HomeMy WebLinkAboutPermit Building 1989-8-8 (2)
{name1
Phone
(address \
I NFORl1ATlON LI NE
726-3753
Sq, Ftq. 'Hatn" \.
SQ:Ft~, Access, J'o-
Sq. Ftq, Other I ~
New Add Alter Pep. ~
-Fence Demo Change/Use
oJ. Hark: Other- - ~\)
'R' 50(), DC)
Built,;no Pemltt Info: Descr,be Work(Le,. Build Single
Familv ~esidence Hith Attached Garaoe)
oh JJ I III ~ i: J !J S'T JIL, !~t7
DI2/ VtlZ:-UP no ,.1
(exni res 1 (ohane
i
~ nlSPECTIOA LINE
172..6- 37 69
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,Job Address <j /;L'5 Y'yjll /JU ~ T
So<.t.,l-\- We-57 COlC2NeK
;f:. I./.;)" W '-51-.
r\,,)L~M fA")
A~~rcss -,I') / j( /IJ'()IIU c; <rnt'\J
1J,t./b-Lj 7 5'1 J-knd b S" 7 ~ 2. q ( ,
A)Ofl.le
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
I EIIERGY SOURCES:
Heat
I Hater Ileater
Range
1 Valu,
Legal Description
Owner
111 .4t fJ OS f
).{""f,,)
Phone
)10RI'l
tUDi'l!) FRAMIr.
WltvDo~ FtJR
Construction Lender
AJdress
DESIGN TEAM
(lics. no.)
Pri ma rv
t) l.l.l /0 rz..R.
,\'t.,
~
~
r
Structural
Electrical
Meehan; ca 1
CONTRACTORS
(name1
(addresc;,\
(lies. no. \
(f>xlliresl
(nhone no.\
Genera 1
Plumbino
Electrical
Mechanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO, '
Each single fixture
'FEE CIIARGE Nn
eFr . r.HARr.F NO.
._ LE.L .cJlAIlliL
SQ. FT.
furnace/burner to
BTU's
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] b,th 1
Duplex (1 b,th) e,ch
SERVICES
Recessed wall
SD~rp hp~tp~ ~nd vpnt
amps.
Appl iance vent
o;eoal"'i\tp
Stationary evap.
conlpl'"
Vent fan wi th
sinnle duct
Vent system apart from
heatinq or A.~.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Chan~e in existing
'P5 j ~f"J'H'P
multifamily. COrlln. or
~ndus.tri{ll
Additional bath
Water service
Storm Sewer
Of
COI~'I. II NO. FEEDERS
Install/alter/relocate
di",trib. (peder...
Wood stove/he,ter
Of
amps.
TOTAL CHARGES
WIlERE STATE L,\H REQUIRES
shall not be vali~ until the
, TOTAL CHARGES
that the Electrical work be done by an,'Electrical
label has been signed by an Electrical Supervisor
I SSUANCF. OF PFRlIIT
TOTAL CHARGES
Contractor. the electrical portion of this permit
and returned to the Building Division
I HAVE CAREFULLY EXAtllNED the completed application for permit. and do hereby certify that all infannatton 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 OreCJon ~ertaining to the work described herein. and that no OCCUPAllCY will be made
of any structure without the permission of the Building O;vision. I further certify that my registration with the Builder's
Board ;s 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 comP1iance with Or.S 701.055 will be used on this project.
Zone
Fire Zone
Flood Plain
RE"~ ) AWl} A) 60 .eQg)ilYZJR41~
FOP. OFFICE USE 0I1LY
Sq. Ftn.
Sq. Ftn.
Sq. Ftg.
,
~CL"
Dm~
IWIE(ple,se print)
Stories
IJnits
f)ccy load
,tkcy Group
t1ain
Access
Other
,
,
Value
Value
Value
TOTAL VALUATION
Type/Const.
Bedrooms
,
BUILDING PERfllT
Charges an~
Surcharges
. /-z:-:.:>-l::> . Plan Ck.
L_./ - 65%1Bldo
-- ----7-:s;-- Plan Ck.
~ 30%'Bldo
Conmll nd
Ppr Fpp
ROes
Per Fee
ISystems Development
Charoe (1.5~) ,
~>JI/ft:.r'?'r~
/c::::
==
~
PLU!~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERI\lT
\ Charges and
Surcharges
'MECHANICAL PERMIT
~harges and
l~rCharges
.->
Of111lO
'Sidewalk
A/C Pavi ng
Total Comb. rermit
Curb Cut
TOTAL
30.7S-
1
,
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A, Job Address
B, legal Oescription
I. examele- Tax lot 100, lane County Map Reference
II U3 43
2. exam~le- lot I, Block 3, 2nd Addition to
springtield Estates .
C. Name, etc, of owner and construction lender
O. Energy Sources
I, example- heat/electrical ceilin%r forced air Oi
2. exampJe- waterheater/electrlc3l,or ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq, foot garag'
2. example- 1lFIiew project, check-new - if addition
cneck add, etc,
F, Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family ro(
3. examJPle - convert single family residence 1nto
restaurant (chonge of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonnation 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 adjacer
to the appropriate item(s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building ~ivision
1. To conserve space on the permit form the schedule
have been abbreviated
2, I f the item( s) to be ins ta 11 ed a re 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
0, As noted on the CAP, the label must be delivered to t
electrical contractor for signature by 'his electrical
supervisor. The general contractor 1s ,not authorized
to sign the electrical label. ---
Ill. 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
signa ture.
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
......
,
'_ ..,; """,,CI1~Y.IiOF-.SPRINGFIELD, '. .,
City HoIl
, , ,.' Sp,lngftold, O;ogon "
Office of Community and Economic Development
OFFICIAL RECEIPT
14587
Date A/~. ~ _ 19;::?9
, -::R: I' /"'"
Rec'd From t~8N ~. /"I L €::..r.?.A>-x?
Address LIP.> ~~H ~ .
"
~eceived FOC~~#;:':L;?/;hA'7""';'
ff>7, /c;-:.=
. t..,.. -
~O"
(*-:#/kry' /~
- /..>
/5-~~
?c9- 7S--'
C'4-5'.4 '
Amount Received
--::?c9. 7 S-
J!L
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~-AUT>ib"ZEO ~G~~ ""'/ /
r
r. . _ 8U$lI\I(SSFORt.1S,Ir<lC 450313"2-1'"
15&13
Permit Clerk
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
5u7V~7
~./'.....~S
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?,Y ~ /;;r;r ~4rr'?'C:
6~ C-> --:. /-/ ~...y
0. v........5.--",...-,49 "
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY;
name L'~.7i~~ /=2~c.rfSignatur~ ' ~~:.?-;;date 'i? -g-~
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