HomeMy WebLinkAboutPermit Building 1983-8-12
j
.,
ItISPECTION LlIIE
716-3769
.
.
Job Address l.j 2. L q ,A fficUxl 'SI:.,
Legal Omription \lb8.3:43d.. 019rY)
CITY OF SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
r-, \ ~t'\.-~ br l f"\clLY"
!~O\\ e.c~~~_
<;")C'",,,~ ~J
Construction lender d
Owner
Address
Address
Ut~lliN TEA11
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
Nechanical
NO.
vall of Hark:
:< ~C'--b
, .
BUllciina Pennit Info: Describe Work(Le.,
Family Residence I~ith Attached Garaoel
Range
Phone
NFORlIATION LINt
716-3753
Sq, Ftg, 1,Iain
!:q. Hg. Access.
Sq, Ftg, Other
New Add Alter Pep,
Fence_Demo _ Change/U se
_Other
Build Single
\'~\'~~'1 ~
'!' vY\ or\). 0 , ~_~f\ rm ~ ~\l'_;r, ~\)
(liCS~Xniresl Inoone
(name)
Phone
(address)
lnamel
(address)
(lies. nn. \
......110U1 2..W-L,(SI
PLUIIBItIG
ELECTRICAL (ctXIJ7.) I
I Residence of I ~...1!Q.....
SQ, FT, I
I
FF'
r~nRr;L .Jll'
Each single fixture
so?
\
New circuits alts.
or extensions
!SERVICES
I
Temporary Construction
Change in existing
fpsjdp.:nf"p
Imultifamily. comm. or
,IndU':;.tr;al
Pi.
-l~
~
y ~
(pxn;rpc:.)
fohnnp nn. )
I
I
I I
-,
I
I
I
I
I
I
I
I
I
C\)
uI
"-
'l\
~
no_ l
MECHANICAL
(eY/..r7.)
I I:'~~ 1..c.uA.RG.E.
...
I
I
I I I
f--HOf
, I I I
I I I I
TOTAL CHARGES ,'): ClIO .1 TOTAL CHARGES
WHERE STATE UI~ REQUIRES that the Electrical work be done by an.
shall not be valij until the label has been signed by an Electrical
I
I
I
I
I
I
I
I ISSUANCE OF PFRlllT
.1 TOTAL CHARGES
El ectri ca 1 Contractor. thee 1 ectri ca 1 rortion of thi s pernit
Supervisor and returned to the Building Division
IRelocated building
(new fix, additional)
IS.F. Residence
(1 bath]
-----IDuPlex (1 bath) each
IAdditional bath
-I ~Ia ter servi ce
Sewer
IOf
ICO~1,/INO, FEEDERS
I Install/alter/relocate
nic:trik f"'J'OnJ'Orc:
amps.1
amps.l
ve'DG-L.AJj-'>
IIAI.IE(please printN' ::Ei3,Jl\Ji
Zone G t::-
Fire Zone
Flood Plain
BUILDING PERNIT
Charges and
Surcharges
PLur1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Tyoe/Const,
Bedrooms
Stories
Units
Occy Load
Occy Groupft-2
Storm Sewer
I
I
I
-----I
furnace/burner to
BlU's
I Floor furnace
and vent.
Recessed wa 11
h~at_pr anrl
vJ'Ont
I HAVE CAREFUllY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and! 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 Oregon pertaining to the work described herein, and that UC OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
Board is in full force and effect asrequ;red by ORS 701.055, that if exempt the pasis !o~xemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701~055 will b"used o9Vthis p~ject. ~
SIGIIATUR!i ,jJ ~'Ul
FOR OFFICE USE O~L Y J~.
Sq, F~/llain x Value
Sq. Ft9. Access ,x Value.
Sq, Ftg, OthergclO~~ Value /~,O~-
TOTAL V ALUA Tl ON
____/_o_:.._o~___ Plan Ck, Conm/lnd
tJl _ 65%/B1d~ Ppr Fpp
~. ~~ ~~~~Bi~~ ~:~ Fee
S ,aD I Fence
------ :-z.-Cfl O~RlO
I Sidewalk
------------
I Ale Paving
I Curb Cut
I
"3.,. --
I App 1 i ance vent
seDarat~
I Stationary evap.
cooler
I Vent fan with
sinole duct
I'Vent system apart from I
heatina or A-.C.
I Mechanical exhaust
hood and durt
I ~lood stove/heater
DATe/;2 -&'3 I
Systems Development
Charqe t1,5~l .
t/.A.
Irota1 Comb. rermit
Co 7. >6~
1-
I'OTAL
1~6.(;O
/'s A'E~~/7-? €Z> / p
C~ (?"c.T~~,..<.. C/7i"cv//A''Y.IS #~7&f"~ ~ G.TE~~';"~l
~ ::2 - Cc,O!&?Z?/./VA' 7lE hA"'~ ~)7'~ '-YSH tF~ If' C=-(Cr J "" >~~.5?>.T- :
w/-C::::::/rcr A/Y"~ /n,RS~c .
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A, Job Address
B. Legal Description
1. examDle- Tax lot 100, lane County Map Reference
II U3 43
2, example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceiling/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. exa~le- if new project, check-new - if addition,
check add. ete.
f. Building permit information:
1. example - construct single family house with an
attached gar~ge
2. examEle - remodel existing garage into family room
3. exa~le - 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, DESIGN TEM1 AND CDNTRACTORS
To avoid design or construction delays, Building
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 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 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. ---
III, 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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I ~ Au
tE (, et:::.7A/ c:,. c...
-n
/ ~rrM/:r
.
PERMIT VALIDATION
..~ ,~3
g Ijt!
& 153lp
~
/ -
,
Permit
Clerk~
Permit appl icant exempt from registration with the Builder's Board because:
REVI EWED BY:
Lo7'i'i</~ ~~ ~ signature /~/2~
Additional Project Information:
PLANS
name
]
date
?
8-/'<-8::;;'