HomeMy WebLinkAboutPermit Miscellaneous 1990-9-7
I INSPECTION LINE
726- 37 69
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Hea t EL~c..
Ilater Heater c..AS
Range c,AC;
ValUE of Hork:
$~~,OOO
BuildinQ Permit Info: Descr.be Workli~e..
Familv nesidence With Attached Garaaej
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INFO~\ATION LIOt
726-3753
Sq. Ftg. l'Iain_2"1'O>0'l'
~q. Ftg. Access.
~'l' Ftg. Other
Jl!lew_Add_Al ter .-Rep.
Fence Oemo Change/Use
Other- -
~
~
~
Job Address /9a:> M.;p-:;q Ce>t,AI' 7I}?
Legal Description \ rJf'\,.:(f~ ~ -\ ~ 00 tk:;:O
Owner . JOE\(A~c..H(:Ji:.
Address 2..q(.,~ SAMH
(Jet ~srAWRANTS)
LN.
S~INuFIf:L-D, OREuON Q1401 34-2.-10551
Phone
Build Single
t-II:W (,AJ<:L.:S J~. 1C:ESTAU~ANT
Construction Lender,
Address
DESIGN TEAM
tnamel
Phone
iaddress\
-z.q W.2"l"!!:!.STll:E.t:T
E.11r.I't.JC, ~r:'"\1oJ
(l;es. no.l
(exnires)
(ohane no.'
Primary ~RU(.E E.. SIl..jICEYAI~LH, pc..
0101 r::>C 12. - 31 -qo
343:-"I1,"'I4
{namel
(addrpss\
(lics. no. \
tiI
,.,.,""~"". "" ,
Structura 1
"
Electrical
"
Mechanical
CONTRACTORS
"
General ~C.t;>/, I$'lt- 'W'ILLAMJ::iTl=- <;1: I::U(..I!.N~. Ii~, 4~:2:S
Plumbino ""'1J&:,Rs.A?;t:::;.
Electrical \. //~ ~~
Flechanical · "J1c?J~~~.,:ft"
J
A-IA-Q,\' ~,f;>,,,,>- f'>l\.:L
PLUI,IBING
ELECTRICAL ' MECHANICAL
FEE CH~RGE NO FFF rH'.B.IiE NO, FFF C'JABliE.
Residence of I ~rJ~/burner to 7.~
1S7.:2 SQ. FT. z..... ' ,~ BTU's ~..,.../~,*,
~/"""'/!,Ir "'""
~ New circu~ts a1t5. Floor' furnace
or extensl0ns j?t> and vent
SERVICES Recessed wall
Snac~ heatPf and vpnt
NO,[
Each single fixture
-:ZS-
Relocated building
(new fix, additional)
S.F. Residence
II bath\
Duplex (1 bath) each
Additional bath Temporary Construction
I'" 'water service .,z__ _ Change in existing
,. ~ rpc;jrl~.nce
'''' 1 S 00 multifamily, COITlll. or
.,~ ewer ~. Industrial
~~ 'Storm Sewer ~- / Of ~C> amps.
L fJ;;~~",- ~M UE- 7..1tt> _ COMf1,/lND. FEEDERS
Install/alter/relocate
~istr;b. feeders
'It>
--
/'
Y
~
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with '2 ~ """
sinale duct .; ~~
Vent system apart from','~ 'P~-
heatino or A,C.I"~. .,,~~
Mechanical exhaust //~~-
hood and duct. 7r',?- t-
Wood stove/heater
I Of 1"'2~ amp~ C;-o '7 ~Kt7"""/L";;'..J .:5l>~-z5l;
-::? ~-:::?5'" ~p
a.:c;;r. G:..,;",/, ~~~~.::~....
. (l- -:6'd~~ ~,~'r ISSUANCE OF PFRrm
TOTAL CHARGES ~ 2<0 . -. , TOTAL CHARGES "2....:?~ ,TOTAL CHARGES 5.0 .~O
WHERE STATE L'\H REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this pemit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 performed 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 ,flO'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 compliance ~ OP.S 701.055 will be used on is project.
~.e <;.IN.L<.!Z:-'t' ./ '
HN1E(please print)
DATf1.f.? ~f)
BUILOING PERfllT
Charges and
Surcharges
SIGIIATURE
/,"; fXl. Y "-. FOP. I FFICE USE DilLY/' "~
Typ 7Const., W Units "'-- I Sq. Ftg.r1aIn-?~"c:?' , Value 3 'I "/ ~
Be rooms Occy Load ~ Sq. FtlJ. Ac~s x Value
5t . / Occy Group A-'3 /,5q:-Ft9",Other%ION~ x Value ?~a~Q
. ( 7/~' l1J 1 TOTAL VALUATION;' V~ ""'2>.
Plan Ck. Conm/l~<W-\ - Systems Development
__2~-S::.?-.~__M!/81dO p.pr Fpp",,"'" <5'n..9~ ~~harq. (1.5~ ~J?5"
ifL" <> Plan Ck. Res '"
.". . ~ 00 30%/81 do Per Fee .........
___~-:;{~.;.~___ Fence -------?c,#~fC/.i'/4"
I ~. - Demo.
.~/-,v. .'b......'Sldewalk
- -'/-T y.~ AIC ,Pa~i-!,g
__n:ia,,-~~__ Curb Cut
~,5tJ i
/,/,d"3 )
Zoire~
Fi re Zone
Flood Plain
PLUr~BING PERMIT
Charges and
Surcha rges
I ELECTRICAL PERIIIT
Cha rges and
Surcharges
,
::? / S"
Tot~l .Comb. Permit
1?5~."'Z8
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL\.o;t3~ I
~.7' -I , '-/1
. .-':":-'. '-; -" .
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COMBINATION APPLICATION/~ERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, lane County1Map Reference
1/ oj 43
2. examele- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examyl,e- heat/electrical ceilinq/or forced air Qas
2. example- 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,
cneck add. etc. . .
F. Building pernfit information:
1. examole -:construct single family house with an
a ttached 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
Structur,al Specialty Cod~,
H. DESIGN TEAM AND CONTRACTORS
. To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design infonmation 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 fonm 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
wi.ll 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 penmit is issued.
V. FOR OFFICE USE ONLY
.
. PERMIT VAll DATION
:"' ...
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Permi t' Cl erk
~Q)
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PROJECT ~ONDITIONS TO BE SATI~FIED BEFORE-O~ r/?ar/? /S5P/j"/Yc3 (
;Y~o5'):::;be?J j)7f/ZZpPfr~ /#!~/?~~/YT k/<?f'
10 ?a:J/:#/T /"75?>'H.4/r?, y..~ ~~ V- ~HA' p-
... - - "- _ 0' -
/Y.A'.
Permit applicant exempt feom registration wit~ the Builder's Board because:
, ~
.''-.
Additional Project Inf~rm?tion:
, . ~
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PLANS REVIEWED BY:
name ~J&J.N~ ~~~ignature ~~--:,_~.. date 9-;:>-5'0
-/r ,,..
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