HomeMy WebLinkAboutPermit Building 1988-2-23 (2)
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I INSPECTION LINE
726- 37 69
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CITY Of SPRINGFIELD . INFOR/1ATlON UNt
COMBINATION APPLICATION/PERMIT 726-3753
EilERGY SOORCES: Sq, Ftq, ',1. i n
Heat ~q. Ftg. Access.
Water Heater Sq, Ft9, Other
flew Add A lter ~ep,
Ranqe Fence_Demo_Change/Use
ValuE of f1ork: _Other
:<'.:1/",,4:>, ~"" ,
BUlldlnQ Permit Info: Describe Work{i.e.t Build Single
Familv ~esidence With Attached Garaoel
Phone
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Job Address 3.,.,,. NU.I~ 5t , 5f'f1?. O~ .
Legal Description 17YJz.,?/-Q/ c!>L"'f~
,
Owner M'~, I..ES e
Address C,B2. IV7WJ.N
'$Pf~J}1l. '11A17
74G. . .,q'52. ~XI71ING ~~fA~~1
Construction Lender J<:.~~: Aw WINWW5, aM09.1.rr,c9N of
Address Phone f/f(,ff~ U;V~/../NGI flF ,:~
DESIGN TEAr~ (name) (address) - (lies. no.) r~xoires) (ohona no. \
Primary A.lJk:LL, ft7R.~R... ~rr1r,cr /3li3 flN~ !'J1. I ~rfr?, nf_ q741J 11.(.. '5r.gp'
Structural
Electrical
~),~ 1 S~M
Mechanical
CONTRACTORS
(name)
(address)
(lies. 1'\0.'
(pxoirpc:. ,
(ohnnp nn
Plumbina
Electrical
-..{
;1
......,
I
11
~
Genpral
~1echani ca 1
PLUf.1BING
ELECTRICAL
FFF f.HARr.F Nn
Residence of
~6 5'2. $"C SQ. FT.
New circuits alts.
)< or extensions
7"",P,""b~
SERVICES
MECHANICAL
NO.
;i7 Each single fixtur.e
Relocated building
(new fix, additional)
rrr rH~ NO_
rH rl-I~
furnace/burner to
BTU's
-;>2,se.
Floor furnace
and vent
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tp~ ~nd vpnt
Storm Sewer
Of
amps.
Appliance vent
c:.eDilratp
Stationary evap.
cool~r
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnd durt
~/ater. service
Sewer
Temporary Construction
Change in existing
rj:l<ijdYJlrp
multifamily, comm. or
Induc:.triill
COMf1./IND, FEEDERS
Install/alter/relocate
dic:;trih_ fpprlpro;.
Of
amps.
Wood stove/heater
~ ~.N~~.,/'p' ~,., 2~'-
9 /,' -vDuru;r.s
~' r/>>'~
I ~,= /HSPGr7/6Nrae ?s:-
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I SSUANCE OF PFRrllT
TOTAL CHARGES .)2-::>0 TOTAL CHARGES :;22.5'.:1 TOTAL CHARGES (j? S"G'
WHERE STATE L.\Ii REQUIRES that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
J 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 performed 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 OCCUPAr~CY 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 ORS 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.
IWIE(please print)
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Units
Occy Load
Occy Group .,1- '3
SIGNATURE
FOP. OFFICE USE orlLY
Sq, Ftg.
5q, Ftg,
Sq, Ftg,
DATE
Zone. Co":
Fire ZonE'
Flood Plain
Type/Canst.
Bedrooms
Stories
5"'#
r1ain x Value
Access x Value /
Other~".. .J.?F~L Value~~co:--'
TOTAL VALUATION
PLUt~BING PERMIT
Charges and
Surcharges
s
ro
u-" Plan CL Conm7Thd
____~~-'-?~__..M!/Bldo P.l'r Fee
Plan Ck. Res
7.03' 3nt/Bldo Per Fee
____ff.?.?~__ Fence
7.63
2'2- '5"0
------/~/5_--1 AIC Paving
____7"~:..~<2__1 Curb Cut
<,18 I
:;:-II'''~ Pc..}If:1J> ~/~~
- - Systems Development
"1/,~? Charqe t1,5~)
#,.4'.
BUILDING PERfIlT
Charges and
Surcharges
~
ELECTRICAL PERr:IT
Cha rges and u
Surcharges -I
Demo
I'Sidewalk
I
I
I
ITotal Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges f.t?
I
I TOTAL
'27/. ?7
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COMBINATION APPLICATION/PERMIT (CAP)
;----.,
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PERMIT.VALIDATIDN
I, Applicant to furnish
A, Job Address
B, Legal Oescription
I, example. Tax Lot 100, Lane County Map Reference
II U3 43
2, exa~le. Lot I, Block 3, 2nd Addition to
spnngtield Estates '
C. Name, etc. of owner and construction lender
D., Energy Sources ,
1. examele- heat/electrical ceilinq/or forced air Qas
2. exa~le~ waterheater{electrical/or solar
E. Square footage or valuation, etc.
I, example. 1250 sq, foot house, 500 sq, foot garage
2. examp'le- 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. 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 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
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
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. ---
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
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.
12~~IPT
Permit CI erk
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
/D9 8.5
;=I. R...-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name L".,R/VG' 7? ~c;. ~
Signatur~___~/-"'7
J
date ;2'- 73..-'5'9: