HomeMy WebLinkAboutPermit Building 1987-4-15
CITY UF SPRI;IGFIELD NFORllAT:.:1 u..O I'
CDrmI;IATlON APPLICATION/PERMIT 726-3753 i
E!IERGY SOURCES: So, Ftq, I';ain !\t\
Job Address ?R7~ /->7.M'-//V ~T': Heat ~q, ,tg, Access, Vv
I I D t 7 -= '/~ \'later Heater SQ. Ftq. Other \J
.ega escrip ion /. -1'>_ ,?_,."..., 1_71 , OZ,)O'c::::.
--" . R Ue\~ Add .A.l ter ~eD. \J
,I, Vanl Qe f 1/ ,. -oFetnhceer Demo Change/Use
I ai!7;:;;:~ ,= - - I tv
BUll{lnq Pernnt Into: Descnbe \.lork(l.e., BUlld Slngle J ".f;
Fi'r.1ilv nesidence \lith Jlttached f1araae)
Il!,:,:;:~-~;~~~ '-J
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Electrical Contractor, the electrical portion of this per~it ,.
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAtlINED the completed apf11ication for germit, and do hereby certify that all information hereon ;s true
and correct. and r further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Sari ngfi e 1 d and the laws of the S ta te of Orel)on pe rta i ni ng to the work descri bed here in. and tha t IJO OCCUPAHCY I...i 11 be made
of any structure without the permission of the Guilding Division. I further certify that my registration with the Builder's
Goard is in full force and effect as required by ons 701.055. that if exemot the basis for exemotion is noted hereon, and that
only subcontractors and employees who are in cornoliance with OP.S 701.055 will be used on this !Jro,ject.
SIG;IATUR,E~ rIZ.~/ OP,TE_lf-/ J-:J'f''1
FO~ OFFICE US~iJl Y V (/
Sq. Ftg. rlain x Value
SQ. FtlJ. Access x Value
.?-2. Sq, Ftg. Other/:5~~ Value <;/""'_,~
TOTAL VALUATION
HISPECTIOil LliiE
726-3769 '
Owner b"; 1? ~=~7.........;- 'I:
Address /4N#~ ~'-p 6'~ /?;::rco Phone
Construction lender
,\ddress
Ut.~llill ft.Alt
Phone
(addressl
lnarneJ
(lics. no.)
Primary
Structura 1
~
L--'\,
E1 ectrica 1
!1echanical
COt/TRACTORS (name 1 (address) (1; cs.
General 1?H~ ~~,q//A">='/'?7 ~=,z=-/n=. ~.2;~
/ ~
/,~
Plumbino
Electrical
f.lechanical
PLUI18 HlG
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,
n:~ r~ARr.F: rlO.
--1
I
.1
1- --f-
ELECTRICAL
ilO. I
, FE E 'CHARGE
>!n
Each Single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
S. F. Res i dence
/1 bath)
Duplex (1 bath)
each
I
I
I
I Temporary ConstructiQJ1
r- Change ""'in' existing
I r~'i i dJ'nq'
I mul tifamily. comm. or
Tne!tlc;trinl
SERVICES
Additional bath
I
I
I
I
,--
C0I11,1. /I NO, FEEOERS
i-!a ter servi ce
!sewer
Of
Storm Sewer
amps.
Install/alter/relocate
rlic;trih fpprlprc;
Of
amp~1
I
'-'?\(?k I
l'q )(1 \VV I I
TOTAL CH~.RGES \...../ I TOTAL CHARGES
,./HERE STATE L\I'/ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
11A:-1E(please print)y't-',,'-! /1.. 13'H'1e r
<7
Zone .--- L
Fi re ZonE'
Tyoe/Const. ~'f'/.
Bedrooms
Units
Occy Load
Occ,V Group
Flood Plain
Stories
BU I LO IIIG PERI,Il T
Charges an~ '\ -
Surcharges ~
<!:/ - Plan Ck,
---tJ.~5'~ 65X/Rldn
Z Plan n.
<.6 , 30X/Blda
Fence
COllVll/l nd
Ppr ~tle
Res
Per Fp.e
PLUI1BING PERMIT
Charges and
Surcharges
O.emo
, ELECTRIC;.L PERI~IT
Charoes and
Surctiarges
~-----------
Sidewalk
Ale Paving
11ECHANICAL PERI1IT ~
Charges and __.:..________'I,.eUrb c.ut
Surchar1]es
I TOTAL
(exni res)
(onone no. t
&'~ . (" )
't ( ~
t1'-/VU
A
~
~y
'\1
no. 1
(exoi res 1
(ohanp nn.)
G,;vtl~
7l./,c- <7A6'~1
- --,
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MECHANICAL
eo,
r~ARr.F
furnace/burner "to
BTlI's
Floor furnace
and vent
Recessed wall
<:;r');:lr'"P hp;:ott>.. i"nrl IIP"t
I Apol iance vent
~f>Oal'ntp
I Stationary evap.
cooler
Vent fan I.lith
sinale duct
Vent system apart from I
heatino or A.C.
i'lechanical exhaust
hone! nnd e!urt
Wood stove/heater
ISSUANCF nF PFRlm
TOTAL CHARGES
Syste~s Development
Charqe (1.5<)
f/4
Total (omb. rermit
&-2-5<
',/
.
.
'.., ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. legal Description
1. examole- Tax lot 100, Lane County Map Reference
1I U3 43
2. example- Lot I.'Block 3. '2nd Addition to
~prlngtield Estates
, -, C. . Name. etc.,of owner,and construction'lender
, O. Energy Sources-- . .. '.
1. examole- heat/electrical "ceilina/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examble- 1250 sq, foot house, 500 sq. foot garage
2. examole- if new project, check new - if addition,
check add. etc.
F. Building pennit information-;
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of u'se)' .
.~. Value of work as defined in 'Section 303 (a) of t'he
Structural Specialty Code
H. DESIGN TEAM AND CDNTRACTORS
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
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 pos'sible, 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.
j
Permit Clerk
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO 8E SATISFIED 8EFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's 80ard because:
Additional Project Information:
"
J
PLANS REVIEWED BY:
name U8;v& 71' ~~
signatur~~~ _~
.,..;/, - --- -, ~-"
,
date C/7 S--@",
liISPECT 10;1 Ll;:E
726-3769 '
Job Address 5"&>7:"> /->7/-?"//V 5>7':
Legal Oe<cription /7-C>2-~/- 'II. c)2,)0-=
,
LIlY Uf SPRlilliflELU
COIIBWATION APPLICATION/PERMIT
I E!IERGY SOURCES:
Heat
I Hater Heater
I Ranoe
Valu€
Owner ~..; 7? ~""'~}'" .c"~,
,
AJdrcss)./'74N.......r:::::: _"-n H~ ~
','" ,"",,-- - --.-
Construction Lender
,\ddress
lJtSIGll n.AJ.l
lname)
Primary
Structural
Electrical
!1echanical
CONTRACTORS Inamel
General ~~~ -!~-5N//-'A'
Plumbino
Electrical
~"echan;cal
PLUIIBIrlG
;:0. i
-----lEach single fixture
----- Relocated building
(new fix. additional)
, ;t:?,c-7?~G""5r~~D~_
~~:f;:;: t!;:/;c,~~ 73r~.
. (lies. no.l (exnires)
'- Phone
'"
of Hark.:
t:? =-0
(Jull{;;nQ Permit Info:
Far.lilv rlesidence l'lith
Phone
(address)
:0-. ~ "
~~~dress) (lies.
~=,cn'_ ~.a;~
, ,;-' / ,
ELECTRICAL
fff I [HARef ...llIl.......1
Residence of
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TOTAL CH~,RGES I TOTAL CHARGES
HHEP.E STATE L,\I'I REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
S.F. Residence
(J bath)
Duplex (1 bath)
each
Additional bath
~!ater service
I Sewe r
_Istorm Sewer
I
i
i
i
i
!
I
!
Electrical Contractor, the electrical portion of this per~it ,.
Supervisor and returned to the Building Division
C<c
rlJARliE: .....illL...1
lliFORtI-'i. .:, l;.,;,
726-3753
Sa. Ftq. I.iain
~q. !='tg. Access.
So. Ftq, Other
Ilel'i . Add ft.l ter ~ec.
--Fence O~a Change/Use
Other - -
%
I~
IN
11"0
'J
I
sq, FT,
New circuits alts.
or extensions
,--,-
I
I
I
I
Describe \'lark( i.e., aui Id Single
/I.ttached r.araae l
(onone na./
no. )
(exoires)
(ohonp nn.)
ISERVICES
I
ITemOOrary Construction
IChange in existing
rp",- 1 dJ>nr:~
Imultifamily, comm. or
Tnduc;tr'iill
Of
amps,
7l,/~- '766'~
MECHANICAL
furnace/burner 'to
BTlI's
I CC<
r "!\RUL
Cm~'I./lNO, fEEDERS
Install/alter/relocate
dic;trih fppdprc;
IOf
amps.!
