HomeMy WebLinkAboutPermit Building 1985-2-19
CITY" OF SPRHIGFIELO
COMBHIATION APPLlCATION/PERHlT
E!lERGY SOURCES:
Heat
l~ater Hea ter
Ranqe
I IrISPECTION LINE
726-3769
.
(Y/A-i 1'1 :.~ Sprl'n~f\~LiJ
CS:.AM'" \iA.l,""''''
17-03- ?(".'3/- ~7c;1a:::>
Owner'J'\c... 1'.rO L 'u.l M.le........
Address JR'li "Kr~~cr s4
f:.......< -ef\ p , 0 r-f'
Constructiorr lender I
Job Address 1/ L.{.. 4/ (p
Legal Oe,eription (J. '^~ lp
Phone
:'Jl.(3- ~ &)( (')
Address
Ut.~lliN It:.J\J1
(name I
Phone
(address)
Primary
Struetura I 6;', t ~
'ff\M 1r ~ ~ .,
Electrical
Mechanical
CONTRACTORS
(name)
Z e fA C; ('" ('\ .,.....J
(address)
'3~i~~~ ^J
Genera 1
PlumbinQ
El ectri ca 1
~1echani ca 1
PLUI1B I NG
-1!Q"
FEF I f.HARr;E
No....:..
Each single fixture
Residence of
Relocated building
(new fix. additional)
INew circu~ts alts.
or"extenSlons .
S.F. Residence
(1 bath I
Ouplex (1 bath) each
Additional bath
1~later service
Sewer
I SERVICES
I
.
I NFORlIA TI ON L. ,'t
726-3753
SO. Ftg. l'lain~c;/l!(""
~q. r=tg. Access.
Sq. Ftg, Other
....J1ew_AddXAlter _~eD.
Fence Demo Change/Use
Other- -
,~
I"
llu~DfHDrk: (j?),
~ 0-00.
BuilriinQ Permit Info: Describe Work(i.e.. Build Single
. ?J~::':;:1d:~hA;:~~~ C\J
r<2f!.y V.J-iA.} rJ-6 (A/'-~-t..,_,
flies. no.l
........
~
\""
()o
l
no. )
(exnires) _
(ohone
(1 ico;.. nn.)
I
I
I
,
I
(ohnnp nn. l i
'1L.{1..~?2 2ft I
J
,I
!
I
U.~ ~ I r'1AlliJ
I
I
~
(pxolrpo;.)
ELECTRICAL
MECHANICAL
CEL.L.lJAB.G.E.\ fin
SQ, FT.
furnace/burner to .
BTU's
Floor furnace
and vent
Recessed wall
~n"rp np~tp~ ~nrl vpnr
ITemporary Construction
IChange in existing
rf>'$; dencp
Imultifamily, comm. or
Indus.trial
Of
COMH./INO. FEEDERS
IInstall/alter/relocate
dic:.trih. fppdprc:.
Storm Sewer
Of
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be valij until the
TOTAL CHARGES
amps.1
Appliance vent
seoaratf'
Stati onary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
amps.
I
I
, ISSUANCF nr PFRllIT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed aprlication 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 n9 fi e 1 d and the Laws of the. State of' Oregon perta i ni n9 to the work descri bed herei n, and that" r~o OCCUPAr~CY wi 11 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 ORS 701.055, that if exempt the basi f ex mpt n is noted, hereon, and that
only subcontractors and employees who are" in compliance with ORS 701.055 will be u~d is 1"'0 ct.
IIAt,IE(please print)'TlP.u;.S1l. \~C\C'\ov-.. SIr,IIATURE 0..
'-F6~ oFirCE USE iiiiLY
Sn. Ftg, 11ain, Value
Sq. Ft9. Access x Value
Sq. Ftg. Ot~ ~E~L Value..2~- .-
a/;:;/:r J'" /; <i4S"6 TOTAL VALUATION
it I:; ~ HI. 1m ~i:~~~~S (~:~~lopment #,4 .
~...,Q /N Ad'- ~_Fas-
7#''Y~~,',e tIP /.-
Zone C C
Tvpe/Const.~
Bedrooms
Units
Ocey Load
Occy Group
A-"3
Fire Zone
FlODd Plain
J
Stories
BUILDING PERflIT
Charges and
Surcharges
.-,"" ~ 'Plan Ck, ConmlInd
~~. 65%/Rldo Ppr ~pp
--------:80- ~6~~Bi~~ ~:~ Fpe
I Fence
I 001110
I Sidewalk
I Ale Pav; ng
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlilT
Charges and
Surcharges
/1ECHANICAL PERMIT
Charges and
Surcharges
L ' I~~ ~t
,-----------,
';;;-1/-2')
OATE rl.?'- t5'"
I
ITotal
I
I TOTAL
Comb. Permi t
-::?~ .1!fjt:::J
-::iT86
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. JDb Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd AdditiDn to
Springtield Estates
C. Name. etc. of owner and construction lender
o. Energy SDurces
1. examole- heat/electrical ceiling/or forced air qas
2. exam)le- waterheater/electrical/or ~
E. Square footage or valuation. etc.
1, example- 12SO sq. foot house. SOD sq. fDot garage
2. example- if new project. check new - if addition,
checl< 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. example - convert single family residence into
restaurant (change of use)
G. Value Df work as defined in SectiD" 303 (a) Df the
Structural Specialty CDde
H. DESIGN TEAM 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
tD the apprDpriate item(s) tD 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
O. As nDted on the CAP. the label must be delivered tD 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.
'k-=lr 0 ~ aJ-J
fd.t1)9/!.l
V. FOR OFFICE USE ONLY
Permit Cl erk
hi
.1
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~T/i!!>H.#~ ~7i..~.f!T"'<, _f'??e .>f~~JiU!Z> ,-::...><
p ':">~/,M:;'.,-_ _~i':c:.H{'P-J!"&.JC ~77 ~.;IIV
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~~/ClC._
/'/?-t$Dr p/ ~.n-<!:J~
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, Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
" ~.
PLANS REVIEWED BY:
name~~ ~~~ Signatur~;._,e~L -.,
date 2-/~S-