HomeMy WebLinkAboutPermit Building 1984-1-18
II INSPECTION LINE
1I726-3769
Job Address 1485 Market
legal Oescription\~ a~ 2.6
41_ Lease'
CITY Of SPRINGFlElO
COMBHIATION APPLlCATION/PERMlT
E!IERGY SOURCES:
Heat
Hater Heater
Range_
ValuE of Hork:
$4,200.00
Phone 746- 50 3lf~~~~~n~e~~~~~e Inf~h A~i~~h~~e G~~~~~ 1-.e. I Build 51 ogle
~w.ACzf)
~~
no.) (exnires)
1.t
-
.'
~~
\0605
"
Gene Bartlett
Address 90366 Shadows Drive
Springfield, Oregon
Construction lender
Address
UI:.:'ll:iN Tf.Af~
Primary
Structural
Electrical
{namel
Phone
(address)
,
~'"
!1echanical
IfONTRACTORS Inamel
General Fredrick Christiansen
Plumbina
Electrical
~lechanical
NO,
(addrpsc;)
Construction 658
(lir:<:;. no.)
Fairview Spfd. 39287
(nhflnp flQ- \
747-1381
Dave 0 sElectric 401:5: '. Main Spfd.
PlUI1BING \).I~
I FFit rHARr,F Nn
ELECTRICAL
Residence of
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
1\ 5.c::t \5 cD
I I
I I I
I I
I I
I I
I I
I
I
I
I
I
I I
\~.OJ I TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an,'Electrical Contractor, 'the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the BUilding ~ivision
S.F. Residence
11 bath)
Ouplex (1 bath)
Additional bath
Water service
I Sewer
IStorm Sewer
TOTAL CHARGES
\
New circuits alts.
or extensions
each
I SERVICES
I
13240
~~~ r~4Qr.~ Nn
INFDRllATlON LINt
726-3753
Sq. Ftg. I-tain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Al ter Rep.
Fence_Demo _ Change/U se
_Other
CX)
~
C)
Q
~
~
ITemporary Construction
IChange in existing
rps.i d_e.nce. .
Imultifamily, comm. or
Inrlu<;triil.l
IOf
ICOMI-t./INO. FEEDERS
I Install/alter/relocate
r1i~trih fpprlpr~
I Of amp~1
C1TCUJ."'C I
liS amp. to
uu lb.Lc..s .b.Lgu I
8 nllHl'-inR
I I
amps.!
I
I
TOTAL CHARGES
(Dhone no.)
(pxoirpc;.)
3-19-84
5-10-84
746-5640
MECHANICAL\" \\ ~
~~~ r~4l)r.~
furnace/burner to
BTU.s
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust '
hood and rllJ~t
I Hood stove/heater
ISSUANCE OF PFRIIIT
I HAVE CAREFULLY EXM1INEO 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 Springfield and the laws of the State of Orec,:lOn pertaining to the work described herein, and that rw OCCUPAHCY 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 compliance with OP.S 7Ql.055 will be used on this project.
SIGrlATURE 'rr-tWo~ ~,Q,~"",,0.6JU-o./'
Foii"'o'r'FICE USE OIll Y ~
Sq. Ftg. t1ain x
Sq. Ftn. Access x
Sq. Ftg. other.3.R?--.~ x
IIAHE(please print) M A<>CE:fJ€
20ne CJ
Fire Zone -
Flood Plain -
BUILDING PERflIT
Charges and
Surcharges
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
~
I1ECHANICAl PERMIT
Charges and
Surcharges
CHRISr/AN5.erJ
Type/Const5-U
Bedrooms
Stories
Units
\
Occy load
Occy Group~-~
--::2 (') C:C::> P I an C k ,
___~,,~_____ 65%/Bldo
2. 0 Plan Ck.
\ ~ ~ 30%/BldQ
___~~~___I Fence
OfIRIO
CO
COIll11/1 nd
Pj'r FpE'
Res
Per Fee
;-:/!; i'l rAJi_
-!J.{) ~o "4oZZLLJ
\5,
--------~-- AIC Paving
_ --.k). \ ~ __ -' Curb Cut
~ I ' '
'Sidewalk
DATE 1- le-84
Value
Val ue
Value ,-/, 'l_()/')
TOTAL VALUATION
\01~
~--\\-- ': I~
Syste~s Development
Charqe (1.5%) ,
Total Comb. Permit
k\ ~. 8B f
TOTAL
,
l
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
II uj q3
2. exa~le- Lot 1. Block 3. 2nd Addition..to
Sprlngtield Estates ..'
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- 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 addition,
cheCK add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examele - conver~ 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 TEM~ AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
perSOilS rega'rd1ng :design in'formafion 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 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
signa ture.
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
(,l .t..
-
~
PERMIT VALIDATION
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J'Penni t C1 erk
~~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ ~\~\ \\')'b'->F.C'"'t\C"\\\,q.. "Tl"'\ ~F: ~QQQ~("') \AC=.~~_E:
D('{\.\~~"\('~
Permit app1 icant exempt from regi strati on with the Buil der' s Board because':
Additional Project Infonnation:
PLANS REVIEWED BY:
name\'"")~'\C"\ ~"9\.}.,~~
Signat~....A~:'P"" \r dt~e\':"'\~-~"-\
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