HomeMy WebLinkAboutPermit Building 1988-2-28
-
...... _. H ..._......;,-.
I INSPECTION LINE
726-3769
.
CITY UF SPRINGFIELD
COMBINATION APPLICATIONfPERMIT
.
INFORltATION liNt
726-3753
Sq, Ftg, 1,Iain
~q, Ftg, Access,
Sq, Ftg, Other
New Add Alter Pep,
-Fence Oemo ChangefUse
-Other- -
~
tJ
Q
IX>
#49nn lI~rf #48nn
Owner FIlTllllF Iclr.,r,nll-; ('(1
Address 3112 _ 3114 T,,,ml.t'.JLia1.
<:'r>J11Vlol.,;p1.d. OIL 97478
Construction Lender Fu;flJJtP LoooiVln Co
Ave
Phone 747-23
ENERGY SOURCES,
Heat
\~ater Heater
Range
ValUE qf.~ork:
/'".;' _;.<1>.?~ ' 'er<'
BUildln~ Permit Info: Describe Work(i,e.t Build Single
IFamilv nesidence With Attached Garaae)
//Y~l7I~t:.. #eJ-y Zf>~.5E?-> ;?~
~ f?E7?~~€- Gif'PS.7%;.;;..... :~T
;t?crc:>F
flies. no.)
Job Address
~112 I 3114 TVldflldJrJaI A"p
Legal De5cription TWN 17
Ra: 2
See.: 30
Address
Ut""N ItAI1
{namel
Phone
(address)
(exoires)
(ohone no.'
Primary
Structural c;15CJR.GE L. qRlffl'N. f!E:
~8bft> kfltN{!)'<..VIl; 2.( &.1.0
~1~1=I'I/l' "..~-r1 <71'r,
. , , I .
('2. - 31 -e,B '14(.,- '2. '2 So
Electrical
Mechanical
CONTRACTORS
General
(namel
/frVce.-
/1!hJ..d
jadgre~J ((lies. no.) (pxoirp~)
l/I;A~o..!i.' ll,"r~l1rch'ls-\ 2609/ '#I€~
(ohonp nn_ 1
?2C-~69L
Plumbina
Electrical
t ,"" 1""\
-, ~"'1
~'1"'e,
",'"1
~lechanical
PLUJIBING
ELECTRICAL
MECHANICAL
NO,
FEr cHARGr Np
~H. rl-l.q,&G[ NO
SQ, FT,
furnace/burner to
BTU's
l:~~ r-uARG.E...
Each single fixture
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~,..p hp~tp~ anrl V~nt
Sewer
ITemporary Construction
IChange in existing
, rp$ ; d"'p.n"'~
Imultifamily, COnIn. or
Tnrlu<:.triil.l
IOf
ICOMfl,/IND, FEEDERS
l'Install/alter/relocate
,di~trih. f~~rl~r~
[Of
I
I
I
amps.
Appliance vent
sp.oarat~
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from
heatin9 or A.C.
Mechanical exhaust
hood and du("f
Wood stove/heater
~Iater service
Storm Sewer
ijmps.
ISSUANCF OF ~FRIIIT
TOTAL CHARGES TOTAL CHARGES " TOTAL CHARGES
WHERE STATE L\I~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not. be .valid until the label has been signe~by an".Electrical Supervisor and reFu.rned to the Building Division
I HAVE CAREFUllY EXM1INED the completed application for permit, and do hereby certify that all information hereon is true.
and correct, and I further certify th~t.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 UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~ith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
SIGrlATURE_.L.:.4(l~ )
,7'1"'1 4, C.HR ls.r/AAJ
DATE Jh-'/ff
IWIE(please print)
FOr. OFFICE USE or,LV
Zone_L /S? / Type/Const, ~# Units Sq, Ftg. 11a;n
Fire Zone Bedrooms Occy load Sq. Ft9. Access
Flood Plain Stories / Occy Group :1:?-2 Sq, Ftg, Other ~
~~-;:~~h~~;:~;;:,{~ ,?-If) Jf.~
BUILDING PWIlT - 1/./ -0 Pian Ck, Conm/lnd J,;l7... '2' Ilnqq' Systems Development
Charges and __JL~:..2____ 65%1Bldn P,pr Fpp fLvo7.", , Char~e (!.5~)
Surcharges"' .c-> ~? Plan Ck, Res T\\\ '
d- '.J .0;;> 30%fBlda Per Fee \.Y
x Value
x Value
O..-9L..... Value
TOTAL VALUATION
/6_""&e:>
;
//4
PLU11BING PERMIT
Charges and
Surcharges
Fence
D/IlllO
ELECTRICAL PERlm 'Sidewalk
Charges and ------------
Surcharges A/e Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
/'2<,:33
;
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
,
,.
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 oj 43
2, examole- Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender,-
D. ,E.nergy Sources I \ .
1. examole- heat/electrical ceilinQ/or forced air Qas
2. example~ waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
check. 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 of work as defined in Section 303'(a) of the
. Structural Specialty Code
H, OESIGN 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
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 OIVISION 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.
If :;5).-
~ /.5 ~ ~
V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
7#/.5 fr~/€cr ~...c;/""r- 6'c ~~...,rL"~h /...h77C:
~);;?~cn-:_~ /nsc L:sr L/.n<'G'.~?VP5r/"1P~.."ty7
Br ,~~;P~ Y.'/B)...;?;
cu
'~ /7h?;~_r-
~
'"7>
. / )~a>c...>/.?'?~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name LP~$<E/t,EZf:E~
Signature/'2-"...-.-. ~~
/' /' ,;;r
date '/-:S".6C