I
Floor furnace
and vent
Recessed wall
~nilr:p hpiltpr ilnrl vpnt
I Apol lance vent
c;eoarilte
Stationarv evap.
cooler ~
Vent fan with
sinale duct
Vent syster.\ apart from I'
heatino or A.C.
Nechanical exhaust
hood nnd dur:t
I
I
I
I
I
I
I TOTAL
Wood stove/heater
ISSUANCE nf PfRIHT
CHARGES
I HAVE CAREFULLY EXN1INED the completed aprlication for germit. and do here~y 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 Soringfield and the laws of the State of Orel)on pertaining to the work described herein, and that IlO OCCUPAUCY I'Iill 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 ons 701.055. that if exemot the basis for exemntion is noted hereon, and that
only subcontractors and e~p1oyees who are in como1iance with OP.S 701.055 will be used on this ~roject.
IIA:IE(please printlM't,o<j 11 ~"lr'1~ r
v
SIr,tlATURE&b/.':.~.,.,,;,/
FO~ OfFICE lIsH":fl y 'i:/- >-. //
OATE_'1-/,;-: ;;'7
Zone /"" L
Fi re Zone
flood Plain
Tyoe/Const.
Bedrooms
Stories.
-=?'-f/ ,
'.
Units
Occy Load
Occ.Y Group .??-2
"
Sf1.
SQ,
Sq.
Ftg.
ft9,
ftg,
f1ain 'X
Access _ x
Other k5E?-?~
TOTAL
Value
Value
Value
VALUATlO1I
'Y'.:::?.:=--
//4
BUILOJlIG PER/.IIT
Charges an':
Surcharges
<"/ ~ Plan Ck,
___J.O--')O 5S!lRldo
2 I Plan Ck,
<_C> 30%/Bldo
_ I Fence
------------1 Demo
I Sidewalk
PLUl1BlliG PERt1lT
Charges and
Surcha rges
,ELECTRIU.L PERI~lT
Charaes and
Surcharges
11ECHANlCAL PER/HT
Charges and
Surcharl)es
~__:'_n_____1 Curb Cut
Conm/lnd
Pl;>r Fpp
R-es
Per Fee
A/e Pav; ng
Syste~s Development
Charoe (I.S')
Total Comb. rermit
I iOTAl
5"z-S<..
.
COMBINATION APPLICATION/PERMIT (CAP)
r.
II.
Applicant to furnish
A, Job Address
B. legal Description (
1. examole- Tax lot 100. Lane County Map Reference
17 03 43
2, example- Lot 1, Block 3. 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole. heat/electrical ceilinq/or forced air (
2. examole- waterneater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq, foot house, 500 sq, foot gara~
2. examole- if new project. check new - if additior
check add. etc.
F. Building permit information-:
1. examole ~ construct single family house with an
attached garage
2. examole - remodel existing garage into family ra C,'
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 TEAr.! ArlO 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. ,
Abbreviated 'Plumbing, Mechanical, & Electrical Schedules
A. Except where blank scaces Occur in the description
portion of the Mechanical and Electrical Schedules, (
the applicant need fill-in only the No. Boxes adjacer
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 schedulE (
have been abbreviated
2. If the item{s) to be installed are not covered or
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
suoervisor. The general contractor is not authorized
to sign 'the electrical label. .-
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. '
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 ;s issued.
I II.
IV,
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
CITY OF SPRINGFIELD
. City Hall
, Springfield, Oragon
Departmant of Public Work.
OFFICIAL RECEIPT
No. B
Date A:r?uc. J~ 19 37
Rec'd From ~~"j )'0-0/ If?~ ~--~
t4 ~ l N::l ;S '{'If;L 5>7' .
Address ~/."a _ q~ <17 e
( ~eceivedFor:in6-~6Z~Lo~
r
...
(
(
68114
c
1:7>. ~6>, S'c>
( '~tIf?:O ? ~ 6L.-,
1Pr
C;-2, 5"':2
(
~#I3/'8
Amount Receiveif ;;;'2"';:;-2.
/2~"r--&... ,~ .-,
, ; AuTf1'ORlZED Sl(;AA TURV' .
E!.{"
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Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name 6r~&n C?:~
,
l
"
Signatur~~-A'_9-
date C/r S--@)
,i1