HomeMy WebLinkAboutPermit Building 1983-8-22
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I IrISPECTIOII LIrlE CITY OF SPRINGFIELD INFDRlIATIDN LINe ,I
726-3769 COtlBIilATION APPLICATION/PERMIT 726-3753
--- E!lERGY SOURCES: Sq. Ftg. r.lain--L8~'
Job Address' "S6/<:' M-9/N... !; T.RSe7 Heat ~g, Ftg, Access.
I.ega I De<<ri ption /".,,;Z_"2 3- (,JI . ~ <!lOe) .I -:>00:11 Hater Heater Sg, Ftg, Other
F .. ".. oJ '7 ..... Ilew Add Alter Rep.
, Ranqe -Fence Demo Change/Use
Valu, of I'/ork: x.Q.t.her~"""_rE'
Owner Ctf.v~ fit! (krr~ . <# ':!lZ . n()O.OO ,,' cr~'83~#~1f:
Address ,--;) I //",,-n'. Ph ,gf' Bui~I'oino Pel'mit i"fo: Describe Work(;.,e.. Build Single
,i j C; <l lIJ,'IIf1~1 t"?{J) on ,,</b// Familv nesidence Ilith Attached Garaae)
I:;("~/) 9'/'7/5.5 C~k..~r~..i..J:;d.s....dP~~PJ~5Lr~
Construction Le<n'der I VI1><S"O-:~,ft:,4P'~L: ' .' ..~~it-..... ~,
Address Pho"e I _.... - ,_-.:LT- -c "...,. ...--........, IJ
Ut~HjN 11:.Ar-' (name) (address) (1"les. no.) (exo;res) ~Ohone no.')
1/1"A.:h.r) .. _r> 11.../ f;r:- e-(l~~t/-b0tix
J to&.:> I 11-1<::/'""-' ~ t \. /
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Primary
4("/1~
A/II
Ph (ltll? If f~,
l~ /'I? (J I' /1n 1'l2A
Structural
~
Electrical
Mechan;cal
CONTRACTORS (name) {addrflssl Oi!"- nn 1_ fexniresl (ohnnp no 1
, I .. '~:r"-'O W/l;lM'.Ihe l:Tc.lIP./:5."'T~S.Y3 ( :'\
General ,M~AII.1''''#~.sC< '/ e$JI~~ AR..~!S, <::..4.. "'d-::ZF~ ";;.r3.J::Z7/~/'?'71
Pl.mbipo It\ ,J..L0r\ V (' f). '\\ () ~ "'-- *'
Electrical (\ l\
~'echanical
--
PLUlIBIIIG
ELECTRICAL
MECHANICAL
--.till.,,'
5 Each single fixture
. FFF . CHARGE
'J(1
TOTAL CHARGES
WHERE STATE L~1l REQUIRES
shall not be vaIil until the
;: - ~S'O
" I INew circu~ts alts. I Floor furnace
,K. 0.;:~';l!i~...)9~ /S:-~' and vent
I I I I I I Recessed wall I
SERVICES SOiH".p.....P~tpl" i'lnrl vpnt
I I I I I I II~A7' -;::t..,.,."", I~. ... I
I I ITemporary Construction I I Appliance vent I
spoaratp
Water service I I I~~:j~:_n~~ e~.isting I I I ~~~r~~nary evap. I I
I I Sewer ~:tct'JD.ha.u:I~.- I~~~~~r~~~~y.conm,or I I <I~~~~l:a~u~~th ~~"I".-
I I I 10f J 3JF amps,1 I-..-- I Vent system apart from I I
Storm Sewer J,..(.."). . -' , heatino or A.C. ' .
I I I IC0I1H,/INO. FEEDERS I I Mechanical exhaust I
hood and duct
I I I I Install/alter/relocate I I I ~lood stove/heater I
rl;~tr;h fpprlpr~
I I I 10f amps.1 I I I
I I I I I I I
I I I I I I
I I I I I ISSUANC, OF PFRIIlT AlA .
;s:-/ TOTAL CHARGES o/'G>.uoj TOTAL CHARGES 1-:<. _A
that the Electrical work be done by an "Electrical Contractor, the ,electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Residence of
ITL'..cJJAIlliE.JlQ.....
...
rlJARliE
I ,
" I
"
SQ, FT.
furnace/burner to
BTU's
IRelocated building
(new fix, additional)
IS.F. Residence
11 bath]
IDuPlex (1 bath) each
Additional bath
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and 1 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 OCCUPAHCY will be made
of any structure without the permission of the BUilding Division. 1 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, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
Ahrs :/66 ~~""""N tiS 7?'/~~ e-<Ho,D ...../V~.M',.. T#SSD<.. /.
IIAf.lE(please print) --r:e-e e. V\ (;y ~ (iAJ SIGII^TURE1/A~ (";,LA,,/k..
. "FOP. OfFICE u~mlL Y
Tyoe/Const. :tzr-N Units so,)tg, 11ai,,_J~""
. Bedrooms Occy Load /~ Sq, Ft9. Access
Stories J Occy Group 4-3 Sq, Ftg. Other
n~ 2 '2-13
I
Zone
C;~
x
2Ze>QD. ....
Fire Zone
x
Value
Value
Value
Flood Plain
x
TOTAL V ALUA TI ON
BUILDING PER/lIT ____I.!/!!.._~--- PIa" Ck, Comm/Ind 76.7(;) Shstems Development '!II< +'~s: "'0
Charges ant: 65%/Blda p~~ F~~ C arge tl,5~) ,
Surcharges 'I.7Z Plan Ck, Res lol4lo~ 7\' Q.. ?In R:~'
30%/Blda Per Fee
PLur1BING PERMIT ____Js: eo Fence I ( I () I I
Cha rges and
Surcharges /. YC::>> I Demo I I I
ELECTRICAL PERr:IT ~c:>. c::o.C> I Sidewa I k I I I
Charges and -------i~-.;-I A/C Paving I ITotal I '=< 13'. ~ .,.
Surcharges Comb. rermit
11ECHANICAL PERMIT 1<. -. I Curb Cut I I .# ~/8.<o
Charges and
Surcharges __n_=__.~~1 J I TOTAL
._~------_._- --- .
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description
I, examp.le- Tax Lot 100. Lane County Map Reference
II 03 4J
2, example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D~ Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. examole- waterheaterlelectrical/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,
Check add, etc.
F. Building permit information:
1. examole - construct single family house with an
a ttached garage
2. exam21e - remodel existing garage into family room
3. examDle - 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 TEM4 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 OIVISION 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
wi 11 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
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PERMIT VALIDATION
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Pennit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '."
1)4"PJ7',U>hAL ~~. ~M.....~ ~ ~~~eA_J" ..R€tPoh~EZ::>
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i F~ ~c~""".N~<"""< ,C('~C7.H/Gil-L ~W',p 5V-':::;N.
- ~. - ,
~ St..>7r'u/r ~ c::::.~~ ~ (;""'~'.4~ ~rJ~=~~~ AiL...,,,,,,,'
'OP~FS S.Ae........,...c;.: ~ '7 s?....~~ ?Rc::ot--....&>Ep M./.S ;Z:~.......... _
Permit applicant exempt from registration with the Builder's Board because:
~ Additional Project Information:
S"..D c:::... /-S
I.:?(:.I".~....-c.;
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;::E~ F~~ ~~'c..
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PLANS REVIEWED BY:
~~h"E...P';t'l5't::.<i:~ signatur4:a
name
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W~~ N'~~ ;;>~~cC'"'..z:,
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