HomeMy WebLinkAboutPermit Building 1986-3-28
-- -------;- -~
-.----,----. - .
t
_._.___..._..._,,;.~_ .",_" ....__...~.d__ '.'___'_._.._
'. .;-:-....
. . - " .
...... .'
( "
.-
jlNSPECTION LINE
726-3769
Job Ad~ress 3.3 2D MAtI. ')
Legal Description 17-l)z.9J.3J.
CITY Uf SPRINGFIELD
COHBINATION APPLICATION/PERMIT
. .
ElIERGY SOURCES:
Heat .
l~ater Heater
.<;r.
"2~
INfDRltATlON LINe ~I
726-3753
Sq. Ftg. Hain ~
~q. Ftg. Access. ~
Sq. Ftg. Other 'I .
..Jlew_Add~1ter -Yep. 1'.,
Fence Demo Change/Use \J
ValuE of HO;} PO Other- - ......
3CiPO , "
Builoino Permit Info: Describe Hork( i.e., Build Single 1-,
Familv nesidence With Attached Garaoe} ~
t".NAr:,.,~P/A'( ~ l1;fft~~__'U..1.i - I
br. I:/Li!u.NrlL. 2/;;01.. il,fFf#- ; JJ4tJtiir./L I
, . I
. ;Q$IfAt'AU , 'I
llic5. no. \ (exoires\ (ohone no. I
---..
RanQe
Address
Owner ~<;'a,I#,' 6UJUA.
Phone
Construction lender
Address
UI:.:::dlil'i II:.AH
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General
..., /JJ ~,..,
P1umbino
, Electrical
~1echanical
~.
'FL.h.ef-
(namel
Phone
(addressl
L
.~
(name)
(addrpssl
(lic:c:., nn.'
(pxl]iriic:.'1~'
(I}hnnp nn l
-- -,,-
I
PLUllB I NG
ELECTRICAL
HECHANICAL
t~~ . r~~ Nn
'~'
Each single fixture
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Add1t1ona! bath
Water service
Sewer
.,-,,'
Storm Sewer ;,v
New circuits alts.
X or extensions
::2.. t:>>< lMhLE
SERVICES
22.~
Floor furnace
and vent
/ Recessed wall
,:: .~~~itnd vent
t,eE
Temporary Construction
Change in existing
rpc:. i dpnrp
multifamily. comm. or
Tnduc:.trial
Appliance vent
~eoarittj:l
Stationary evap.
cooler
Vent fan wi th
c:.inole duct
Vent system apart from I
heatino or A.C. .
Mechanical exhaust
!"u...nti itnd rlllrt
3t1t::>
I
, 2t)€P.
1fJo
Of
amps.
V Afll(UII1 ~tf)fKbr..
Wood stove/heater
I
I
I
I
I
2~
COHH./INO. FEEDERS
Install/alter/relocate
rlic:.trih fpprfpro:;
Of
GM. ~/I'I~
amps.
I ISSUANCF OF PFIU1lT l
~1'!! TOTAL CHARGES 22 $"0 TOTAL CHARGES #11,-.} ,
that the Electrical work be done by an. 'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
. . .... . ~. ' . I
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 .shal1.be done in accordance with the Ordinances of the City
of.Springfield and the Laws of the State of Oregon pertaining to tije' work descr1bed herein, and that NO OCCUPAIICY 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 7014055.~that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with 'ORS 7Ql.055 will b~ used on this project.
TOTAL CHARGES ~/~IIH~~
WHERE STATE L~W REQUIRES
shall not be va111 until the
NAt1E(p1ease print)
Zone G ~
Fire Zone
Flood Plain
BUILDING PERmT
Charges and
Surcharges
PLU!\B ING PERHlT
Charges and
Surcharges
ELECTR ICAL PERI\lT
Cha rges and
Surcharges
HECHANICAL PERHIT
Charges and
SurCharges
/5"'"
TYDe/Const.~)(,I
Bedrooms
Stori es /
SIGrlATURE
FO~ OFFICE USE ONLY
Sq. Ftg. rlain x Value
Sq. Ftg; Access x Va I ue
Sq. Ftg. OtherL~'~Lx Value.
TOTAL VALUATlml
3,-:)n~~
DATE
1
Units
Occy Load
Occy Groupfi-'Z
3.-<1. $"" Plan Ck. COll1ll/lnd
~ 65%/Rldo Ppr Fpe
-------7/------
, / S ~b;~B~~~ ~:~ Feo
___~'2_:e:..___ Fence .
/10'
"
22..5'0
------------
,'1 ()
/ so<>l C~rb' Cut
--n-~b-o----I.
Systems Development
Charne tI.5~) . .
0_
Sidewa 1 k I
I AlC Paving~~,:::1
I
I
~8. $.:s
Total Comb. Permit
/ l/ 6.1,/ I
TOTAL
()
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMI1 VALIDATION
t. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100, Lane County Map Reference
1/ 03 43
2. examp1e- Lot I. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
1. example- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. ------
I. example- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. check-new.- if addition,
check add. etc. .
F. Building permit information: .
1. example - construct single family house with an
attached garage
2. examole - 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 (aJ of the
Structural Specialty Code
H. DESIGN TEA/l AND CONTRACTORS
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 ab~reviated 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 b~ 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
5 i gna ture.
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.
lo eo/ f()
V. FOR OFFICE USE ONLY
Permit Clerk
~/,'/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
BtltLlJlJ)Ct F/~~/ ~fl" mpf/ //!F IV ;J~ ~
/J"..4.F.f/'~JlI-r' D("~
U.JirtflJt) L"I'J ~~~
;U"'lJt,Fre.A:Tq7vr/P/=~:,;t?..r AUI&..,'7" -tit,!'; ~~
7'wtfF: 'p)""fi/~~~'r-/l 1.<:; rM1.rr 6A&.7~ .
Permit applicant exempt from registration with the Builder's .Board because:
.'.
Additional Project Information:
PLANS REVIEWED BY:
name1~f3tAM
~
.~. ~
signature~at'LA L. m~
'.
date
11-:2.~ I!W-
I /
.
_.~~. -. >. . .. -