HomeMy WebLinkAboutPermit Building 1984-10-10 (2)
I
jlrlSPECTIOrl L1r1E ..n. CITY OF SPRIrlGFIElD INFDRl1ATION l,r1L II
726-3769 l'l t ~ l~., COMBHlATlON APPLlCATI,Orl/PERMlT '. 726-3753
J b Add ./--7 ~ //1 i / I LIERr,y SOURCES: So. Ftg. 1'lain~L.S.
o ress "-7 ? ';f O..A-f' ~..e 6::::J:U..-:t- Heat ~q, ,tg. Access.
legal De,cription I'''~AO''.''~. ~.'~. '......~ LI"'~~ ,Water Heater SQ. Ftg. Other
/' vc ;)J . ~." ~~_ "'f.r <J'C/' -1lewi:Add_Alter-,~ep.
J ill d U ' _ . I Ranqe _Fence_Demo_Change/Use
~ Z!. '7 ,~/~~_.It&aluEJ>f l'lork: , _Other
Owner LI/1.f'~ ~L- '...,(,l,,'.. ri.o_"..-.v ,#L(~ rro-o-ro
Address 170 .4 ri. / Ph fo!r7 - Buil<i\nQ Permit Info: De,cribe \/ork( i.e.. Build Single
\"-- J A""fl :J -:; (tJ <'1 _ one _ . . l' F~i 1J ~eS~id;nce \~i th ".ttached Garaae)
1:.>y" 9~,t{J 97</{Jrl- ' ,,/ ~n<.t. JJ~.h.~ #/
Construction Lender ftr1-'t ~/J~.A Y ~JJ~_
Address Phone "\
Ul:.~l(.iN IEM1 (name) (address). flies. no.1 (exnires) Cohone no.
Primary ~}~ ~~F~ .,IRa. ,/~~ ~H?:iJ.~ ~~ Ev~8tE ~ ~- 'E " /1
Structural "5A/II~ Jfhr~.. 1YJ& ,~~~ot!'=' ~ ;Y'z:l>1ov PCe::.CAs.uJ. '\-vi
:::~:~;::: ~
CONTRACTORS lnamel (address) (lice;. nn) (eXOirpc;.)" '.j (ohnnp no.)
,
C)-
~
~.
()
~
OQ
Genera I ~ rYLP A ~
Plumb;nQ ~~.Ila-d III
Electrical (3jJ cfd,,,,, ? ~,
~s'S''k7 {bj.6.II,L
~O,& IIJVcJ..1
~~'<.r;,~
<.;..a.!lr:
iV,W<J
1:2~(/
(,,87-/</:f /
7L1b::!L<,i-7, ~
t.;,J(("' -O~
~'echanical
, PLUflBING
ELECTRICAL
MECHANICAL
..JlQ..,,'
'I Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath I
Duplex (1 bath) each
Additional bath
I FFF I CHARGE
5:- ~.s:-""
llil..-'
Residence of
I ~~~ 'rl-lf1RGE- NO.
'1=1=1=
, r"ABliE.
SQ. FT.
furnace/burner to
BTU',
New circuits alts.
c...- or extensions
7~~~
SERVICES
JS:-
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
1$(:)' Sewer
1/500
Temporary Construction
Change in existing
fp)iqp'f1t'p
multifamily, camm. or
Industrial
/ Of """'....-> amps.1
COMM./IND. FEEDERS
Install/alter/relocate
n;~trih fppdpr~
I
I
I..(~.' (
I
I
:3 : #e~r 7t-,.~
Appliance vent
seoarate
Stationary evao.
coolpr ~ .
U I' Vent fan with
f sinole duct
I Vent system apart from
heatino or A.C.
I Mechanical exhaust
hood and dur:t
I I-load stove/heater
I
1
I
G. ....I..s.-
I
I
...- -
.1- 1':<.
~Iater service
Storm Sewer
Of
amps.1
ISSUANC, OF PFR'HT
TOTAL CHARGES /6<?.... TOTAL CHARGES Jf~- TOTAL CHARGES -<?~. ~
WHERE STATE l;\\~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 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 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 ORS 701.055, that if exempt the basis for exemption is noted hereon.~d that
only subcontractors and employees who are in comaliance with ORS 701.055 wi,~~e ~'ed~ thi~~~~t. I '
IIArIE(please pri~t) MAC/'.( /00fJ/( E SIGtlATURE II'~<.. /r~ DATE/tJ~cJ/rk:
FO~ OFFICE USE OW Y
So. Ftg. 'lain~._or
Sq. Ft~Access
Sq. F~~~ .~__
/
Zone R-L, .c.V,P, Type/Canst. ";:',N
Fire Zone" Bedrooms 1"1<"'- #
Flood Plain Stories I
Units
Occy Load
Occy Group~.:?
x
BUILDING PER~IIT
Charges an~
Surcharges
j7.'?""" Plan Ck. Conm/lnd
~.. 65%/Bldn P~r Fpe
_u --6.-88-- ~~~~Bi~~ ~-~~ Fe.
____,~'_~_ Fence
6. yo De,,"
(/ CJ .,.,..
_____.J.J_...:___
/.60
-----7~~~- Curb Cut
/:<0
Sidewalk
A/e pavin~7S~"
Value 41.~~--
, ;;
Value
?.c- ./ -,."...__.....
)l' ., I'~ Value t::::I# /tt;,J~
TOT^L VALUATION
--
/')(/,"r'
;,I'JL...H- ~ / )" hI. I Systems Development ./ S 60
"/.LJ.~o .'lJl!i;th CharQe t1.5~)' ~ 7 .
4-'L.It5(;~d~ -6b,~" O?>~_:r- _ ,
I~ ~~x .J7%J.~3'CoII!'O." ,
I
I
q'c7. 00 Total Comb. Permit I
x
PLUlIBING PERMIT
Charges and
Surcharges
ELECTRICAL PERIIIT
Cha rges and
SlJn~harges
11ECHANICAl PERMIT
Charges and
Surcharges
I TOTAL,
~S'8tP8
~/9~&'S
J
I
t
!
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample. Tax Lot 100. lane County Map Reference
II 03 43
2. example- Lot 1. Block 3,,2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/~lectrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq, foot house. SOD sq. foot garage
2. exam~le. 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. examole - remodel existing garage into family 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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; ---
Ill. 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.
. 17
~ \!P~'t
\0.,
qp~\
V. FOR OFFICE USE ONLY
Permit Clerk
rAOJaJ
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
/- ~""N/~ O~ --5~r ~~~VG;Hl9'Yr ~/?t5-~~
,
2- 5/&Yv~ c::>F 5~wG')f>' IH '~<:f(.r~ .k-&;;::;5~hr- r~_
<,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
-'name~ 72~~
Signature~~ ~date/~-z'~-B9'
, " / '
.,
J
.'