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HomeMy WebLinkAboutPermit Building 1988-1-27 '. II;SPECTION LINE . CITY OF SPRINGFIELD 726-3769 COMBINATION APPLICATIONfPERMIT Job Address L /-'...., J .x...... EIIERGY SOURCES: 7' < < /.r/~//Y ~r. Heat Legal De<cription /7-<':;?- '? -:?_ ~ '<. ~<!>-c> lIater Heater Range D'X;L. - #Al-7Y6_;""~ U.o(!="o ValuE of flork: Owner'h.;"_~A/ ,37.--.z:., ~~,..,,__~_ /5~-C> Address Phon Bui16inQ Permit Info: Describe Work(i~e.. e Familv llesidence Hith Att~<:h~d G~r~o~l . INFOR/1ATION UNl 726-3753 Sq, Ftg, I,'ain ~q. Ftg, Access, Sq, Ftg, Other New Add Alter Pep, --Fence Demo Change/Use Other-- -- Build Single Gtl ~ "./ j)0fl7ZA'-_~ Address DtS1GN ItAH (name) Phone (addre<< I R~v~/H?: ~-if'0'l!},_. ~ ~r/7/e::r.-> i 1~fjr-1'~ ( ~~'7,-= IH //,. z;/C-c:> ? 7>J:>.8~ flies. no.) (exniresl (ohone no. ~. Construction lender r Primary Structural ~ .,(~ \If q"{)} OS ~80 E1E(;tr'ko 1 Mechanical CONTRACTORS (namel (address) (li('<;,. no.) {p)Cnirl?c:l (ohonp nn ) Genera I ///.....,. ...............,i,.,.s:;><, Plumbino Electrical ("4 S- &~C7: ~ ~I 1'1' 0 ~1echanical PLUI,1BI NG ELECTRICAL MECHANICAL NO, FFF rHARr.F Nn "TI- J:.IlARGf. Nn J=~L J:.IlARGf. Each single fixture Residence of SQ, FT, furnace/burner to BTO's Relocated building (new fix, additional) New circuits alts. L.._ or extensions ~~",,"'R~ SERVICES <;;? .s~ Floor furnace and vent S.F. Residence f1 bath I Duplex (1 bath) each Additional bath Recessed wall ~n~~p hp~tp~ anrl ~pnt Stonn Sewer Of amps. Appliance vent ~~o~ratp Stationary evap. cooler .. - Vent fan with ~inale duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and dud Wood stove/heater Sewer Temporary Construction Change in existing ~p~ i 1('n("{". . multifamily. comm. or TndlJc:.trial Water service CO~~,/IND, FEEDERS Install/alter/relocate rli~trih fppdpr~ dtl( \'^' Of amps. ISSUANC, nF pmlm TOTAL CHARGES TOTAL CHARGES ;;;>;Z,S"" TOTAL CHARGES WHERE STATE L\li REQOIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the 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 performed 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 UD OCCUPAUCY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only SUbconp;;r~ emPl~~o ar~ c1C~~ce;;~/:~rl1 ~:~hi'rlir:t' IW1E(please print) ~L.\e..1'r ~o tV CE' SIGIIAT~~~ ~~_ FOR OFFICE USE DIlLY .J Sq, Ftg, liain x Value Sq, Ftg, Access x Value Sq, Ftg, Other/HT./~~< Value /~ ~ TOTAL VAlOATlON DATE 1-t:J 7S;(, Zone .:::: c. TypelConst, Bedrooms Stories .~'h< Units Occy load Occy Group~ - "2. Fire Zone Flood Plain / BUILDING PERfIIT -2..5: ~ Plan Ck, ConmlI nd (]) /6'. ?S" Shstems Development /Y':4, Charges and ---- -~----- 65%1Bl ~~ pp~ I='pp C arae O,5~) , Surcharges ~ /,<? Plan Ck, Res 30S/Blda Per Fee PlOI~BING PERMIT Fence I Charges and ------------ Surcharges D~R1O I ELECTRICAL PERI~IT ---~~~- 'Sidewalk I Charges and '-'\ Surcharges ("./5 AIC Paving ITotal Comb, Permit 1./9-&25. HECHANICAl PERMIT I Curb Cut I Charges and ------------ I I TOTAL 66./3 Surcharges . . . ", COMBINATION APPLICATION/PERMIT (CAP) :i I. Applicant tOI:furnish A, Job Address B. Legal Description ~ ..... ,0_ 1, example- Tax Lot 100, Lane County Map Reference II oj 43 2, ~xample- Lot I, Block 3, 2nd Addition to , Springfield Estates . C. Name;'etc.