNt I
COMBIIIATION APPLICATION/PERMIT 726-3753"
EilERGY SOURCES: Sq, Ftg, 1,'ain3"', nn.o...: CJ:)
Heat gas ~q, Ftg, Access, ~
Hater Heater Sq, Ftg, Other ~
--1lew_Add_Alter--Yep, "
Range _Fence_Oemo_Change/Use ~
ValuE of Hork: Other
50.000
BUlltiinQ Permit Info: Describe Work(i~e., Build Single I,
Familv rlesidence Hith Attached Garaae)
,:... .
.
, I
I IrISPECT I 011 L1IIE
726.3769
I
Job Address ::1040 Harlow Road
legal De5cription
map 170322 tax #2305
Owner Kle'inschmidt Development
Address P.O. Box 7Z6070, Redding
CA 96~ Ll9i.~' 222-0215
Phone
.
Construction lender
Divide buildino wita.c 1 hr. 'nrr,',];l......
'seoaration wall
owner financed
Address P.O., B9X _7,2QI3"7,0; 4027.
Ut~lGN ItAf.l j -.TnameT::'" - .-.......-
Phone
(address)
Primary M.S.S. Inc; --P.O. Box: ,16,88"CorvaJ.lis OR
Structural
. ,
M.S.S. Inc_
M.S.S. Inc.
Elf:ctrical .
fl ics. no.)
98081
(exn; res 1
I,
Dec. 1984 (503) 757086~
..... (Cf/~) ;Z~/' %81
(ahane no. I
I
Mechanical M..5-.S. Tnl""__
CONTRACTORS {namel laddressl (lic~. nu.)
,. ,'p..(J..~J:lnQX /L.UU/U '16'378
General Century Construct~on Rt::Ou~ 9
Appliance vent
~eoariltp
Stationary evap.
r.nnler
"7 Vent fan wi th
'" sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust I
hood and durt
I
I~"" I ~'\' ~'V/C::E'" I
i<-s. - ....-- A78? Zt..c:nvMk
V5. .0 I
I
rr- Or- -- IV. iJb
TOTAL CHARGES ~~ TOTAL CHARGES I'~..... TOTAL CHARGES }".
WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed 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 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 NO OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that ~ 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 and that
only sUbcontractors, and ~IOYeeS who are in compliance with ORS 701,055 Wil~n t 's pr '
IIAI,IE(please print) ~;;;1 /(;i{;/)J"r~n,.Jr SIGI1ATURE~ . ~2-~Y'
Fon OFFICE USE ONLY
Sq, Ftg,
Sq. Ft9,
Sq, F~g.
. Pl umbi no
Electrical
~1echanical
PlUI.1BING ELECTRICAL
NO, FEF rHARGF Nn
if Each single fixture ~.... ~,. Residence of
SQ, FT,
Relocated building ~New circu~ts alts.
(new fix, additional) or extenSlons ~
..,,~
S.F. Residence I I SERVICES
(1 bath)
Duplex (1 bath) each I I
Additional bath I !TempOrary Construction
Z. Iwater service Vt? ... 2a- IChange in existing
rp\J l1p"nrp
1 I Sewer I 15.- multifamily. comm. or
Intiustrial
I Storm Sewer I I Of ~CC> amps.1
I ICO~1,/IND, FEEDERS
I Install/alter/relocate
rli~trih_ fpptipr~
I 1 Of 1.00 amps.
I I Y~A'MP
I I Za::> #..-r?/"
I
,
I
I
tJ
~
Zone
Type/Canst.
Bedrooms
Units
Fire Zone
Flood Plain
Occy load
Occy Group
Stories
..
BUilDING PERflIT
Charges and
~urcharges
Plur1BING PERMIT
Charges and
Surcha rges
/.'a? c>.> Plan Ck,' Conm/lnd
_____qf.:____~/BJdo P.l'r Fpp
q(fJf> Plan Ck. Res,
7, '7<:::> 30%/Bl do Per Fee
_____~?-<:Po Fence
Z .:;'>0 D~mo
___.lLS. '-"S1dewalk
~".GO A/C paving
L 't.. .:>0., r Curb Cut
__u _ ~~_I .
ELECTRICAL PERI~lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
, ,
(pxoirpl;.)
(ohnnp no,
March 'ro, 19811
<<<
rH~1 Hn
ru'lW..
, MECHANICAL
<<<
furnace/burner to
BTU's
.I
1500
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
I
I
I
I I
~C) 16.~
I
I
I
Iz, co.
G. oc:o
I
~,-
I
Wood stove/heater
IE5"'.."....... ...
~,',",u ,
tiain
Access
Other
x
va'iue
Val ue
Value
x
x
TOTAL VALUATION
&/ s-s-
Systems Development
Charqe O,5~)
lI.4 .
Total Comb. rermi~
?B$7:!PI-
5"07. 3~
TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
l. Appl icant to furnish
A, Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
II 63 43
2, example- Lot I, Block 3, 2nd Addition to
Springfield_Estates .
C. Name, etc. of~ner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq. foot garage
2. examp.le- if new project. checknew - if addition', ~'.
cneck add, "etc.
'F. Bui,lding permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examjle - 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 TEM1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to eonta.:t appr-opriate
persons regarding design information or jab 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 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. ---
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
~lan 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.
,
Ill.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SAfISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: NoD}"'.' .4-v Az;>.z>,Th/:'^,A/
JP&vou=1;LF~ 7H-~ .7kcP~l:> aWNL:.
/~ A'.~-:r;_ve:> ~~ 7H-E 7?-Ry,;M"""~
-Y~/ANC'"
PLANS REVIEWED BY:
, name f..op UE R.E~~
signatur
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