HomeMy WebLinkAboutPermit Building 1984-4-24
INfORllATION Li~"
726-3753
Sq, Ftg. '.Iain 2.'100
~q. Ftg. Access:
Sq. ftg. Other
flew Addl.-Alter Rep.
Fence_Demo _Change/Use
_Other
V~E.of.Hork:
W t9-~~. 00
BuilriinQ Permit Info: Describe WQrk(;~e.. Build Single
Famn v. ~esidence Hi th .A.ttached Garaae)
Qt"IMf}J.~1 ~i' '("'\M\\<<"r<:''b.l itd..a'I Sp<ue
e
,
'I IrISPECTIOII L1I1E
726-3769
Job Address ~~~
CITY UF SPRINGfiELD
COMB illATION APPLICATION/PERMIT
- -
EflERGY SOURCES:
Heat
!~a ter Hea ter
rIA il-I~ (, ,I-\r;- \l(UHU PIJ-7lo\-Il
Legal Description 'I1't't LO""" :l600 /' 1700
~<;"",,",JV"~ f,J"", 11-01-3/-1.(-1 t
nr' n e/fc".....-
Owner C"..I 6a"';\\.t?r f lUllh'/JAM \?,..,.et'0VI I" P""lk""
Address 40 1 ~ IOf{. ~5bO
{;V~".. Of' Q'7/.fO /
Ranqe
Phone
'1e~'..oe>o~
Construction Lender
Address
Ut~ll:iN ItAH (namel
Primary r;.,.t\e. \Ilo"~\'"'' p.'t:.
Phone
t:" - Jad~ress) ...;... . (lies. no.l
,~CM..,. 1:,,-1 l' ~.:r:Y~
1Ql: . .'j~. Q7480 "'62.
(exoi res)
Structura 1
Electrical Mcnk", ~l.il\'~... '30lbQ L-~I...u (2d
Mechanical COr. _, .\...1 t\l.. 1/5"5 VJ ~ f;uc.~~
CONTRACTORS (name) r address i'
General '1(" Cn.....-{"'c,-\n.." Qo ~ \1000
~~(')~ PI"""\..lj 108S" 35-rl,
Electrical 14ci\l....:v. Q\.i1I\~c:. 30\bq Lei2:l..." (<J. 6-0",.." Q140$"
'Iechanical tcMA"""V"<\...1 "'I\t'" '31'S'? W ~ 'j;V"'''-1M Q7<ez.5
[;UM'tJ 'fJV05"
..
Q7'fO 2..
(1iC'~
20-17'l (' '-1-30- eb
:l <;9-550 A-
no.) (p~oi~p~'
Plumbina
~..... Q1'i40
~~c,.."", Q74CJl;
'f~5q ,-/6-196
').(;-1'16- PB
1CJ-/7Q C
:l <;<;s- !:>:>O
I
'1-~f;b
PLUflB I NG
NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
11 bath]
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
/ ~~ ;$"1l'5'l5'
ELECTRICAL'
MECHANICAL
fFF rHARt,F.Jln
IF" rHARG.E'_lliL...J
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
'2 ~E NJ6Xi>t9
SERVICES
tr--
Floor furnace
and vent
,,/
$,.0
ITemporary Construction
. IChange in existing
rp~; rlJ'.nC'P
Imultifamily> camm. or
Indu"trial
I Of amps.1
ICO~~./IND. FEEDERS
IInstall/alter/relocate I
dio;trih_ fpprlpro;
Of
amps.
(ohane no.
~
~
t
'-!<rslf..l{06o
3~S-Ml~
'3Lf~-"'U7tJ
(""'n~p "',1"\ \
lfP,~-3lf2~
6X33- 7694
'?J45-O~711:
3'1~--237'-1
ISSUANCf Of PFR!lIT
Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
V Ai.T8t. 'p"'';7~
App 1 i ance vent I
c;.poaratp
Stationary evap. I
cooler
Vent fan with I
sinole duct
Vent system apart from I
heatino or A.C.
I' r.... Mechanical exhaust
,~ ~ hnod and durt
J~.. r I-load stove/heater
1\1.r~ I
I V I
I
I ""L I J:ifARG.E.
I
I
1/t/.-
I
I
I
I
I
I
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I
.I~ .... /.'-- J,,! ~
TOTAL CHARGES .IV. TOTAL CHARGES ,:J. TOTAL CHARGES IV.
WHERE STATE L'lj REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
shall not be va1i~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAr1INED 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 Oregon pertaining to the work described herein, and that UO OCCUPAI~CY will be made
of any structure without the permission of the Building Oivision. 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 be used on this project.
~,
SIGrlATURE \~ \ ~
FO~ OfFICE USE orlLY
Units Sq. Ftg. f1ain)( Value
Occy load Sq. Ft~. Access )( Value
Occ.v GroupJ -2 Sq. Ft9. Dthe~m7.:~~c:... value.4-4k:_. .....
Ll.....I.... b '0./ TOTAL VALUATION
f'-"C."f" {3615?,; i!,2o.{'.'-S.
Q? ""0 Plan Ck. ConrnlInd I <1>7" ~'}o Systems Development
~~~ 65%/R1do Per Fpe ~ G/,C7' CharQe (l.5~)
----- ~68- ~6;~B~~~ :~~ Fee 1-
L~- -c:> fence I
---- --,-10-' De.o
----/$ oc I Sidewalk
. (;0 I A/C Pavin9
crC> I .
It!). Curb Cut
-------~~c--I
NM~E(please print)
~
101M.
,-...
\\"l~(\
Zone If!:.~
Fi re Zone
Flood Plain
tr-N
Type/Const.
Bedrooms
Stories
2
BUILDING PERflIT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
It.AHe;N4<K~
~gPA I'Mi!iYr
I
Irota1 Comb. rermi t
ELECTRICAL PERf~IT
Cha rges and
Surcharges
DATE If-'ll/-ell
//.19
-
It? ~C
rlECHANICAL PERMIT
Charges and
Surcharges
I
1 TOTAL
/sz. '08 .
t/ I ~.t':68
..
,
COMBINATION APPLICATION/PERMIT (CAP)
"
I. Appl icant to furnish
A. Job Address
B. legal Description \ " \\
I. example- Tax Lot 100, Lane County Map Reference
1/ U3 43
2. example' Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examyle~ waterheater/electrical/or ~
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example~ if new project. check-new - if addition,
check add, etc.
F. Sui lding penn; t information:
1. example - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. example - 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 TEAfI 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 ~ivision
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
"0. 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:
t
PERMIT VALIDATION
.
L~
cr""
Permit Clerk
~
I
Permit applicant exempt from registration with the Builder's Board because:
":Add,itional Project Information:
\
PLANS REVIEWED By:..,..
"';;~e:'Z.6~"'::- IZEtS€o1l? Signature~
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date 5-9.S$'