HomeMy WebLinkAboutPermit Building 1983-3-14
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llflsPECTIOtI LlIIE. CITY U~ SPRINGfIELD
726-3769 COMBI:IATlON APPLICATION/PERMIT
Job Address "II~ MA/AI "ST~€Er ~~;~r,~~~lr
legal Oescription 17o(}3- 35:'-'3/ . "'/SOt!J !.Iater Heater "
, Ranqe
Valu, of 1.lork:
~.oo
Builtiina Pennit Info: Oeser be Work( Le., Build Single l
Familv nesidence With Attached Garaoe\
4ns.r-"""" .........A ...P< s;~o"" ~,II: ~"a
~~~ /N~ .b'~~CN Wf#,(..~. ~~
E<.ie:TN/~"c..< VE~n4.9)"/~->>~. ~
(lies. no:) (exoires) (ohone no.,
Owner . J~8'; Z4sMrH8~ ~ E~
Address ~/ H. ~ NJ) !'F.P#1D'"~ PiW.3?.'f~
Construction Lender
Address
DES I GN TEAll
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
~lechanical
(name)
Phone
(address)
(namel
(address)
"~~I .N~~ (..,R2> .
I/7.Y"J G. MA/H ~.
~~S H. '3 ~_"57'.
-.
PLUllB IrIG
~
l'
INfORllATlON LH<t
726-3753
Sq. ftg. 1.lain
:q. Ftg. Access.
Sq. Ftg. Other
t1ew Add Alter Rep.
-Fence Oemo Change/Use
Other- -
~
~
}f
(11l"s. no.)
(exnires)
(ohone no.)
7V~ SS"'f'S"
'797-~c::;)
7'2~' 7S~S""
ELECTRICAL MECHAN I CAL
fff fHARr.F Nn "" r~.ll.R~~ Nn FFF fl-lARr.r
Residence of furnace/burner to /
,
).4>0 ~ .. SQ. FT. BTU's
New circuits alts. Floor furnace
or extensions and vent
NO.1
~ lEaCh single fixture
I Relocated building
(new fix. additional)
I'S.F. Residence
(] bath)
/Ouplex (1 bath) each
IAdditional bath
I~Jater service
I Sewer
IStorm Sewer
I
/a~
~_... . TOTAL CHARGES ::?5".- TOTAL CHARGES ;rS.~
that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this penilit
label has been signed by an Electrical Supervisor and returned to the Building Division
SERVICES
ITempOrary Construction
IChange in existing
res i (tence
/multifamily. cOrmJ. or
Inrluc;.trial
/ 10f 74&- amps.1
ICO~1./INO. FEEOERS 1
IInstall/alter/relocate I
di<;.trih. fpprlpr<;.
IOf amps.1
I
I
I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
I
I
I
I
I /
I~s.-i ,
I
I
I
I
-:2" R,ecp<;.sed wall
-" \ ::O"'c;' hP~ ~nrl vpnt
6.- I~O<
I
I
1
I?--'
r. :sc'
Appliance vent
separate
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart from I
heatina or A.C.
I'Mechanical exhaust
hood and duct
I ~lood stove/heater
I
I
I
I
I SSUANCf OF PFRrlIT
1 HAVE CAREFULLY EXN1INED 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 rw OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S 7~1.055 will be used on this project.
NArIE(please print) D0/2C THr. SEIeR R SIG;IATURE~J~t:'--t14 -IL.Z."b OAT~& /4..J5'<;
Zone ~ c:::..
Fi re Zone
Flood Plain
BUILOING PERHIT
Charges an~
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
FOR OfFICE USE orlLY V
Type/Canst. 5'-1\1 Units Sq. Ftg. Hain x Value----B(/II::I{!). ......
Bedrooms Occy Load ~9 Sq. Ftn. Access x Value
Stories I Occy Groupfl-Z Sq. Ftg. Other x Value
TOTAL VALUATlorl
'1u oW:>
______J..!.____
/.?~
Plan Ck. Comm/lnd
65%/Bld~ ~pr Fpp
Plan Ck. Res
30%/Bldo Per Fee
2' S. C:;D
_____~<::J... Fence
/.~O O~mo
':Z'S'..... 'Sidewalk
------- I. ct-/ A/C Paving
_____:rs-;~ Curb Cut
.. y-z
Systems Development
Charqe (J.5~)
/ ~t:P. "0
Tot.1 Comb. Permit
/3?-98
I
TOTAL
~
'288. 'Ie.
r
()
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example~ Tax Lot 100. lane County Map Reference
II 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
5prlngtield Estates
C. Name. etc. of owner and construction lender
D., Energy Sources
1. examole- heat/electrical ceiling/or. forced air Qas
2. examole- waterheatertelectrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check-new - if addition,
cneck add, etc.
F. Buildi'19 permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - 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 TEAI.i AND CONTRACTORS
To avoid design or construction delays. Building
~ivision Staff must be able to contact appropriate
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. ---
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.
(00'502-
~-\~ -83
.."
/.
V. FOR OFFICE USE ONLY
Permit C1 erk
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)
. ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
J
j
'I
Permit applicant exempt from registration with the Builder's Board because:
m
Additional Project Information:
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~Ec.J~QD-8Ze>//~ N>P ?~M.seJ:r- MA-sC:>WR~ .~........-.::.c
PLANS REVIEWED BY:
name ~be n c!'=C; ~
5ignatured~ ....
~_.
,
date $-/~-1i?3
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