HomeMy WebLinkAboutPermit Building 1986-6-10 (2)
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111<~PIClION LINE
,726-3769
Job Address.. '3 +0 2.
Legal Description <;'pp
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Owner' WALLACF IUJE('H-r-:.
Addr... 34-97 ('{\,Aif\l"Sl,
SPQiNC.Flt::LI) ,O~G60rV
Construction lender
Address
Ut::dlir~ ItAli
Primary
Structural
Electrical
Phone
74(s, -44+("
7t/~~'t-S32
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Phone
(address)
l.JILL.""" 1-1. Neel A"..td.c.+
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IHFDRltAT ION UH..
726-3753
Sq. ftg. flaln ,
~q. rtg. Access,
Sq, ftg. Other
Ifew ~d Alter ~ep.
--rence Demo Change/Use
Other - --
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CI TY OF SPRINuf"iELD .
CDMBlttATIDN APPLICATION/PERMIT
ElIERGY SOURCES: ... .._..
Heat
Ilater Heater
Ranqe_.-__=~_
ValUE of Work:
'iP/:?9._'f72- ,
BuilcifnQ""Pennit Info: Describe Work(ioe.,
Fa~11v nes;denc~ Hi~h ~~t~f-h~d Garaael
Build Single
ClAd
--l-o
wo I \( I t8' I<. 1(,,' k;0-- c;ke.\ L-.IJ~
ell i o;.-H~,j I o...la.re.!;0 v...S e .
2.4- \ 1=. :>'nx.J."""1
ELl"1l!..u!) Olt.t:
Mechanical
CONTRACTORS (name)
Genera 1 R. A. L.-I--\{.\, IIV1 r:>, IS. f2. S f /.l S'!)L;lC..
Plumbfna
E1 ectrica 1
ffechanfcal
(address}
1& 1'1 Gard." AvE.
elA..o,e~t51 ORE.
'2.,,\ Mo""fWlO
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Bl-I.; l..i)n'S SEC:T1L-ic..
PLUlIBING
ELECTRICAL
NO. I I HE I (HARr.F
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 batH)
Duplex (1 bath)
Additional bath ITemporary Construction
IWater service IChange in existing I
rp~5 de:nrp_ ~
I Sewer I multifamily, COrTm. or I
Tndu"triil:l
~'IStorm Sewer '111)5"- Of amps~ I
, I I ICOH/I.IINO. FEEOERS I
I I Install/alter/relocate I
rli"trih_ fpprlpr~
I I I Of amp..1 I
-, III' I
I I I I I
I I I I I ISSUANCE OF PFmUT
TOTAL CHARGES ~-l TOTAL CHARGES, ~.~ TOTAL CHARGES /'5:-
, WHERE STATE LW REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this pemit
shalli~~.,b:.Qd~i~j;,ntW.ti;"l;l'a~~~trt'"},s~p;;r~;s'P..m~.:..o ~i~~~ .. .
1 HAVE CAREFULLY EXAtllNED the completed ap~lication for permi~d do hereby certify that all intonmation hereon is true
and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the la.....s of the State of Orel.:lOn pertaining to the work described herein. and that rlO OCCUPAIlCY 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 OP.S 701.055 will b~ used on this project.
SIGtlATURE, -'sJl.,AAQ.-"U Q. Q..Q nATF. (,. 110/ i'f.,
FO~ OfFI CE USE Q;IL Y .
Sq. Etg. llain 9$1~~ x Value~~7.?CO
Sq. Ftg.~Mv/.IV"" x Value 0:2"'("~""
Sq. rtg. Othe~~~lV"'-"".p Value~."..,...~
. . TOTAL VAlUATIONR~ 5'~
2U '45 (Ust;7 ~h~;~~s t~~~Wpmeot /9 ,/2..~l!5
r
Nn. I
Residence of
~ New circuits alts.
~ or extensions ~
SERVICES
each
IIArlE(please print) -re...0't'!.1t:e.
/2. 1<0/";1\1$0";
Zone~
Ffre Zone
Flood Plain
BUILDING PERlIIT
Charges and
Surcharges
PlUrmING' PERMIT
Charges and - --
Surcha rges'
ElECTRICAL PERl~IT
Charges and
Surcharges
t1ECHANICAl PERMIT
Charges and
Surcharges
Type/Canst.
Bedrooms
S tori es
'3.N
Units
Occy load ~<9'
Occy Group J5..::?
/
L/=:7~ _ Plan Ck. Conm/lnd
:1~~ 65t/Rlda Ppr F'pp
- - - /- "> -:::l'; - Plan Ck. Res
. / . /.,. JO%/Bldo Per Fee
____3.s-: ~ I Fence
/ ,.yO I Demo
L~__::?.::?.::-S..eJSidewalk -:uC .
r . -;7c:::!> I A/C PaYing I
~___t~~_lcurb Cu't /-~' L
, ~~F' . r~ARr.r NO.
SQ. fT.
Z2;)
MECHANICAL
. n~ rJ..lAI'U:
furnace/burner to
I\UU Joo.OD/J BTU's2
Floor furnace
and vent
7,50 /SoC
Recessed wall
~n~rp hp~tpr ~n~ vpnt
Appliance vent
!:.eo_ar;ltp
Stationary evap.
c.onlpr
Vent 'fan with
~inole duct.
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and rluc:t
,-
I
I
Wood stove/heater
I
I
I
I
I
I
I
I.
ITotal Comb. rermit
~SlO
/7&1,Se>
L.'I- 70
I
I TOTAL'
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I 7~3.1z
f-z ~ ~s:ZC>
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
.(":.~~~.::.!'~
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t. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot lOa, Lane County Map Reference
1/ oj 4J
Z. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinq/or forced air OdS
Z. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house; 500 sq. foot garage
2. examole- if new project, .checkMW.- .if addition,
el1eck add. etc. .:
F. Building pennit information:
1. examole - 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
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 f111-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
~henever possible, the initial application will b~ used as
a worksheet only. Where possible, Building ~ivision 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.
~fo& 1?tf
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V. FOR OFFICE USE ONLY
Permit Clerka-__
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PROJECT CONDITIONS TO BE SATISFIED BtFORE OGCUPANCY:
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~/Yrrc ./;-~C ~;;: fA:r:.:.-..iL~.c~ >~~~.r. /3 T~Vt=Z>.
Permit applicant exempt from registration with the Builder's Boal'd because:
I Additional Project Information:
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I
PLANS REVIEWED BY:
name
L~FJ~ ?t~E?f'
signatur
~
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,;
date 7.../-&,c
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