HomeMy WebLinkAboutPermit Building 1984-4-24 (2)
INSPECTION LIfIE
i 726-3769
CITY OF SPRINGFIELD
COMBIrIATlON APPLICATION/PERMIT
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Job Address gR", IIUI fJ ","~ ~~ 71.\-' I ~~;~GY SOURCES:
Legal Description il\V LO'" ?6C1O r 1700 \later Heater
Ranqe
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Owner ~\ 6a.J~~ r With'lIMo \?'.....Jo.-
Address 40 I G IO~ 41-%0
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INFOR/IATlON LI~L
726-3753
SQ. Ftg. Hain 2. '100
~q. ~t9. Access:
SQ. Ftg. Other
Ilew Addl-1l"lter ~ep.
Fence_Demo _Change/Use
_Other
% ~(J~,k
P'-'I'P""'"
Phone
V~E of Hark:
'!l.J~ SI~. .00.
BuilrlinQ Permit Info: Describe Work{Leq Bui ld Single
Familv nesidence Hith /1.ttached Garaael
QI'WlUJt\ "t r"'IMMerYl'a.l OJ,,'I Sp"l"~
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Construction l~nder
Address
Ut:::dbN II:JU"
Primary r;;....\\e.
fnamel
~t-~\''''''
~t
Phone
f. I!;.."c(af'f.fss) ~ (lics. no.)
,'-" ~'::F...e
1Ll'1 ",;'jlll. ,Q7480 ~/62.
(exnires)
(ohon!'! no. :
't<rsI(JlOfJO
Structural
Electrical M~\\ ~l.ill'?'" 30lbQ L,.F,I..u Qd r;;V~r.I' 17VO,> 20-rlU' 'i-30-'8b
Mechanical t'<JM_r<l"'\ ~t.. 1/5"5 \AI ~ &'c.<'W' e(7lf02. 2t;e-~O"
CONTRACTORS (name) (addre~s) (lies. no.) (pxnirp~l
General 2(, ("n......-t..,c-~ QD ~'>C 11000 ~.., Q7'lilO '-1(:)$5'1 5"-/6-e6
\_ Plumbina ~~").J... P\"IM.~/j loBS ~ 3S-rlo ~~C,"'W1 Q14CJ<; ').o-/~B- PB
Electrical "'~ Q"'i\l\V~ ?,O\&,q Lel2::\..." (2c9.. Gvo,~.." q7l{O~ 10-/7Q C
~lechanical tcM.tW'<1vn...1 I\t.. 3/57 W ~ i:-v"'......... q7~ ?-<>'is- !;."'50
PLUMBING ELECTRICAL'!
--1!Q.." FFF rHAPf.F...llil.... FFF rlJAR&l: JJll...1
Residence of
3"s:.O~it(
'3LfS-237i./ !
(ohnnp nn l
'1-~-i)6
Itp,.,-342R i
,
b'i33- 7be,! I
~4S'--o~7l/: !
3,,~""'237':1
MECHANICAL
Each single fixture
SQ. FT.
furnace/burner to
BTU's
IJ:LICHAPf.F
I
I
I
I
Relocated building
(new fix. additional)
./
New circuits alts.
or extensions
7 e:JE Nl6X?8
SERVICES
tr-
Floor furnace
and vent
'. ..~
S.F. Residence
11 bath I
Duplex (1 bath)
Recessed wall
Soace heater ~nrl vpnt
/~.-i
I !
I
I
~.4
~~
......, r- lJood stove/heater
I
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/A.OO I.,r--
TOTAL CHARGES "". TOTAL CHARGES ~ . TOTAL CHARGES
WHERE STATE L\l; REQUIRES that the Electrical work be done by an -Electrical Contractor, the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervjsor and returned to the Building Division
/
Sewer
lstorm Sewer
i~~ 1$"1'l17f
I
1
I
I
I
/11....
10f
I COHl.I./IND. FEEDERS
I Install/alter/relocate
rl;~tr;h fj)prlpro:.
Of amps.1
amps.
t/ AL."'IZ!R P"'~7~ ~
Ap!> 1 i ance vent
seoaratp
Stationary evap.
r:ooler
Vent fan with
~;n"lp ,f"r...
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd and durt
each
Additional bath
lremporary Construction
_IChange in existing
rp~ j r1J'JH"P
Imultifamily. comm. or
T",-i,'o:.td"l
Water service
ISSUANCE OF PFR!UT
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I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and 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 Ore90n oertaining to the work described herein, and that 110 OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
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IIAI-1E(please print) \ 0"'"
,-.....
\ T' l...-:.JL Il
. ~ r----
SIr.IIATURE \~ \ ~
DATE I(-).Il-el/
Type/Const.
Bedrooms
FQ~ nrF~(~ '.I~~ ~:JI_V
Sq. Ftg. 'lain
Sq. Ft!J. Access
SQ. Ftg. Other~7:
~eb15'7f
, Q?...o' Plan Ck. Conm/lnd ':117" _1"
____15.:..____ 65%/Rldo Pi'r Fpp (,/,c;;\..t..../
? "8 Plan Ck. Res
~.e>, 30t/Bldn Per Fee
./ t:? ~ F enc.
____..Lc_:____
_ yo
----/.s.~__1 S1dewalk
. (;0 I A/C Paving
~____l~_'~~_: Curb Cut
.,
'.
Zone t!:.~
Fire Zone
Flood Plain
G:N
Units
Occy Load
Occy Group--.!3 -2
x Value
x Value
~G"c... Value.~~-
TOTAL VALUATION
Stories
7
BUILDING PERmT
Charges and
Surcharges
Systems Development
Charae (1.5~)
#A
PLU'lBING PERMIT
Charges and
Surcharges
~
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
1l't-4Y~N4<K~ /.'"". LI~
~A"M<i!'iYr - v T'
I I
ITotal Comb. rermit I I';;r~. ~~ -
~ / ~'1':68 .
DIjIllO
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngrield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-nfw - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examyle - 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 TEAll 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
8. 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
fu 11 schedu 1 es
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 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
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 USE ONLY
PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY:
.
PERMIT VALIOATION
y~
lY
Pennit Clerk
~
Pennit applicant exempt from registration with the Builder's Board because:
".Additional Project Irifonnation:
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PLANS REVI EWEO BY: . .'
name
L6RA/a" ;z:tEtSt!F..l?
signature ~
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..... .-.'
date 5-9.8:5'
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