HomeMy WebLinkAboutPermit Miscellaneous 1988-5-10
jlNSPECTION LINE
726-3769
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CITY Uf SPRINGfiELD . INfDR/1ATION liNe
COMBINATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq, Ftg. I"a i n
Heat ~q. Ftg. Access.
Water Heater Sq, Ftg, Other
New Add Alter Rep.
Range -Fence Demo Change/Use
ValuE of NorkJO; rtf)fJ Other--
Bu116inQ Permit Info: Describe Work(i.e., Build Single
Faml:esidence With Attached GaraDel J
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''AJI/Vv\~c:./ ~
. ~ J I
Job Address
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Legal Description '7~tJ 2- 3;:..-= 0/.....--"
Owner', ...... {'-----n.4 f1-~AJ r"'" ~~/+/~
Address ~q77~ fYl~ Phone
Construction lender
Address
Ut~lliN n.Ar~ (name)
Primary ljL.H-A.J;>~/2/ ~
'97 !rIIe_,}.; /:;>:r~ ,'k..n-,.,e- ::ZC>'lE~ ,c;>y19~/
l-
II /7 ~~
~n me} ~ /i (addr~S '\l (]irs. no,) (p,nicpsl 11' -(nhoop 00,1
/ ,_/ ~ r- / Jrmh/.f..R:t:r ~r ,::~-~~__
1/ # I
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbino
Electrical
~'echanical
NO.1
~
PLUIIBI NG
I HF" I r.HARGF
Phone
(addressl
(l ics. no.)
(exo;resl
(nhone no. I
:-?y~. '3/351
ELECTRICAL
MECHANICAL
Nn I
t ~~L'...cHARG.E. NO" I
1~~LI~
Residence of
furnace/burner to
BTU's
z
Each single fixture ,
?~q:l 'f'r,J). 7$ '/S~ .
Relocated building
(new fi" additional)
~ New circuits alts.
obe~;JJf~E
SERVICES
Recessed wall
~~~o ho~tpr ~nrl vpnt
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
/ ~Ia ter servi ce< ;52$ I
V Sewer f)(> 7P/S2S I
15:-
~-
Storm Sewer
1 ,~rz~P~7a:- 7-Se>
SQ, FT.
-;;:.2.j2 ,
Floor furnace
and vent
Temporary Construction
Change in existing
rps i ctp_nr:p
multifamily. corrm. or
Tnrlll,trial
Appliance vent
c;poarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hp~t;rllJ or A.C.
Mechanical exhaust
hood and dud.
\-lood stove/heater I
/ //a;-;- ?CJ,??;Z:> I
I
I
Of
amps.
COffi1,/IND, FEEDERS
Install/alter/relocate
r1ic::trih foorlprc::
Of
amps.
ISSUANCE nF PFR!IIT
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
~;? DC> TOTAL CHARGES
/?:~
-:2:2-sP TOTAL CHARGES fi? //.Y.
that the Electrical work be done by an,-E1ectrica1 Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED 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 Spri ngfi e 1 d and the Laws of the Sta te of Ore~on pertai n i ng to the work descri bed herei n. and that fW OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
Board is in full force and effect as required by ORS 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.
IIAI-lE(please print)
Zone/I'L~
Fire Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
__L'?~:.~
?G:5
_n~2:-~_ .Fence
-g. '3 ZJ Demo
___~:..~_ 'S1.dewalk
I -J 3'.
--_/...z;;-~-- Curb Cut
.?S"
121c..HAR.D
TYOe/constJ".-=sL.
Bedrooms
Stories
C:,)Lj TZ-SIGIIATURE~~'
FOP. orF I CE USE DilLY
Sq,
Sq,
Sq,
om" MItf ffIB
Units
Ftg. riain x Value
Ftg. Access x Value
Ftg, Othe~~ ,,"Q ""-Value, ~__
TOTAL V ALUA TI ON
Occy Load
Occy Group
-
Plan Ck.
65%/Bldo
Plan Ck,
30%IBldo
\14-'iS~
{;!.S.L/to
~S-a "'"Z:>
COIl111/Ind
Ppr 1=,,1"
Res
Per Fee
S /0 c.( Systems Development
- 'b'CharDe (J.5~l '
s:-
A/C Pavin9
I Tota', Comb.. Permi t ?3'//',."7/
" .
I TOTAL 707. '7/
-
.t'
COMBINATION APPLICATION/PERMIT (CAP)
,
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax lot 100. lane County Map Reference
17 03 43
2, examole- Lot I, Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceiling/or forced air Qas
2. examDle~ waterheater/electrical/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq, foot house. 500 sq, foot garage
. .2. exarnple-. if ne~ project, check----riew - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examyle - 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
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
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.
V, FOR OFFICE USE ONLY
Permit Clerk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1/131
(p/(1-r:!
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. 'Permit applicant exempt from registration with the Builder's Board because:
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, Additional Project Information:
PLANS REVIEWED BY:
'name /~/f'NE ~ cz;- ~
signature 4-.7~~:s:>
I" . "
date
5'-2:>-8'&