~of owner and construction lender D. . Energy Sources .. . 1. exam~le- heat/electrical ceiiin~/or forced air Qas 2. example~ waterheater/electr1cal/or solar" E. Square footage or valuation. etc. - 1, example- 1250 sq, foot house, 500 sq, foot garage 2. example~ if new project. check-nfw - if addition, check add, etc, J. Building' pennit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. example - convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (al of the Structural Specialty Code H, DESIGN TE~1 AND CONTRACTORS To aVOid:1 design or construction delays. Sui lding 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 avaHable at the Building Division 1. To conserve space on the permit form the schedules havelbeen abbreviated 2, If the item(s) to be installed are not covered on the abbreviated schedules you should consult the'. ".' fu 1111 schedu 1 es 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 the electric~l contractor for signature by his electrical supervis~r. 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 prepareia type written copy and return it to the applicant at1lthe time the actual permit is issued for his signature. I 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 ~ALIDATION , " " ' " , ' I vg cf 1 1- /- 1 Jft ,.... Pennit Clerk cdLP I II PROJECT CONDITIONS TO BE SATJSFIED BEFORE OCCUPANCY: ./ H }~.ermiCapp11cant exempt from regi strati on with the Builder I S Board because: :, ' ,Additional ~roject ,Infonnation: \. ... PLANS REVIEWED BY: II, . 'name Lo/?.vc.::- A~-=~ signature ~~~ -" ry date /- .':?~a'R -/ .-., " ....... " ,-o-{vp,^ -15\O~ , '9'-',1,\",-.11 ~...~ . '" - - ] >"<<.......><1..... " , ~'OT I ....'^~. )f~1'?<> v.,c- --==> ( /, 10 r , I' I' ~I (' , E,4:=>7' ~<. < -.... --=- ~~\ 1 0 yf"\uE: .~ ,~ /f' y~ //:Ij7?f"~'--"r' .-/ ' .....""- W&>-"P At'~/f '., " w-~t.- "'---..- ~ / ~, ;2 -- .. ........ o 'I .~ -- DATE hECI.,,' D / -~ :>'-88 JOB NoB8C'~ ZONE G c.. OCCUPANCY GROUP i2:...-.~ <. .-.-.---..---.--... ._- _y.:::,I~:J O~U.~~NC~AD i Il_M?2.~.~~i.~_m___.f__T..~.=.?!:~T. :5'~. ~~I ,- ., rl.'.:.:.".~_D,".:.Cr :".T~~/.Z-: "'~:..Z_'"3 -3 'f- .:O/9.en=: I I,I(~ I~ AonRE55 .' tYZ~__~t'/Y ~7 ..=--- i -- i' '_~:'=i.:,,:,?"~,.bl5!.-a,, ~~/:,-,_y&e;zs '. I T;.r? C':::-,:"-:;:~-r!> HEn~ c,~ H.~.'J7. B!! !':.f I I15:Vl!:WED. WITH \ AL-r!:R-'.nC~~s 1'~D:::';'l;::J i:-I c:o..., ,,;:0 ~::NCil~. CH,'NOES .. ~ ... ," r,-, .,'" toLl! L' ".- OR A, ~'...~l\qONS :.~/,C!!. \1--, R .... 1.,,-" "''' .. '--/1 ..\P?",OVEiO D. n.r:: SlIll JIN'"; OFFIC~L CITY OF SPi1 roiGFIELD, ORl':GON ~ ..k- ._,./-2'.:" .~_",p""'-'"" !:ty '.-!II ~--,r- .;>" "'" . ..I'r",..:,..r r--". . .:: .~ .:- =..... J "S~ ..... . - '1 , - I I I I I I ...., ' \, :i .~,... TUES-WED-THURS $1.01 DAYS , ' EXCLUDING NEW RELEASES . ., HOLIDAYS ANlipROCEEDING DAY > , :1 -- Mon. - Thurs.: 2 MOVIES /VCR $ 7.9S Ii ' Fri.- S,un. f 2 MOVIES/V~R $9.95 II II 1 MOVIE FOR $1.95 2 MOVIES FOR $3!5 3 MOVIES FOR $ 5.95 4 MOVIES FOR $6!5 . (ANY MOVIES) -.. , MOVIEMATE FUN-PAK NEW RELEASES JNCLUDED V.I.P. Card $9.95 PER YEAR GOOD 7 DAYS A WEEK New Releases $ 2 . 99 Regular Stock , " $1 . 99 Wor~d's Largest Chain of Video Sto~es! ."SPAING,FIELD LOCATIONS . ' " '. , ~! - ' 746-6788 746-3323 " 1600 N. 18th 4221 M~in St. Springfield, OR 97417 McKenzie West Shopping Center -- -- -----......111111.....----- ~