HomeMy WebLinkAboutPermit Building 1979-9-27
CITY OF SPRIrIGFI,LD lNIORt!ATlDN LINE II
COMBIIATlON APPLlCATlON/PERI1IT 726-3753
!La4~ . II 4 n ,_. . "'.....Ar--. IEnergy Sources: Isq. tt. m'.ln & accsy. biOS
?I-I~ IV~ ~ heat ~T ~";oo-i:. (IDO
I 0 ~ter heater ~ r::;r-'f" _newX-add-Yalt.er._rep ~
legal Oescription \'''1 02 ~(") "Ii" 0 ranoe __".... fence .reinol1tl0n
f $ 7Z ~ change/use other
AAl:5I.'nZL lU:>1A/"JU 'fio2..alU""""'-l1 _ lue 0 work: ,000 - - ~
'oJ-tru> ' ulldlng pernnt lnfo.: descnbe work (1.e., bUlld I
Owner (name/address/~) ~L"D ~~ ;;nole fam. res. with detached aaraae)
::s.f1t;; Afl>t2.U::u> ~ ~~ ~~J;.~1:. I
JZ1o.Ig.t.,6 s.1'eJ~'fi~ t:L t'/?4-11 ~s. ~ l'.bJ..)~ccr ll,.,...t:') 1,"\
Construction lender (name/address/phone) / -r2> LeIJ~. I
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{ohane no. I
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IlIlSPECTlOll LlIIE
726-3769
Job Address
Ut~lliN itAr.,
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~lechanical
~
.
f0~e..
{nameJ
(address I
(exoires)
,
~//J\-_.
"': .,,'
~~\
,; v
(1 ics. no.)
~~
(name)
(addrp'is)
(ohonf> no.)
(1;e5. no.)
(exo;res.)
~~
\t ~ M --PL.0Mt;l~
G'" S ~~Cte.lL
::;:PDAA ~ ~:nL-
>s~,; ~ f "':Re..
Z 140 (J::\.,.-n;:;,..11JJtL. ~.
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1~.~z.
344-- zz~
s+-;. "S71v
PlUI!BIIlG
MECHAIIICAl
ELECTRICAL
FEE CHARGE NO.
I FFF rHARGF NO
r1-lARr.F
~iEach single fixture
Relocated building
(new fix. additional)
TOTAL CHARGES
WHERE STATE lAW REQUIRES
shall not be valid until the
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
~later service
I Sewer
I Storm Sewer
'"
3~ I{.J..PD 'f
furnace/burner to
/..!;>!?""J?'? BTU' s
/b~
noor. furnace
and vent
New circuits alts.
or extensions
Res i dence of
~16~
SQ. FT.
Recessed wall
SO<lrp hPrttpr rtnrl vpnt
ISERVICES
1
3
I
Appliance vent 1
c;poari'ltp
Stationary evap. I I
cooler
Vent fan with l..,c;P 1 /c;1fit)
sinole duct IL
Vent system apart from I 1
heatina or A.C.
Mechanica 1 exhaust I 1 ..et:>
hood i'lnd duct ~...
I I
1 1
I I
I I
31J9
'4~~:;- 9"OTAl CHARGES
Electricaf Contractor, the electrical portion of this
Supervisor and returned to the Building Division.
perm; t
ITemporary Construction
IChange in existing
resJ ~f!.nce
Imultifamily, conm. or
Indu<;t.r;al
~IIOf ~
ICOMM./IIID. FEEDERS
I Install/alter/relocate
r1ic;:trih fpprlprc;:
10f amps. 1
INew circuits, alts.
nr py.tpn<:.inn<:.
I
I{~G
I
I
1
I
I
amps.j
I
Wood stove/heater
I SSUANCE OF PERI1lT
I
1/,;z@ TOTAL CHARGES
that the Electr;cal work be done by an
label has been signed by an Electrical
I HAVE CAREFlILl Y EXAMINED the camp 1 eted app 1 i ca t ion for penn it , and do hereby cert i fy that all i nfonnat i on 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 describe herein, and that NO OCCUPANCY will be made
of any structure With:~ ,t:7issi,oln..:'~ .:he, Buildinq Division. I 1\, ., DATE '~~2'l}'"7Q
NAME (please print) ~ \~ ~l'< SIGNATURE ~.'" 'If' /~
-r~ 01ttL.P LeW~~ I
Zonest1...~. P-R 77X
.
Deey Load
BUILDING PERfHT
Charges and
Surcharges
PLUt4BING PERMIT
Charges and
Surcha rges
ElECTRIC~.l PERI1lT
Charges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
FOR OFFICE USE OIlL Y
Sq Ftg. 1IfJJL/.If'!v
Sq Ft.g..:]1Jnf'J I1I."'P?h.
~'
Value~'7-7
Value ...
c ..
Flood Plain Bdrms Type Const. !!-AI
Deey Group ,fl-Z- Stories I Units
ACe U U N T SUM MAR Y
Plan Ck. COllll1iInd \~ \~0 "...
______~:s.f'_~Q 65%/Rlda ~er 'ee \J. ) '?Y7J-H
Plan Ck. Res
9.:1if 30%lBldQ Per Fee
"'-tl Jf':f' Fence
_______Lc_2;d_
;. b II I Sprinkler System
Storm Sewer Connec.
Other
Other
_ _ _ _ _ _ .1t1S.fJ.9_ Demo.
11&1 /,)(".,.: .~
Oth~..;:/..;,*;.: :1-);:y.t1o
I '
T9ta1 Comb. Permit
r I <,0/
DC ._ /r:.
I
1 TOTAL
~~-- ~~
. t J.. ~ '- ..:.;.
':""'." .
.
d.c!?~
A/C Paving
~ .
. .'
__~~~~ Curb Cut
I./~~,.-{j I Sidewalk
~ 7ijo. '1'1 J
.
COMBINATION APPLICATION/PERMIT (CAP)
I. 'A~Pllcant~ t~>'f~rn1Sh '1~ ~~j'''J.',;:/
A. 'Job Address - : '\ ,#,.
B. Legal Description' ~ .
1. example- Tax' tot.lOO, :lane County,Map Refere.nce..
II 03 43 .
2. example- Lpt 1. Block 3, 2nd Addition to
. ~pringfi_eld ~s~ates .,.... .' ".... r
G:' 'Name, 'etc. of ow'ner and 'construction. lender
D. Energy Sources ' . .'
)..,... l.",>"examole:- heat/electrical'ceilinQ/or forced air Qas
2. example- wa~~;heat~rlelectrlcalior solar
E. Square footage .or valuation, etc. .
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. example. construct single family house with an
attached gar.!lge
2. examole - remodel existing garage into f~mily room
3. examole - 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. DESIGN TEAl.' AIIO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
I ~' ~ persons regardi ng des ign i n,fc.fmation. or .job ..s i te
. corrections, etc. . . . - .
H;. 'Abbreviated Plumbing, ~lech51n'ical, &'~Electric.a'.l Schedu1'es
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
signature. I'
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
~
, .
-
.'"'.~~
PERMIT VALIDATION
. \. ., '. .
BP Q..:5 ( .00
-. ,.....\ , 40/0, C'f.14-
.,. '.
rP 47.00
4610 .1 ;iPB
'rP ~'5. ()O
.. CfD)D 2..00
hp Z<c .00
qoJ15 IIT~
5DC -e, <-Vi. 60
-
~. :136.40/
~
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?d q~'G1-19
Permit Cl erk
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