HomeMy WebLinkAboutPermit Building 1988-5-31 (2)
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. 1IIJ CITY Uf SPRINGflE~O
COMBlIlATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater.
Range
Va 1 u€ of Harle
72,000,
Builriino Permit Info: Describe Work(i.e.,
Familv t'lesidence Hith Attached Garaael
I INSPECTION ~INE
726-3769
Job Address
5344 MAIN, SPRINGFIELD OR
legal Description
__T}\ X L()'l'- T 1.ll2 3 3 31 6506/6507
Owner VETERAN' SOF FOREIGN WARS
Address 5344 MAIN
SPRINGFIELD, OR 97477
Phone
.
INfORltATlON LINt
726-3753
Sq. Ftg. I.lain
~q. !='tg. Access.
Sq. Ftg. Other
)(New Add Alter Rep.
Fence_Demo _Change/Use
_Other
Do
CA)
10
I~
~
Build Single
Construction Lender
NEW 1ST AND 2ND
2,440 SO, FT,
FLOOR ADDITION,
Address
DtSIGN TtAI1
Phone
(address)
(name)
flies. no.)
~PRH~NF'TRLn
746-8211
Primary ':"SE JH<lYNDliQN JlliliOCI""'''''
Structural
? OJ) ~. MTT.L ~J'
Electrical nF'~Tr-N p.TlTLn P.V ()WNRR
Mechanical DESIGN BUILD BY OWNER
CONTRACTORS (name)
{address'
(Hr." fin. \
Genera 1
Plumbino
\
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I'1i
,
/\""\,.J .
t, . I
, Electrical
~1echanical
PLUIIBI NG
. ELECTRICAL
NO.
FFF
fHARGE
Nn
1IL..cJiA&G.E. NO.
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
r~s i d~PJ1r~
multifamily, COIllTl. or
Industrial
Iwater service
I Sewer
Istorm Sewer
I
I
I
Ar.v/7/P,yA-C ~"""S
"'. I
r ~/?:>/7I
I
I
I
4r,
., .,
I] I""ZP or R.e?::>
I
I
I
I
Of amps.1 I
;t?J3lZ>/7/~/'7"__C A-#'~
.~~ ~/-#'/ ~ I
~/;z;"6Z> I I
amps.1
I
Install/alter/relocate I
rl;~trih f~~rl~r~
Of
CO~1./IND. FEEDERS
(exni res)
(ohone no.
~L
~
(~'lrrJi ,..~c:,,filP" " ''lnn...p..,.., \
10<::-00
It. ~1 /4
MECHANICAL
furnace/burner to
aTU. s
c~~1='
I
I
I
r"'IRliE.
Floor furnace
and vent
Recessed wall
~o~rp h~~t~,.. ~nrl ~p..t
Appliance vent
"poarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hnnd and du~t
Wood stove/heater
. / Z7.m>/ Rz>-'7/9 ~.~~,..
/} "7n ~;7.;, //'
; / ;f@-o;'/? i!'E;b
ISSUANCE OF PFroHT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that tile Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and re~urned to the Building Division
I HAVE CAREFULLY EXM11NED 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 oerformed 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 OCCllPAUCY 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 79~, that i exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comolianc('with ORS 7n 0 I be U~~~iS project.
IlAl'IE(please print) John M. Amundson ">-.. 1~~ATE 5/31/88
FO~ or ICE USE miL Y
Sq. Ftg. rlain
Sq. FtO. Access
Sq. Ftg. Other~
Zone c:::. /". Tyoe/Const. .<"-N Units
Fire Zone Bedrooms Occy Load "2 </R
Flood Plain Stories~ Occy Group .11- '3
l)..fl/4/7 ,r-:.i!;" ~c<::: ~;::::y-
BUI~OING PERNIT -:;rL.i~.-e> Plan Ck. COI11Jl/lnd
Charges and _ _ _~ ...L-1'-"_ _ _ _ 65%(Rldo PJ'r Fp~
Surcharges"""\ /7 ",,,..- Plan Ck. Res
.... ..r~ 30t/Bldo Per Fee
Fence
x Va 1 ue
x t Value
-:z-</~FJ Value '7.:9...--c:;:...
TOTAL VALUATION_
/").... :'\
1\("l,oI~W~~s(~~~Wpment -;8&L5. o---e>
5-3(-g<is
-Z2(P-f55
Y
PLU!1BING PERMIT
Charges and
Surcha rges
------------
I 0_
I Sidewalk
I A/e Paving
I Curb Cut
------------1
ELECTRICP.L PERlnT
Cha rges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
I
I
I
I
\Total
I
I TOTAL
Comb. Permit
3'6"6. '111
'i~5/~, r$; /
ft.:
- " fi.::
.
"~':'J ~ ~.~
.~.?;:~~. .~
. .' ..' ~.-" ",<<,,~ .
.'k...> '--1If::
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B, Legal Oescription
1. example- Tax lot 100, Lane County Map Reference
II oj 43
2, example- Lot I. Block 3, 2nd Addition to
~pr1ngtield Estates.
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
cneck add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examele - 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 TEM1 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. ---
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.
PERMIT VALIDATIDN
I ( (5~
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.... .
,
,.
V. FOR OFFICE USE ONLY
Permit Clerk
Cu
".
.
l
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~~ L::t..L7:',,--:-:zr signature ~..-?~~__ ,? date C-/7'~f?B
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