HomeMy WebLinkAboutPermit Building 1985-1-7
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INFORlIATlON L1Nl
726-3753
Sq. Ftg. l'lain ? 1 hf'\
. "t A .
_q. . g. ccess.
Sq. Ftg. Other
!lew Add Alter ~ep.
~Fence Oemo Change/Use
^ OtherC6mp!ete-
Ear~i~;~n & r~
Bui16inQ Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaael
I INSPECTION LINE
726-3769
CITY UF SPRINGFIELD
COHBI!lATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat Elec.
I~ater Heater Elec.
Rangen N / A
Valu,"of Work: $4,675.00
Job Address
3831 E. Main Street-Suite 205
Legal Description Tax Lot 2600
Assessors MaD 17-02-31-41
Owner .Carl Gardner & William
Beedon
,AddffSS c/o Poppen
401 E. 10th Ave,
Construction Lender
& Assoc. 485-0808
Phone
Suite 560~ EUQene. OR 97401
N/A
Install Partitions and 'Car net in
nn:~-
viOll!=;] v hIJi It-"Rlli' npr_~ Pl ;:J'7;:J"
Address Phone
UlSIGN HAr~ (name) (address)
Primary N/A
Structural "
Electrical "
Suite 205-2nd Floor-South WinQ
(lies. no.1 (exoires)
(ohane nO.1
"
Mechanical
CONTRACTORS (name I
General- Russell Dandurand
WA
~/A
III/f).
(address)
(1 ;l"c;. no.'
(pxnirps)
(ohnnp no 1
Plumbina
*
3831 E. Main. Suite?
7t...l_?071
; Electrical
~'echan;cal
Existing
NO.
PlUlflllDG
41<511(, ~ Existing
""LIJ:.liARliE. NO
MECHANICAL
ELECTRICAL
None
FEF rHARr,F
Existing
Nn
Each single fixture
Residence of
furnace/burner to
BTU's
SQ. FT.
I Relocated building
(new fix. additional)
IS.F. Resideflce
(] bath)
IOuPlex (1 bath) each
Additional bath
V 'New circuits alts.
or exten~ons ~
"7 e>T~ ~___. t:
SERVICES
15:-'
Floor fu rnace
and vent
Recessed wall
~n~cp hp~tpr ~nrl vpnt
/" .tr4;rf don ~~
Appliance vent
seoaril.te
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
h""rI ,::Inri rl"r:t
Temporary Construction
Change in existing
rps i d_PJ'lcP
Imultifamily, comm. or
Industrial
IOf
I COM/.I./IND. FEEDERS
IInstall/alter/relocate I
rlistrih, fppdprs
IOf amps.1
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ISSUANCE OF PFRtlIT
~/#'A?-
Hater service
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IE;.-
Sewer
Storm Sewer
amps.1
Wood stove/heater
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1.1)
c-...
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TOTAL CHARGES None TOTAL CHARGES w.,..., TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be valid 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 Derformed 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 IlO OCCUPAI~CY will be made
of any structure -nthout 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 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Poppen & Assoc. ...-0 11~/1 _
IIAI-IE(please print) Property Manager SIr,rlATURE f-- fI.- r ~
FOR OFFICE USE DilLY l' r
Zone ~ <: Type/Const.~..,;y Units Sq. Ftg. 11ain , x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories 2 Occy Group ,jf'-:2 Sq. Ftg. Othe~__"~ c(eo-4!:J"e-~alue y"".,,-"-
tPtP (,4ll~ TOTAL VALUATION
Ifo.V<J L ~ystems Development
it! .<J~fli<t AJ~ Charne (1.5~)
OATE
BUILOING PERIIIT
Charges an~
Surcharges
___-s:.2=-~__ ~~~~B~~~
Plan Ck.
30%/Bldo
I Fence
------------
I DfJAlo
157-1 Sidewalk
-------~~~-I A/C Paving
.I. 6. ""- I Curb Cut
---- --:~2fl
I
I TOTAL
5~<,8
l'i~YI '
t.2.15
COIlm/l nd
PE'r ~Pp
Res
Per Fee
7 t:J. I "$
PLur~BING PERMIT
Charges and
Surcharges
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ELECTRICAL PERI~IT
Charges and
Surcharges
11ECHANICAL PERMIT
Cha rges and
Surcharges
!Total Compo Permit
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
1/ oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater{electrical/or solar
E. Square footage or valuation, etc. ------
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - 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 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 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.
0: As note~ 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. -
Ill. 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
signa 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.
V. FOR OFFICE OSE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit C1 erk
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Permit app1 i cant exempt' from regi strati on with the Bui 1 der I S Boa rd because:
AddHiona1 -Project Infonnati.on:
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PLANS REVIEWED BY:
'ria~e &NN'~ ~~""Signature ~~d~~e /-/~81:>