HomeMy WebLinkAboutPermit Building 1987-6-23
Job Address
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'CITY UF SPRINGFIElO e INFORIIATJON LIN<
COIIBIIIATJON APPLlCATION/PERMIT 726-3753
· EIIERGY SOURCES: Sq. Ftg. 1,Iain
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
New Add Alter ~ep,
Range -Fence Demo Change/Use
ValuE of I'I":J/ROO ,,,,, I Other- -
Bui161na Pernlit Info: Describe Work(i.e.. Build Single
Farnilv nesidence With Attached Garaael
Phone
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1 INSPECTION LIIIE
1726-3769
Legal Description
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Owner-'=\='r~r' 8r't j L
Addres~s3.S Hn(~ ~
_~nVlol'\ eld ; ()(2,
Construction lendecl - .
r;Li7-{)3D" ~""'~'T"""-'L 'T WOOD F??:///77t!E.D
Address
Ut~l(;N II:.N1
I name!
Phone
(address)
_~!.f;S:""",,,-;;::-,oN .7A1.".~' /".5/Z"
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(lies. no.1 (exoirps) (ohane
no, \
Primary
Structural
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Electrical
Hechanical
CONTRACTORS I name I
Genera 1 OLe. '1 C>v-
1/e J.....-
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f address 1
5"3 S- l-'ltu"'J'I
(1 in. nn.)
(p)(nirp~l
fohnnp nn
Plumbina
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Electrical
~1echani ca 1
PLUIIBItIG
....
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
I HF I fH^RGF ~l I n~~ I r~JlRGE. Nn
Residence of furnace/burner to
SQ, FT. BTlI's
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Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
f1 bath)
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Sewer
ITemporary Construction
IChange in existing
re'i j 4encp
Imultifamily, coom. or
Tndll<:.t.ri~l
10f
ICDlf'1./lND, FEEDERS
IInstall/alter/relocate
rli<:.trih. fpprlpr<:.
10f
I
amps.
Appliance vent
seoaro'l.tp
Stationary evap.
cooler
Vent fan wi th
sinole d~ct
I Vent system apart from I
heatino or A.C.
I'Mechanical exhaust
hnnd ~nd dllrt
I Hood stove/heater
I
I
I
~Ia ter serv i ce
Storm Sewer
amps.
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ISSUANCF OF PFR!IlT
TOTAL CHARGES TOTAL CHARGES TOTAL CUARGES
WUERE STATE L.'I~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building ~ivision
I HAVE CAREFUllY EXJ\tlINED 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 Spri ng fi e 1 d and the laws of the Sta te of OreC]on perta i n i ng to the work descri bed here; n, and that flO OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard is in full force and effect as required by On.S 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 7Ql.055 will be used on this project.
UAIIE(please printl_?ck.., ,1_j-S rj.:.f
Zone L L
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
SIGNATURE
FOP. OFFICE USE DIlLY tY
~-N. Units Sn, Ftg, 11ain ,
Occy load Sq. Ftn. Access x
Occ,Y Group ,/.--;3 Sq, Ft~, Other Mn/f"6-r-=
CD,_~_ -<?/_ __~
I 'PlanCk.Conrn/lnd 1- ,-;
__2~~-::?___~/Rldo Ppr Fpp ,'2/~
/ /= Plan Ck, Res I
. l!? 30%/BI do Per Fee
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DATE 612J/n
Stories
Value
Value
Value
TOTAL VALUATION
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BUILDING PERfII(j)T
Charges and
Surcharges
'Systems Development
Charqe (1.5~)
/l-d
PLUI1BING PERMIT
Char..ges and
Surcharges
Fence
O!,mo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
SIdewalk
I A/e. Pavi ng
I Curb CU~
I
ITotal Comb, Permit
'30.6/6
~'78b'
I
11ECHAN I CAL PERM IT
Charges and
Surcharges
I
I TOTAL
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examp 1 e- Tax lot 100, Lane County Map Reference
1/ uj 43
2, example- lot I, Block 3, 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender"
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qa~
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check new - if a~dit;on.
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examyle - 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 TEAM 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, 8. Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the appl icant need fill-in only the No. Boxes 'adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are availabie 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 SCHEOUlES
0, 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. .
V, FOR OFFICE USE ONLY
-.
ell OF SPRINGFIELD
City HolI
Sprlngflold. Orogon
Depertment ot Public Workl
OFFICIAL RECEIPT
No. B 68500
Dole /I./#~ -;2'} ~
Rec'd From p~ tfC7r' y'L
Address ~5 M$.N' 5/.
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~eceivedFor: rkBF:;R?OCf7b /L~/?/';'-'
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.. Amount Received# C:;9.ff e;;-. .___._'
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit' applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Infonnation:
PLANS REVIEWED BY:
name 1_A.'7'7~ !~€2?G"~Signature
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dateib-Z'Y-87