HomeMy WebLinkAboutPermit Building 1989-8-8
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Job Address <l1;L<5 tltA.ljlJ 5T..
SO<.t.TJ..\- Wli:'S7 CZl~).)elK.
WA-/fJ Sf i f./.d-.'6D'St.
Owner KG.'A.) rf)L~M D:>. U
Address "j/ / I j( ilr)/ ~ ~ <r/)N
"o.10Rfl.. 114b-c/75""i J-kJl.t€ b'87"629<.
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lINSPECTION LINE
726-376~
I.egal Des.cription
Construction Lender
Address
DES I GN r EAr4
J
Phone
I NFORllATlON LINE
726-3753
Sq. Ftg, Wain \..
~q: Ftg, Access. '"
Sq. Ftg, Other ~
New Add Alter Rep. ~
Range -Fence Demo Change/Use f\
ValuE '15'g('j, DC) Other- - ~_\J
Buildino Permit Info: Describe Work(i.e., Build Singlj
Family Residence With Attached Garaoel
LUOi'lO F~AIVf.I! Oh klll\l~ i J 1JST 'P
\.\.\I/\)Do"" FtJR D~IIi~-U. P
CiTY Uf SPRINGFIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
.
Structura 1
Primary t) LLl kl fl. R..
(namel
Phone
(address 1
(lies. no.)
(expiresl
{ohone no.
Electr;cal
Mechanical
CONTRACTORS
General
PlumbinQ
Electrical
~lechanlcal
NO,
~ ..,
-~
..,~
Ii'
lnamel
(addressl
(1 ics. no. 1
(exnires)
{ohnn~ nn. 1
PLUJlBING
ELECTRICAL
MECHANICAL
r"~1
FEF
CH~RGE Nn
FFF
rH~ _NO
.",
Residence of
furnace/burner to
BrU. s
Each single fixture
SQ. F1.
Relocated building
(new fix, additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
11 bathl
Duplex (1 bath) each
Additional bath
TOTAL CHARGES ~ TOTAL CHARGES . TOTAL CHARGES
WHERE STATE L.\II REQUIRES that the Electrical work be done by an. Electrical Contractor, the e1ectric.1 portion of this permit
s~all pot ,be ~ali1 until the label has ,been signed by an Electrical Supervjsor and returned to the Buil~;ng Divis;on
"-
I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the Laws of the Sta te of Oregon perta i n; ng'~to the work descri bed here; n I and' that UO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 7f11.055 will be used on "this project.
~N ~ o'-""~ ~~DATE-3.~
Water service
Sewer
Storm Sewer
IWIE(please print)
Zone
Fire Zone
Flood Plain
BUILOING PERfllT
Charges and
Surcharges
PLU!4BING PERMIT
Charges and
Surcharges
SERVICES
Recessed wall
Sr~ hP~tpr ~nrl VP"t
Temporary Construction
Change in existing
rp<;. j qeJlr:~
multifamily, comm. or
tnrlu<;.trial
Appliance vent
<;'fI'oaratp
Sta'ti'onary evap.
c.ooler
Vent fan with
<;.in9le dvct
Vent system apart from
heatin<- or A.f.,
Mechanical exhaust
hond And dud
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
di<;.trib. fpeders
Wood stove/heater
Of
amps.
ISSUANCF OF PFRIIlT
BE'/:) )Pw!JA) 60i?O~J'J(1uftll~ ~":"'n..
FOr. OFF I CE USF OIIL Y I
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
I
,
Value
Value
Value
TOTAL VALUATION
Type/Const.
Bedrooms
Units
Occy Load
Occy Group
liain
Access
Other
x
x
x
Stories
. /~~&? ' Plan Ck, conm/I.nd
__L_':::I_-___ _ 65%/BldCl PI'H" F",p
'7~ Plan Ck. Res
~ 30%'81do Per Fee
Fence
'Systems Development '
Charae (1,5~ '
7?.1fI#;r~ T~
/c:::: ==
D_'
ELECTRICAL PERI~IT 'Sidewalk
Charges and ------------
Surcharges A/C Paving
MECHANICAL PERMIT
Charges and
Surcharges
Total Comb. Permit
Curb Cut
30.7S-
TOTAL
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II1II-'"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I, example- Tax Lot 100. Lane County Map Reference
If 03 43
2. examele- Lot I. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D, Energy Sources
1. examole- heat/electrical:ceilinq/or forced air Qas
2. examole- waterheater/electnca(/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, etc.
F. Building pennit information:
1." example - construct single family house with an
attached garage
2, example - remodel existing garage into family room
3. exam~le - convert single family residence into
restaurant (chonge of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
M, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Oivision Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II, Abbreviated Plumbing, Mechanical. & Electricol 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 odjacent
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 fanm 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 Oivision 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:
5U'7l-/CC7 I~ 3i?lff~ C>~ /frA2?"r/c. L/?3<"-",,-,~b'"
m/'....~S 7:fy rC:/~ ~~r/C. OV....-Sv"",--?'9.
\ Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
'.. "
'....
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PLANS REVIEWED 8Y:
name L,:::>8~ /=::2~~ignatur~4"c'? ~,i.: ~~ate 'i? -g-~
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