HomeMy WebLinkAboutPermit Building 1988-2-23
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\ INSPECTION LINE
726-3769
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Job Address 3''1'' M!./N "3l ' ~9., ()~ ,
Legal Oe,cription 17v:Jz-?/- q/ t!!:>2'5'~
CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
l~a ter Hea ter
Range
INFORlIATlON L1Nl
726.3753
Sq. Ftq, ',lain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add A Iter Pep.
-Fence Demo Change/Use
-Other - -
)J
l6
l~
(JJ
Owner, M'~. L..ee
Address C.St, RoWAN
ValUE of Hark:
26'~~, ..'"
Buildina Pennit Info: Descr,be Work(Le.,
Familv Residence With Attached Garaae)
Build Single
14~ . '/'1S-t. ~)(I<7l1Nc;. ~~f..l.uMH1
JC:.t~ : Aw WINW~, ~M.91.11'/6'N of
flm~ Lf;V~L-/HCd flF fl$.
(lies. no.) (exnires)
'3'i3 fl~ ~1. I ~rFI7. J moo q1411
I
-,
1
I
I
I
1
1
1
1
TOTAL CHARGES 5"''2.S <::> TOTAL CHARGES :;.?2',5'6' TOTAL CHARGES Y' ? S-O
WHERE STATE LA\~ REQUIRES that tile Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
-;Pf&J..m.11).17
Phone
Construction lender
Address
Ut~I~N T~AM lname)
Primary 8JJ,MLL, Pt7R.-mtz...
Phone
(address)
J4a1rmcr
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss)
Genera 1
Plumbina
Electrical
~'echanical
PLU'1BING
ELECTRICAL
FEF rHARr.F NO
Residence of
7.$".:l 52. $'"C SQ, FT.
New circuits alts.
)< or extensions
7""'P, ,Me>~
SERVICES
NO.
7 Each Single fixtur.e
Relocated building
(new fix, additional)
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp5 i d_p..nt":p
multifamily, comm. or
lndu!;.tr;al
I ~Ja~~.uervi_c~__
Sewer
Storm Sewer
Of
amps.
COMl.!. /lND, FEEDERS
I Install/alter/relocate
di<:t.rih_ fpprlpr<:
10f
1
1
I
amps.
(I)t)nl'l~ n~. I
7?..t . Ii c, 88-
(lic!;.. no )
(pxoir'p<:\
(1"\11('1,,1" "1"1 \
~L
~
,c' ~
MECHANICAL
FFr rHA~r.F NO.
J:'rJ:' ~ rHAIU~F
furnace/burner to
BTU's
72.Sb
F1 oor fu rnace
and vent
Recessed wall
Snnt":P h~ntpr nnd vpnt
App 1 i ance vent
!;.eoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd and duct.
Wood stove/heater
~ rd~,,"P
~"""A c4>~/~
ISSUANCE OF PFRI1IT
I HAVE CAREFULLY EXAMINED 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 ue eCCUPAUCY 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 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.
SIGN^TURE
FO~ OFFICE USE DIlLY
Sa. Ftg. 11ain x Value
Sq. FtQ. Access x Value /
Sq, Ftg, Other ~_ .J?jC...._"_,.~,~ Value~ ....on:--
> '
TOTAL VALUATION
7"r'~ ;&:>&_~/~<16
Systems Development
'j1<3'? !:harq~5~1
IWIE(please print)
Zone C Co
Fire Zone
Flood Plain
S--N
Units
Occy Load
Occy Group ~ - '"3>
Tyoe/Const,
Bedrooms
Stories
/
BUILDING PWIIT
Charges ant:
Surcharges
L/-"o Plan Ck, Conm/lnd
____~~"_?~__~IBldn Por room
Plan Ck. Res
30%/Bldo Per Fee
7-03
__n5-~.ff~__ Fence
2.63
____ A::?=-?~_S1dewalk
/,/?$
__n]l~'-~~nll'cUrb Cut
<>-/8
PLUI~BING PERMIT
Charges and
Surcharges
D~mo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
A/C Pavi"g
,
DATE
IV.-st
I
1
_I
ITotal
1
I TOTAL
Comb. Permit
'27/. "17
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COMBINATION APPLICATION/PERMIT (CAP)
-r.J
PERMI']\ VAll DAT.ION
III.
I, Applicant to furnish
A, Job Address
B. legal Description . -. ." .~ "._
I. ~xample- Tax Lot 100, Lane County Map Reference
1/ 03 43
2, exa~le- Lot I. ,Block, 3, 2nd Addition to
~pr1ngtield EstateslL '. '.. ~ ,'. '..
C. Name. etc. of owner and construction lender~
D., E~ergy.Sources ....;.j, "J:'~':' ~'.
1. examele- heat/electrical ceilinq/or forced air Qas
2. exa~le; waterheater/electr;calJor.solar.
E. Square footage or valuation, etc. ------
I, example- 1250 sq, foot house. 500 sq, foot gar,age
. . ',..? example-, i,f. new. pr:ojec~;--:check-n:ew <if1addit';on,
eneck add. etc. '
F. Bu il d i n9 pennit i nforma t i on:
. 1. examele - construct single family house with an
attached garage
2. exam~le - 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. OESIGN TEAM ANO 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 ~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, ---
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
payabl~\~b~ry the permit is issued.
V. FOR OFFICE USE ONLY'
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12E<!E l-PT
Permit Clerk
/D9 8.5
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PROJECT CONDITIONS TO BE SATJ5f.IED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project'Information:
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PLANS REVIEWED BY:
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name./~K"NG' 7?~6.~
Signatur~~~
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date '2- '23. g9(
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