HomeMy WebLinkAboutPermit Building 1993-7-10
I INSPECTION LINE .
726,3769
Job Address \_o'l~Cl \'\\'() 1,.(\ ...0\15QQ+,
Legal Dmription \ Yl 0 'rl.,~44 \ ()l rYiOl
- - Range
~ ~. ValuE of Work:
Owner '-dJ\(\ 'O.L. \)\N\-1J(( J (19~o- He>
Address 4\4A)o ~~~(\tq~;tJ~~r) \ ~;t:~e~~~g~:rr;~~~lB:iLngle
"''''":;:.~, \ ~ ~ >'+/(03131 ,c\\m+mR~ I !nil>
Address Phone
UI:.~ll;jN II:.Af1 (name) (address 1
CITY UF SPRINGFIELD
CDrlBIrIATIDN APPLICATIDN/PERMrT
E!lERGY SOURCES:
Heat
Hater Heater
.
INFOR/IATIDN LINt
726-3753
Sq, Ftg. 1,Iain
~q. Ftc]. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
-Other - -
I~
-
C>
:)
t-O
~
(lies. no.)
'.,"'~
(nnnn", nn \
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS {namel (address!
General I K)1 i )()a.f')
Plumbino-ll\l ~V) lllf\\D.llC"\
Electrical \?'\\... 2~ Q c+nC' , (j
~lechanica1 \\ \~
PI.UlIBING ELECTRICAL
(lies. no.)
(pxoirp~l (ohnnp nn \
MECHANICAL
NO.
FFE CHARGE Nn
"L J:l:!ARG.E. NO,
~~~ r':iARG.E..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlJ' s
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath!
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~OA~P hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance- vent
o;;poarat~
Stationary evap.
cooler
V~nt fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnd du~t
Sewer
Temporary Construction
Change in existing
re<; i nJ"JI("p
multifamily, comm. or
IndlJo;;trial
~Iater service
CO~~./IND. FEEDERS
Install/alter/relocate
dio;;trih" fppdprc:
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
,,4 ~P..4~?C5 ~ r/>>~ r
-5.,1'f'.'lU..' ;;:>~~"~"l'~.6~
1?~' CLtEC7. U.J~
TOTAL CHARGES
ISSUANCF OF PFRillT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
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 Derformed 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 OCCUPAIKY 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 OR? 7~1.055 will be used on this project.
NA!.IE(please print) /'k-w U/4 .A.
-- # #.
, '
SIG.MTURE /~ '..,
FOP OFFICE USE OiIL Y
u? ~ t:;/
~ ,
DA,T<" /'0 -7/'
,
Zone~~~,",~ Tyoe/Const.
Fire ZonJ' Bedrooms
Flood Plain Stories
5-;/.
Units
Occy load
Occy Group ~-/
Sq. Ftg. Hain x Value
Sq. Ft~. Access x Value
Sq. Ftg. Other ~n/) ~/'2 x-3R ~Value /~ 9AP,:te>
TOTAl. VALUATION
/
BUILDING PER~IIT
Charges and
Surcharges
~ Plan Ck.
___ZA___~c:.__ 65%1B1do
". Plan Ck.
'7- t>;;>::3 30%1 B 1 do
COITlTl!l nd
Per Fpp
R"es
Per Fee
~/:>./~
Systems Development
Charoe (I.5~)
/?q. 7/
PLU'1BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICAL PERI~IT S1dewa1k
Charges and ------------
Surcharges A/C Paving
Total Comb. rermit
/lECHANICAL PERMIT
Charges and
Surcharges
TOTAL
j; 36. 77
Curb Cut
.
.
COMBINATION APPI.ICATION/PERMIT (CAP)
PERMIT VALIOATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100, lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
,prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Q3S
2. examole- waterheater/efectrlcalJor 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,
ehee k add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. exam~le - 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 TEN4 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 DIVISION STAFF WILL FILL OUT ALl. FEES AND
CHARGES ON THE SCHEDULES
O. 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.
r---.
'}~/O-q I
tf (}Ofoa3
V. FOR OFFICE USE ONLY
Cl"~ )
Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name LLPR/V~
~~E~ignature 4.-'>~~....---, date
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