HomeMy WebLinkAboutPermit Building 1986-9-24 (2)
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CITY OF SPRINGfiELD
CDMBIIIATlDN APPLICATlDN/PERMlT
EilERGY SOURCES:
Heat
Hater Heater
Ranqe
Val.\1€ of I-Iork:
,'~ /} G' C' r' ~:~
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BuilriinQ Permit Info: Describe Work(;~e.. Build Single
Familv P.esidence I-lith Attached Garaoe)
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("rh"<>~ 7P.#CF ~ '//;"T/~~ I
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(l;es. no. I (exoires)
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TOTAL CHARGES TOTAL CHARGES :<25Z> TOTAL CHARGES
WHERE STATE l~W REQUIRES that tile Electrical work be done by an-Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to t~e BUilding Division
I HAVE CAREFUllY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that fle OCCUPAHCY 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 O~S 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
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I INSPECTION LItlE
726-3769
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Job Address ":-',;{:1 / /1-//>/# ,S:,-;
Legal Description /7-o2-1z--3;:;> PA.'K'r~ C? 1900
O '",1 ,-, ',',
wner / (,(/('7:;: /-~';v ~~ /,~- it F::"7',"" _ .....:."/:/~ :-.-.J,/V,~'
Address/v'/IT/~'/,j"I9.L l~;:{)/.."7". - ./.E:.S!:.r::t';"
"!--t-;'..;.J1- /i 7/-/$1'1 'f~:~:,(//i//),lf-0;-:
/1
(:';'N~i?
Phone
'/7'(r~3 3.:1 _~~
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Construction lender ,7. I.::.fi"..../-:::
Address
Ul:.~llirj nAI'1 (name)
Primary ,\~_.)'>:-;/.. r-:
Structura 1 -V /h
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Electrical II';"")
1'// -/
Mechanical (i 1/)
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CONTRACTORS (namel.
J ..;',,; /' (~
General .. ,'f", ( ~'J,A/_/',';---:
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Plumbina NI/J
/
Electrical k//J
t'echanical /-.j/!].
Phone
(address)
(address)
PLUf.lBING
/
ELECTRICAL
110,
fFf
CH!JBl;L jJn
I Res i dence of
Each single fixture
SQ, FT,
Relocated building
(new fix. additional)
New circuits alts.
V' or extensions
'7 1":7r-? .h.7~G
SERVICES
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
reo:; j d_epee
multifamily, comm. or
Industrial
~Iater service
Sewer
Storm Sewer
Of
amps,
cor~'1. /I NO, FEEDERS
Install/alter/relocate
dic;tr;b. fppdprc;
Of
amps.!
IWIE(please print)
- /,:~"J'- . :-,~ ...:~Y / </
.. -" yc::t '. ,; ~), I.' ,ok
Zone <:::: <:::
Fi re Zone
5~A/
Units
Type/Canst.
Bedrooms
Stories
Occy load
Occy Group
K'-,::?
Flood Plain
BUILDING PERfllT
Charges and
Surcharges
"2 Plan Ck,
~;./:Z- 50 65%/Rlda
------------ Plan Ck,
1- 50 30%/Bldo
1 Fence
------------1 D~mo
21,/=3
COIlU11/1 nd
Pj'r Fpp
Res
Per Fee
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~lT
Charges and
Surcha rges
_ ___ ~.:?,;f-=__
-':7"0
Sidewalk
AIC Pavi ng
I Curb Cut
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r1ECHAN I CAL PERMIT
Charges and
Surcharges
.
G, e, ~'l11 ,'S3DQ
INfORllATlON lHit
726-3753
Sq, Ftg, 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Rep,
Fence_Demo _ Cha?ge/U se
, _Other ,
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N
(ohone no.)
(1 ire;. no.)
I~q
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(pxnirpc;) ,...- ~(ohnne no.)
MECHANICAL
"-E.L J:.IiARG.E. NO,
FC,
CH
furnace/burner to
BTU's
'2Z-52
Floor furnace
and vent
Recessed wall
~nnrp hPntpr nnrl vpnt
Appliance vent
'ip.oa ra t.P
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood nnd duct
from
Wood stove/heater
ISSUANCf OF PFRIIIT
, /
OATE f/.:?''//i',<,'
,/ /
t1ain x Value
Access x Va 1 ue
Otherh"r/>>~ Value 7cC<!?,
TOTAL VALUATIOII
~...
Isystems Development
Charoe (1.5~)
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Total Comb. rermit
-57z.c,
TOTAL
78.33
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COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant t6 furnish
A, Job Add~ess
B, Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II uj 43
2, examole- Lot 1, Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of'owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
cneck. add, etc.
F. Buildingl 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 o~'work as defined in Section 303 (a) of the
Structural Specialty Code
H, DESIGN TEN~ AND CONTRACTORS
To avoid: design or construction delays. Building
DivisionlStaff 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 Plu~bing. Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form 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 II 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 the
electric~l contractor for signature by his electrical
supervisqr. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant tollsign and date
Whenever possible. the initial application will be used as
a worksheet 9nly. Where possible. Building Division Staff
will prepare'a type written copy and return it to the
a~plicant at;'I'the time the actual permit is issued for his
slgnature. I,
IV. Fees and Charges
Plan check f~es are due and payable at the time of the
application. land no plans will be processed until these
fees are paid. All other fees and charges are due and
payab 1 e when' ,the permi tis issued.
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V, FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION,
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
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Additional P~oject Information:
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PLANS REVIEWED BY:
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name
L ~.J?.NG' 7L~E??
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signature ~ ~'-.: '0
,,/ ~....ry
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date '7-2C-g6