HomeMy WebLinkAboutPermit Building 1986-3-4
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I INSPECTION LINE
726-3769 '.
Job Address
'1202 '~/AI'
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CITY Uf SPRINGFIELD INFOR/lATION LINt
COMBINATION APPLICATIONIPERMIT 726-3753
EllERGY SOURCES: Sq. Ftg. 1'1ain
Heat ~q. Ftg. Access.
Water Heater Sq.' Ftg, Other
New Add Alter Pep.
Range -Fence Demo Change/Use
va8~~:'.s Other- -
Bui16inQ Permit Info: Describe Work(i~e., Build Single
Familv nesidence With Attached Garaae)
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Legal Description /7",,2.";!/2-~. c/7t!> /
Owner ~~~t:>
Address~~.5. /9tSq,-G7#/~ Phone
~ wa. 9ga 3'~ 1'2~'672.s!:'2:Z
Construction Lender
Address
DESIGN TEM1 (namel
primary:.JR.co .P~~,
. Structural
Electrica"
Phone
(address)
/hT'l9rb.R R'~~/6y'.TO cR..-... cF
~r ~ ii*1#> ., 5l9lV/Ge-
,4n6i9
(l ie:s. no.)
lexniresl
(ohone no.")
SiS<5.ru~~,~A- C,A.~7/
-,. -,
A.
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; Mechanical
CONTRACTORS Inamel
General~' / C/a€ #........_. .,.,.)
(address)
:3 (p 4:2 '3
fit tUtlu L5R
U
lli~<;.. nn_)
PI1'4<:.ud IIi/I
(pl/n;rpt;.\
(ohnnp nn_
Plumbino
1fL/,~ -(Jh/h
'7.;).1:, - .3 9q?
Electrical
~'echanfcal
PLUlIB I NG
ELECTRICAL
I rH'lB.IiE.l NO
MECHANICAL
NO.
FfF I rHARr.F
~n I
Residence of
I ~~~
5'
Each single fixture .,~ ~~~
~&t't ':1/ Mf'V1lD" ilr.
Relocat~ building
(new fix. additional)
SQ. FT.
furnace/burner to
BTU's
I ~~~ 1...c..HAR!i.E.
or
New circuits alts.
or extgn,.siQn~ _ _
'20)liil~t!;.
SERVICES
2?P
Floor furnace
and vent
S.F. Residence
f1 bath 1
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp np~tp~ ~nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C. .
Mechanical exhaust
hnnrl and durt
I
I
I
Sewer
Temporary Construction
Change in existing
rp~ j qpnr:p
multifamily, comm~ or
I nrlllS tri it 1
Water service
COMfl,/IND, FEEDERS
Install/alter/relocate
rlit;.trih fpprlp~~
Wood stove/heater
Of
amps.
ISSUANCf OF PFRllIT
TOTAL CHARGES ';l7- S"~ TOTAL CHARGES "" <,,$0 TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to th~ Building Division
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 cerformed 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 OCCUPAllCY will be made
of any structure without the permission 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 ~ereon, and that
only subcontractors and employees who are in compliance with ORS 7Q1.055 will be used on this project.
IWIE(please print) _1M: flJL /{.Ocu SILJ SIf,NATUREL .
FOR OFFICE US, OllY
Units SVtg. r-tain ,x Value
Occy Load Sq. Ftg, Access x Value
Occy Groupl1li:S:z. Sq, Ftg, Other jl:'~YJS./479 Value 81 ""'...-~~-
TOTAL VALUATION
,
DATE 3-f.{ -fb
Zone~c::.
Fi re Zone
Flood Plain
Tyoe/Cons t,
Bedrooms
Stories
~"'H
/
BUILDING PERI-liT
Charges and
Surcharges
____~.8._~~_ ~~~~B~~~ ~;:.'"~;~d
.., -,~ Plan Ck, Res
-., 7 30%/Bldo Per Fee
---'-2_?--f!:-- Fence
I. i) t:> D_
22,s<:" I Sidewalk
-------:9i::'-, A/C Paving
I Curb Cut
I
'/t./. ~
syste.ms Development
Charoe tl.5~) .
~.4.
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERllIT
Charges and
Surc~arges
MECHANICAL PERMIT
Charges and
, Surcharges
TO,AL
I ~~."l/
(/78. 17 ~
Total Comb. Permit
.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address ."j .: :"\.;;.,',/~ ',:.." _, :~..,~ ':',;'~'" I. .' '
. : ,:-;:,',,_:\,
B. legal Description ,; '. ~ """"
I. example- Tax Lot 100,,'Lane County,Map ,Reference""
11 03 43 ;1" . ':.. _.' . . '
2, exanyle' Lot I. Block 3, 2nd Addition to'.',:'...' -,
~pr1ngti.eld Estates': '",.' '0' ,',; ,',~ ,;: ". ~
C. Name, etc. of owner and c'onstruction lender I ,,,: ':.: ;
D. Energy Sources . , " ......, ~, ~ t" ':, ~ ,.:
1. example- heat/electrical ceilinq/or fo~ced.air. Qas
2. examele- waterheater/e.lectrlcal/or ~ ; ,"
E. Square footage or valuation. etc.
I. exam~le- 1250 sq, foot"house, .500 sq: foot 'garage
2. example- if new project.. check new.- if addition,
cneck add, etc,
F. Building permit information: '.
1. examele - construct single family house with an
attached garage
2. exam9le - 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, OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Buildlng
Oivision 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 ~chedules
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, ---
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.
III.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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,. PERMIT VALIDATION
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Permi t Cl erk Gf )
Permit applicant exempt from registration with the Builder's .Board because:
Additional Project Information:
"
date "2-78~Bt;
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