HomeMy WebLinkAboutPermit Building 1986-6-10
Owner WALLAC.F K..NGCH~
Address ""2 A (Y\ -
-7'T'O'L p,il\l '5/.
5PQif\J~F'/:::L/) ,OR-G6o rV
Construction lender
, .
: ItlSPlCT IOtl LItlE
,126-3169
Job Address... '3 '\-0 Z.
Legal Description 'pp
TIII.'l l-oT
Address
DlSIGI< TEAfl
Primary
Structural
Electrical
Mechanical
COtlTRACTORS
.... . ". --.
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CITY Df SPRltlGflELD
COMBIt~TION APPLICATION/PERMIT
EIlERGY SOURCES:..
Heat
Hater Hea ter
fHfORlIATION L1t1t
726-3753
sq. Ftg. flain .
~q, Ftg. Access,
Sq. Ftg. Other
flew;Add A Iter P.ep.
Fence_Demo _Change/Use
_Other
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'1..'1.c>Q
M"~'JST. SO';^J~dd. O~,,~
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1.. ~ov 0.......<.1 2400
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6-
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Ranqe
ValuE of Work:
1P~,o</.~.' ..
1.c7~ 7 "..~
BuilrifnQ'"Penllit Info: Describe Work{i~e..
Familv nesidence With Attached r,araoe)
Build Single
Phone
7~ -444-(.,
7t/~..'tS32
DAJ
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QO' \( I j,8' l'. 1 In' "';~l. skel \,.. IJj .
ell i o;..t-1.^5 \ ua.re.,^OlAS e .
(namel
Pho~l'!
(address)
'exni res 1
(ohone "0.-\
(lies. no.l
1~)lu_1 Q.M 1-1. l\JE'el' A-,.J,..;kd-
2.4\ 1=. '" nx.a""'1
ElA.."1e.....e) DivE
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l~lC7-"l44S
(namel
(addres,; 1
(lir", no \
lohol"lp M..\
Plumbino
R., A.. (,,\-\-A IIV1 0. ~ 12. S 1 /.l s~.:>C.
GlA i l-i) Eli: s sec.m c..
General
Electrical
~'echanical
NO.1
1\1 /'1' Gade... AvE.
e....Ge>JG, ORG
2..'\ MONIU>15'
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1030
(,,13ol~1D
48S:-0'i22.
2-0-12 C.
PLUllBING
ELECTRICAL
MECl'.AtlI CAL
I fFF
I FFF I rHtlIU~r'
I FFF
cHARGE
rHARr.F
~IO_ I
furnace/burner to
:t>-- /Jot>,ODlJ BTU'sZ
Floor furnace
and vent
7.$Q /S-()(,
Nn.
Residence of
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
IWater service
Sewer
~' Storm Sewer
SQ. FT.
~ New circuits alts.
P' or exte~sions ~
z-z:;)
SERVICES
Recessed wall
~n~rp ~p~tPr ~~~ ~P"t
Temporary Construction
Change in existing
rps i dJ'nr~
multifamily, COlim. or
Tnduc;,trial
Appliance vent
seQ~ratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hood and durt
I Hood stove/heater I
II
I
I
~9"
Of
amps~
COMl-I./ItlD. fEEDERS
Install/alter/relocate
di~trih. fppdpr~
Of
amps.1
I
I ISSUANCE OF PFRlHT
TOTAL CHARGES ~- TOTAL CHARGES" :z:z.~ TOTAL CHARGES '---/?S:-'"
WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical .portion of this pemit
shallf~~/:p.~n1;;nttli~l~as bee~ Sig~ed b ,;":;:tr~ViF.J~iS'P~~O ~~ .
1 HAVE CAREfUllY EXAMINED the completed ap 1ication for permit. d 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 NO OCCUPAIKY 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 subcontractors and employees who are in compliance with ORS 7Ql.055 will b~ used on this project.
1'2. RQloiNso"J . .
SIGN^TURE~ Q. ~
fO~ OfFICE USE Q;ILY
Sq. Ftg. flain '9~SI~ x Value~ ~..7.?co
Sq. Ftg.",,--~V/.JV~ x Value -:2"'r~"'"
Sq. Ftg. Othe~.S7.rv-,,"'p Value~...,.~.-
TOTAL VALUATION~~:5'~'
Jil/,t.{S 'tUsCJ7 ~h~;~~St~~~~lopment '19Y2.~~
f -
DATE (., /10/ Sfo
IIAf1E(please print) 7er..-e....ce.
20ne tt:.G
Fi re Zone
Flood Plain
BUILDHlG PERl-IIT
Charges anC:
Surcharges
PLUMBING' PERMIT
Charges -and------
Surcharges
ELECTRICAL P[RI~IT
Charges and
Surcharges
I1ECHAtlICAL PERMIT
Charges and
Surcharges
Type/Const.
Bedrooms
Stories
'3.N
Units
Occy Load ~C3'
Occy Gro'up ~-2
I
L/~;:;;;> _ Plan Ck. CornnlIn.d
:1~~ 65~/Rldo Per Fpp
--- I-~-::.::i--"'i'ian Ck. R'es
. / . ~2 30UBldo Per Fee
__n3.,~ --
/,ytP' 0_
_"':u::?.::?.:::SEJSldewalk ~/6 '
~ <:7~ I A/C Paving I
__n[~~-ll Curb Cu't /-"36' I
.60' . I
fence
Comb. rermit
I
--- - --
I 7~3.12
(-z. ~'~5'.ZO
qz. $"0
/7&1..Sc:>
ILl, ,'i"c>
ITotal
I
I TOTAL
. . ~~..
=-:::r:-w_-.-... -___
..-~ -' ~.._.-.. -
~
.
,.
-
. . ,
COMBINATION APPLICATION/PERMIT (CAP)
,',
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100. Lane County Map Reference
11 oj 43
2. example- lot I. Block 3, 2nd Addition to
Sprlngtield Estates'
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceili~Q/or forced air Qas
Z. exam~le- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
Z. example- if new project. .check-new.- if addition.
. check add, etc.
F. Building pennit information: ,
1. example. construct single family house with an
a ttached 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 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Divi~ion 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 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
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.
..
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V. FOR OFFICE USE ONLY
Permit Clerk-O; ___
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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/"5 C;;,q.~n~..:>
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_V.tYT~C ,~,~;C A>A;" /.4:/~? ~~~Jl(&>~7: /s Tc...J&X.VS:>.
- Permit applicant exempt from registration with the Builder's Board because:
~'7'/<
I Additional Project Information:
.
~
PLANS REVIEWED BY:
signatur
~
"
name
L~BHE 1t~E?f'
date 7.../-~,c
r
or r
,
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