HomeMy WebLinkAboutPermit Building 1982-9-23
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'j HISPECTIOiI LlIiE.
726-3769
CITY OF SPRIrlGFIELD INFORlIATlON LINt I'
Cm1BI:IATlON APPLlCATlON/PERMrT 726-3753
EilERGY SOURCES: Sq. Ftq. 1,Iain 5000~'.:!~'
Heat ~q. ,tg, Access. 11~2 J0
Hater Heater Sq. Ftg. Other
, flew XAdd Alter Eep, Q)
I Ranqe Fence D.emo Change/Use
~. Valu, of Hork: t ' _Other-"~ ~-
__ ,-- .... 4,/37.38 1= 1--~,~1. ' -on :::-
I I il_ ._-, "-J
dd E Ph 72675" .,~ui1cino Permit Info: Describe \Iork(i.e,. Build Sin9le -
A ress 475 Franklin Blvd. ugene one . ..,.a~i1y Residence IHth P,ttached Garaoe'
Appl.: B&1 Plumbing & R.V. Store Contstruct lean-to.~ ~~'~
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Construction Lender t:e "FfiE:!i!1 1.
Job Address 4425 Hain f't:re0.t.
Legal Description 17.(72.32~3/, '()G3t)C.
Owner tJorman Fran~.
LP
..
Address
DES 1 GII lEAl I
(name)
Phone
(address) flies. no.1
{exoiresl {ohane 00.\
NOO~'8'-"'1
Primary LEE C. PI,ANTS
54 Centennial Blvd. Euqene (4885)
Structural
Electrical
f1echanical
CONTRACTORS
(name)
(address 1
(1 ic!C:. nn. \
(pxoire,)
(ohnne nn. \
General West.over Const. Co.
4034 Ilain. Snrincrf;pld 11441\ 1I';-?0-R1\
747_0071
Plumbina
Electrical
'Iechanical b!!;r il1lIl r .
..'
~.~.-
1 ?n_ 1 "!1--1 1';-1 1 -R1 \
MECHANICAL
tiP <;-()()(J.1
PLUlIBIIIG
ELECTRICAL
Each single fixture
HF CHARGF Nn H~ nIARr,~ NO.
Residence of furnace/burner to
SQ, FT. BTU's
J:'J:'~ 1 n"ARG~
/
NO.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
SO~CP hp~t~r ~nrl v~nt
Storm Sewer
Of
ICOMH,/IND. FEEDERS
I Install/alter/relocate
rlic;,t.rih_ f"pprlpr"
[Of
I
I
I
amps.
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
hea t i nq or A. C.
Mechanical exhaust
hood and dur:t
Additional bath
Sewer
Temporary Construction
Change in existing
rp",_i d~.nr:p. .
multifamily, COrm!. or
Tndll<;.trial
~!ater servi ce
Wood stove/heater
amps.
I SSUANCf OF PFRtllT
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 valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1HlED the completed application for permit. and do hereby certify that all infonnation 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 Ore1]on pertaining to the work described herein. and that He OCCUPAHCY will be made
of any structure without the permission of the Building Division. +-.......-:.::....:..._.....~-:...:~~ :::._~ '..I-~:-=-;-:-.:-~..;.\'.-..l~;...,~:. ..._ :_:~":_,'..
nu .I:.. .:- 'E:.'~.} .c_.,:: :-...'~__~ _,.:. _.,.' _: ~J :r.:' r:..,:.Z.5, f_~ :~ _H_vry>' "-, L ! ,~_. _,.~...,~....:"._. ..,"~.:.~ ....:..._... -..--.-.--._ ~,,_~~
6nly subcontractors and employees who are in compliance with OP.S 701.055 will be used on this c
I
Units
Occy Load
Occy Group
SIGilATURE 15''1.'
For OFFICE 'ISE Ow. Y
Sq. Ftg.
Sq, Ft~.
Sq. Ftg.
p
Dm..:!,)v /n--
NAl-IE(please print)~:r PI",...,,,,, + RV ~
Zone c: C '
Fire Zone }/"./.
Flood Plain hG'
Tyoe/Const.
Bedrooms
Stories
s>>
8-1
f1ain
Access-'/ S Z
Other
x
x
Value
Value
Value
~/3 7. ='8
x
TOTAL VALUATION
"I/:?7, :Ja
~Z.~6
BUILDING PERI,IIT
Charges an':
Surcharges
-:?."... PI an Ck.
., ~ . 6S%/Rl do
_n___;.:ij__ ~b;~Bi~~
Comm/lnd
Per Fee
Res
Per Fee
Al)'6~
,
Systems Development
Charoe (I. Sr,)
PLUI1BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERI:IT
Cha rges and
Surcharges
O~mo
I Sidewalk
------------1 A/C Paving
Curb Cut
Total Comb. rermit
33.28
I1ECHANICAL PERMIT
Cha rges and
Surcharges
TOTAL
95".3 Y
nL
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COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II 03 43
2. examole- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examp'le- if new project. check-new - if addition,
check add, etc.
. F. Building permit information:
1. examole - construct single family house with an
attached garoge
2. example - remodel existing garage into family raam
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 TEAI,I AIID CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonmation 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 fonm 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. BUILDIIIG OIVISION STAFF WILL FILL OUT ALL FEES ANO
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 penmit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
~
'6.0~, p~
~O )jo/D
3d,()O
/ I t28'"
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ToM \fB~6~
1~#59773
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; Permit Clerk ~~
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REVIEWED BY:
nameL.&:>xw:s ~~~ Signatur~~ date 9-<~B:Z
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