HomeMy WebLinkAboutPermit Building 1988-1-27
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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
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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
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PERMIT ~ALIDATION
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1- /- 1 Jft
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Pennit Clerk
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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
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DATE hECI.,,' D / -~ :>'-88 JOB NoB8C'~
ZONE G c.. OCCUPANCY GROUP i2:...-.~ <.
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..\P?",OVEiO D. n.r:: SlIll JIN'"; OFFIC~L
CITY OF SPi1 roiGFIELD, ORl':GON
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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
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'. , ~! - ' 746-6788 746-3323
" 1600 N. 18th 4221 M~in St.
Springfield, OR 97417 McKenzie West Shopping Center
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