HomeMy WebLinkAboutPermit Building 1984-9-28
.
.
'J IrISPECTIOII L1r1E
726-3769
Job Address 7~ 7 ;:?1~/ sr
Legal Description \'1 () ~ ~ ~ l.\ I(
CITY OF SPRINGfIELD
CDMBIrlATIDN APPLlCATIDN/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ran~e
() 'I ~('Y\
INfORlIATION LINt
" 726-3753
Sq. ftq. 1,Iain
~q. !='tg. Access.
Sq. Ftq. Other
Ilew Add Aller Rep.
--Fence Demo Change/Use
Other- -
o
b
"
~
~
0<:
Address
Ut~lliN TEAl,'
(name)
Phone
(address)
va~J of Work: ~
--If. d CJ , Q'Ofj
BuilGlno Permit Info: Descrlbe Work(i.e.. Build Single I
i~v~:tt~M"./..d~!
~-I~ Qp. l.ibjZ-
Owner aJ+ ~d IAI A-7
Address ::);::)() 0: ~C?~
,G't.u:J04t.P 9 79"0. \~
Construction Lenter 'lJi.G- l \ \.\ \t '?-.,
TER">
Phone l,I J-s -
.s(p 3'0
n 1CS. no.l
{exniresl
(ohane no.
Primary
*
Structura 1.
Electrical
Mechanical
CONTRACTORS Inamel
~/V
y <Jj~k~.~/
~~~ 0-=/12.--:1::,' _ J
(address)
11 ice;,. nn.)
(pxoirp,,"\
(ohnnp nn \
Genera 1
Plumb;no
Electrical
~Iechani ca1
PLUllBI NG
ELECTRICAL
,
FFLIJ:.I:!ARGE. /In
MECHANICAL
ND,
FFF CHARr.F Nn
SQ. fT.
furnace/burner to
STU.s
1='H r~ARG.E..
\'5
Each single fixture
5:- %:-
Residence of
Relocated building
(new fix. additional)
\
New circuits alts.
or extensions
"thY'" ('0 \-o\r'\O~
\~-:- \7::,~
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tp~ ~nrl v~nt
~Ia ter serv; ce
ITempOrary Construction
I'Change in existing
re<;jnYfI("P
Imultifamily, COrTl!l. or
Tnduc:trial
Storm Sewer
IOf
I COMl-I. IIND. fEEDERS
I Install/alter/relocate
rlic:trih. fppnprc:
IOf amps.1
I
I
I
amps.1
I
I
I
I
I
I
I
I
I I
\~.=
Appliance vent
C:E"oaratp
Stationary evap.
cooler
Vent fan with
c:inole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hnod and du~t
Sewer
Wood stove/heater
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
~ r;:,= TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE Of PFRllIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit, and do here~v 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 Ore<]on pertaining to the work described herein, and that rlO OCCUPAUCY will be made
of any structure without 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in como1iance with OP.S 7n1.055 W~)2()~C14 5,....,/7&r-
NAJ1E(please print,-.ftr<-rA 'Lv, \ ~/h4'fo~~~,~:~~A:~~~/.f/t..J~ DAT9d- ~Ut
Zone, (" r Tvoe/Const.\\hJ '-'fX'l.': Units Sq. ftg, 11ain x Value '
Fire Zone Bedrooms Occy load Sq. Ft9. Access x Value
flood Plain Stories Occy Grou;;\~''? Sq. Ftg. Other ,x Value
BUILDING PERHIT
Charges an~
Surcharges
~ '2 ,CO ~~ a~R ~~~
------------ ~
~ COB Plan Ck,
,,. 3D%/Bl do
_____:l~.??__ fence
3,00 D~RIO
______\.':!,co ISidewalk
. ~ I A/C Paving
____ --lG:.'L:<:e-11 Curb Cut
IJJ)
Co","1I nd
P.fr Fpp
Res
Per Fee
f. :tt..b~"~
69.:l2 W-~I/.
I
i
I
I
I
I
I
TOTAL VALUATION
Systems Development
Charoe tl.5~) ,
~\.~
PLUt~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
'1ECHANICAL PERMIT
Charges and
Surcharges
TOTAL
\ C\q .f.d{
,
\~
.C~~
Total Comb. Permit
5?i../ 0700
,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax Lot 100. lane County Map Referenc~
II uj 4j
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electricalior 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 addition,
checl< add, etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garz~ge
2. examEle - 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. OESIGN TEAfl 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, & 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
Z. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
O. 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
.
PERMIT VALIDATIDN
/JJJ i?fI> '"$'61
~/:1/8<1 ~
Permit Clerk ~~.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~I I -:t\ \ \ ~\ _ Y\ 1'2-,ffi"\\l1. "\.?.., ,('J ~e ~\-'\-'V()\)e\:) ~~'GF.=
(!\c (,\ ~\. \(' "~,
Permit applicant exempt from registration with the Builder's Board because:
/1 ..../jLE....//_--'
~/;?f-"~,/.,,/
r- ~(/\/. e;:.~ ,
signatur'e\,~,A ~ ~" _ \/ date\I)~~-~~
-- " . - ,
Additional Project Infonnation:
PLANS REVIEWED BY:
. na;e\ )~ '.\';1\~'l-\ \~
."
--
1