HomeMy WebLinkAboutPermit Building 1983-12-7
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II NSPECTI ON LI NE
726-3769
Job Address 5t? '1? IY/u In
CITY OF SPRINGFIElD INFOR/IATlON liNt
COMBJlIATION APPLlCATION/PERHIT 726-3753
II 1 /l -. E!lERGY SOURCES: Sq. Ftg. /.Iain
<::).:, r d, // yf!. I Meat ~q. Ftg. Access.
Description\~,......"n "2." ..;..J.?' ..L <C.\ \ I lIater ~eater _ _ Sq. Ftg. Other
\. \ \. lL. .>'4~"""\ Ckl _ __ !lew Add Alter Rep.
- 'I Rap,qe ----"'-- -- . -Fence Oemo Change/Use
~\ ~\17)1."~ fr17Df!OD~ , )=Other- -
P.h - . Bu'i~'lciinQ-Penni.t-Info:--Descr;be Work{;-.eo. Build Single
one7"/t'3<?,, Familv nesidence ,~th Attached Garaael
r-, :1/ ii, /t/v -r -Ii urJ n f.: / '" -k '"' (;r
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legal
Owner f'- Lv
Address / 7/7
Construction lender
Address
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(name)
Phone ~""I
(address)
(lies. no.) {exoiresl (ohane no.-')
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(lie". no.) (pxnirpc;.,r "1. (ohnnp nn.)
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Pri ma ry
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Structural
Electrical
k:~.i
Mechanical
CONTRACTORS
General
Plumbina
Electrical
~1echan1cal
NO.
<0
Each single fixture
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LP
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J.{ / {I r:f.;"<-c
(name)
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(address1
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J 7/7
PlUIIBHIG
ElECTRICAl MECHANICAl
FEE r.HARr.F NO CEL...cJlARG.E. NO,
?:iJ.($) Residence of furnace/burner to
5 SQ, FT. BTU's
New circuits alts. \~c;s;y~.Cf) Floor furnace
\ or extensions and vent
SERVICES Recessed wall
Sn~rp hp~tpr ~nrl vpnt
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I
1'3 cD I Co. CO
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FFF
r'fARliE.
;
Relocated building
(new fix. additional)
S.F. Residence
II bath)
IDuPlex (1 bath)
IAdditional bath
lwater service
Sewer
Storm Sewer
each
ITemporary Construction
IChange in existing
rpsi~p'nr~
Imultifamily, COrTlTl. or
Tnrlllc;tri~l
IOf
ICOW1./IND. FEEDERS
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
(") I Vent fan with
L sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust I'
hood and rlur t.
I ~Jood stove/heater j
f
, J,...", ~<'>'"
,
I
amps.1
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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 NO OCCUPAllCY 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.
SIGrMTl~~-., O~..;~:v~
FOP. OFFICE USE orll Y
So. Ftg. 'lain
Sq. Ftg. Access '751?O
Sq. Ftg. Other
&;lDZ7
,LI\"'i=>' nil'
I Systems Development
, 3l~40 - p:. ,--., CharQe (1.5~) .
MR.G) ,
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HAl.IE(please print) .sht:J.."Y\ -r. -rAl~i'JmA'"
DATE ,,+"~'-,L",,
Zone \,.(,,~ Tyoe/Const. S- "-.\
Fi re Zone - Bedrooms
Flood Plain _ Stories
BUIlDING PERIIIT
Charges and
Surcharges
Plur1BING PERMIT
Charges and
Surcha rges
ElECTRICAl PERr:n
Cha rges and
Surcha rges
MECHANICAl PERMIT
Charges and
Sure ha rge s
Units \
Occy load
Occy Group~? ,
x Value
xlO.00 Value~?". 9J.D
x
Value
TOTAl VAlUATION
\ '> \ 00 Plan Ck: Conmllnd
~~ . 65%/Bldn Ppr ~pp
--- -u-Oi"u--PTan Ck. lies
~ \ C) ~ 30%/BldQ Per Fee
"').r-" 00 I Fence
--n~~zc--I Demo
~Q. CO I S1dewalk
__n__ \ ~~--I A/C Paving
(!>o I
_,___1..Q-:____ Curb Cut
.~O I
40B.CO
I
b.c\\~l>o.lt'< ~
I
ITotal Comb. Permit
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Co ~f\ .'2.,\
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I TOTAl
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. Lane County Map Reference
II oj 43
2. .exam~le- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examr?le- heat/electrical ceil;nq/or forced air Qas
2. example- waterheater/electr;cal/or solar
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examyle- 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. example - 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 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. ---
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.
,
Ill.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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tl::-lD~O"ll
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Penni t
Cl erk FA LQ(L)
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Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation: r()~~u:::"n::: \....F.'i)..~E ~~~
~t )\\ tl\\....Ch ~\.~~.l....L. ~\ ~\:1'-.. '0- Ron (}"1
PLANS REVIEWED BY:
nameD ~\\~~ ~ E\J\ s i gnatur~')\^."L.~-'=~.\ @A.. r-- date\? ~-D\. -<'?:>~