HomeMy WebLinkAboutPermit Building 1983-4-14
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., JrISPECTlOII LHlE CITY Uf SPRliIGflElD INfDRlIATlON lI,R ,I
1726-3769 ~.,~.n;;:' M.I/N 57:" C011BHlATlON APPlICATIONIPERMIT 726-3753
I EilERGY S,opRCES: I Sq, Ftg. l'lain-l~
Job Address Jl.I/J/2$fJJtJ l~kE /SPJ2.//JGF/EL-D Heat 1.;1,+ au ~/2("ElJI/I]t... ~q, Ftg. Access. -
legal Oescription 17.AZ....~.LJJ. ""'dll- .J?~J !'Iater Heater eLeO)?JL Sq. Ftg. O~h r
.... :;Iv'" - "" -., ~ Ilew Add Alter Pep.
, Range-= -Fence erno Change/Use
valu~o~ I~~I L ~. Other- - (V).
Owner' €&:J1-r ,0<,4/ .:t fK<;O('/f1715 (;#/ 'I '7
, r .7-1/ BUllciin Permit Info: Describe Work(i-.e.t Build Single 00
Address C/3r;o WIL,9-IIIZC' P,LVO,5Tl'!"c9. Phone.:z7H17 J Fa~i1y nesidence ijith Attached GaraDel \0
Revau.Lf /-f1U..', M. C;n~/,;l. INF/Llv 1lJ J3.fJf)flj.J(O e.tJmrnl?J2..(!.lJ!rt.- M
Construction Lender p}t25r P/lCIFIIG f!jAl.L SJ..l..F2L f::cJ(Z-- 1241J1tJ, ~ f>rl!.,JZ.6 ll~
/i = I II HIU. d-l~ V. V
Address 'fC,7 fJ, C4/JOfIJ ,pe.. /Jfl;CA-t "A.! Phone .l1"~-IS2lq
UI:.~Hm ItAft (name) ~ (addressl (lies. no.) (exo;res) (ohane no.
/241)/0 6J.-14CK S1lJ!Z& pf/tTJNlrJG 4 J:Je5/6tJ
,
/JOtJ6"
r;;rzeo W/"TJlC.OP f3J6INGCllIIJcE> .{)?j3 /l1OtJ!ZtJG ,elJa3Je '7Y.::J-1
Mechanical r;y::z(hfJ f),V/00 /'f1 C4(15P ('0. ,?81t' E /...qtJ:, Sr. . <5PIllN6P1~_(:)-
CONTRACTORS ~amel (address) (lir:c;. nd. ~ (~xOirp.5l )
General 'iJd_:40 CO/'J517Z0qJo/v I ptJ. /3tJ~If(" -;;AJ~f?1Vff al7ff&fJ,.J (317t3,
(' .J.IA5..F- (2(), 3k!Lt:;'" e .l..q.J.b. Sf. 5C!z./lJc;FtFlfl Of-.
Electrical e/2E~ t?lZCflZ/C. QJf2/O ..Y;NOPll-rnA1V ro. ~.Of2-
(l.UAf;F ('~ (" S~,:; .4Pft~ I .
- '- I
PLUIIBIIIG
NO. FEE ...QjARGF NO
S Each single fixture f.- IS. ..
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
Wa ter servi ce
Sewer
Storm Sewer J
Primary
Structural
Electrical
, Plumbina
"'~~hanical
ELECTRICAL
MECHANICAL
I
Ws-61d:J-
7rJ.b -Itf g I .
(phone no.)
7:Jb --oO(,r:;
"7;;.h -1iU..
?<f1-(;87!o
FFL .cHARliL
/
.. ...
6,<>e
3.'""
, I SSUANC, nF PFRillT / (). -
TOTAL CHARGES /,7:00 TOTAL CHARGES <~ TOTAL CHARGES /9. """
WHERE STATE 1.,'14 REQUIRES that tile Electrical work be done by an. Electrical Contractor. the electrical 'portion 'of this permit
sha~l not be ,vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
':E.L J:IlABliE NO .
Residence of
furnace/burner to
~._ BTU's
I HAVE CAREFULLY EXN11NED 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 NO OCCUPAI~CY will be made
of any structure without the .penmission 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 701.055 \ ill be used on this project.
A S,.,&:ill .1.U.j<fOCon~UURE ~4
. ~ FO~ OfFICE USE OHL 1 ~ . /:'. . \ i ~. -.......
TVDe/Const. 11L~AI Units _ So, Ftg. rlain S~ x v~ue':i',,!-994(.-
Bedrooms Occy load 5(/) Sq. Ftg. Access x value
Stories I Occy Group g..<. Sq. Ftg. Other - -;:~ Value .
TOTAL VAlUi\TIOIl21- 99Y.-
SQ. FT.
J
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
~J~~
~(
JY .~
I
Recessed wall
SD~r:P hp~tpr ~n~ vpnt
~
Appl iance vent
"ieoarate
S'tationary evap.
cooler
Vent fan with
",inole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hnod And dur:t
Temporary Construction
Change in existing
re'ijrlY.nce
multifamily, co~. or
Industria]
Of 1St> amps,
COI*I./INO. FEEDERS
Install/alter/relocate
di5trib. feed~r~
Wood stove/heater
Of
amps.
IlAI-1E(please print)J~eU l-h
Zone C G
Fire Zone
Flood Plain
BUILDIIIG PERI.IIT
Charges and
Surcharges
PLUt1BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERlm
Cha rges and
Surcharges
l\
MECHANICAL PERMIT
Charges and
Surcharges
/.., 7. - Plan Ck. ConmlInd
.., 65%/Bldo Per F~p
------------ Plan Ck, R'es
S. ~8 30%/BI dD Per Fee
__n.!.~~~__ Fence
. ~~
::<S. - I Sidewalk
------/-:-...--1 Ale Paving
/~...c:. I Curb Cut
___n_ -.-76-1
~
r~ 'Sys tems Deve 1 opment
l?i'''' CharDe 0.5%)
'is:;l.,SS
Demo
I
ITotal
1-
-' IOTAL
Comb. Permi t
DATE t/-/LI-f3
YY9.9/
J'7'3..'1tJ.
6'1.3.3~
~
.
.
~
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. examole- lot 1. Block 3, 2nd Addition to
Sprlngt,eld Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceilinq/or forced air QdS
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example. 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add. ete.
F. Building permit information:
1. example - construct single family house with an
a ttached gan~ge
2. exam~le - 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 TEM~ ANO 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 SCHEOULES
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.
V. FOR OFFICE USE ONLY
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PERMIT VALIDATION
lJ)'6\1l
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/
Permi t
Clerk~~
)
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
...{Pl>.ITA6.NA'<' 72.AN~ ff' ~R"""'/T.$ ~EQ(..)/RED 7&>~ M.a::HA'N/G4<"
---E~_.lJp~($Iy:r ~/~ .?; /.IY$7A~ LA7'/~. (5c:.~~ /77e;;D y- < ,)-B;:~
Permit applicant exempt from registration with the Builder's Board because:
."
Additional Project Information:
PLANS REVIEWED BY:
name L~NG 7lE6e~
~~
- ,
signature
,
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7~~....,.....,.. date ~-<6-8'3
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