HomeMy WebLinkAboutPermit Building 1987-3-10 (2)
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I'! '1 INSPECTION L1NE/87 - m' ( I. CITY OF SPRINGFIELO
';, 726-3769 5 aA fJ )fl'OMBINATlON~PPLlCATlON/PERMlT
..,,~, Job Address 'CJ T11 ~ 111{j'/ll ST _ 19 t4 ~ A ST. ~~;~GY SOURCES:
Legal Description l1~o?,-.3('--"1 4,/>.PJI8tD~a7b()<) \iater Heater
Ran~e
WUE of \iork:
/'.0 "1/ IJ.O.Il. .;.-
Bui"IGino Permit Info:' Describe Work(i~e" Build Single
Familv nes;dence With AtS~hed Garaae)
C' <"V\stl?j ) ( )-IL"( ;m0 ~~ (' n.,4;;
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Owner(!. (oce",.-\ ea,;),:;", '>),1<--
Address 1 <:;/ () Ilk., ~'J 7 q ;(/.
{, L"'P~, V () J-Qo"." 971{ 0.1.
Constructio~ Lend~r (':;77'K('l,0I (fv.~ ;).I{,.
Address / r:; 10 IhJ'1 q 1 /.l Phone0SS'C~3G
DESIGN TEAM lnamel (address)
'/2,,'11 fMJ~l7C'. 1<:::/011<,';<., 79 AJ,
I
Primary
5tructura 1
Electrical
Phone6gg -V~ )(,
Mechanica 1
CONTRACTORS (name I (a.ddre<<).
Generall>,,'\v1 m~f,.,{t(Q '?583o \/,';,~G-,1))'" oJ
. iJ
Plumbina /7 j", ,r ..il/ /h.,/./,v~
Electrical ;I:f/Jt'/t/ t~
"echanic'aJ? ,c-L'r..~'P qyfj
PLUIIB I NG
ELECTRICAL
..
..-.--.-.-
f11es. no.)
INFORltATlON UN.
726-3753
Sq. Ftg. '.Iain /L{ ". Z.
~q. Ftg. Access.L;;<--':?..-
Sq. Ftg. Other
~ew Add Alter Rep.
-Fence Demo Change/Use
Other- -
~
o
\"
IW
\)J
no. ,
(exoires)
(ohane no.~\
l::::-
vi (
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o ~e-OS3(;
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d~""") 1 c,..7.,DU
(plCo;rpo:,'
S-P-P7
iO '67-nl((
. ?</.<::- ""'_,.-
3</,?-7;?<;,7
q,t q-Z 1'.:> ~
(1;,."
35-.(()
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J/9 ~/ '9
7 -m .,
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MECHANICAL
.....tlQ..,.1 I FH I r.I-IARf,F NO I I ~~LI....c..t:iARtiE Nn , I ~~L'J:1fARG.E..
Each Single fixture Residence of furnace/burner to
/'1 . 7.~ 1t75- SQ. FT. BTU1s
#,I" ,,_r
Relocated building New circuits alts. '~ furnace S7olo)
(new fix. additional) or extensions I ~t 6.06
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VS;-"'"
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r.sz~
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IInstall/alter/relocate I I I
n;o:,t~;h fppnprc
::z 10f ~Oe:> amps.~2S4~4
I I I I I
I I I I I
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TOTAL CHARGES ::?/-5. "'4 TOTAL CHARGES /:<'2.501 TOTAL CHARGES /,;;7, fi . Lt:;;'<=>
WHERE STATE L.\ll 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
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 Oregon pertaining to the work described herein, and that NO OCCUPAI~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 ORS 7Ql.055 will be used on this project.
NAf.lE(please printl.:pJolAl /)1 t.-Tci1rJ!<! SIr.N^TURE-Af.a......~~~
FOn OFF I CE USE ~HL Y '"
Zone c:::;c: __T.voe/Const. 9A(__units______So. Ftg. ltain~?C?__..x__.__.__.Value._'_il.? ~cll'c?_, .
Fire Zone Bedrooms Occy Load ,"\8 Sq. Ftg. Access. . x Value
Flood Plain Stories, Occy Group /?-7 Sq. 'Ftg. Otherk..;u~-,,/7~. Value /7,?t::l":>
(j5E ccSD2 '3 -=<7 r-. "Bre'607Q TOTAL VALUATlmlj.;?S', 600
BUILDING PERJ.IlT :;:('q-, 010 Plan Ck. conm/I~ '):;:e<1/_ 11.401/(1 Systems DevelopmQ:') 'j _"?.~. 00
Charges and .'} ____.......L.-::____~/BldoP.prFpp :>lQ\)'/JLLl:.L:Jl.J CharqetI.5~) "\"'\ .L/.J.
Surcharges ~ IS.Qe;> Plan Ck. Res ~St\,,,5' -
. <Pc> 30%lBl da Per Fee
-:;: /5: ~ Fence . _,
------'8:-i.;- D6~O tJ?~~
____L~_.z~~JSldewalk 3;X:{~
~ 9~ I A/C Paving~74> l'n
____.l~_~_' Curb Cut 2' S'.{\~
-be> I - I
S.F. Residence
(] bath)
Duplex (1 bath)
Additional bath
/ II/ater service
I ISewer
I I Storm Sewer
I
I
I
PLQf~BING PERMIT
Charges and r"
Surcharges ::>
ELECTRICAL PERIHT
Charges and I l
Surcharges ....,
MECHANICAL PERMIT
Charges and
Surcharges It:>
each
I
I
I
V~?'I~;-
170' I~-
1r~'I5'~- I 10f L)/)/?
I I I CDMI.1. II NO. FEEDERS
I I
I I
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I I
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amps.l
I
SERVICES
" ITemporary Construction
IChange in existing
rl'lS i d_p~nrl'l
/multifamily, corom. or
lnduo;trial
Recessed wall
So~rl'l hl'l~t~r ~n~ ~pnt
Appliance vent
5~Oa~tl.tp
I Stationary evap.
cooler
I Vent fan with
/ 5inole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust I
hood i'!:nd rlurt
j \'lood stove/heater I
I
I
I
I
I
1-:;> an::.i
./.:~"
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ISSUANCE OF PFRIHT
DAH ?-ti) - d' 7
~. ere:>
t::.7<SO
/2?S. So
3'.5: ~c>
~A'NL,,4.-5'.G/"" h,~ //~V.-:.-=< r
!z;;:~ Co v~Nd~ - .:.30.7/
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ITotal Comb. Permit
I
I TOTAL
/t/7I~. 28
~
25?~.57
flit
flit
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
i7 03 43
2. exa~le- Lot i. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/electrical ceilinqfor forced air Qas
Z. exa~le- waterheater/electrical/or ~
E. Square footage or valuation, etc.
i. examole- i250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
cneck 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
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. . BUILOING 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
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.
13h~ 1& 7-
Lf~~3-?1
V. FOR OFFICE USE ONLY
Permit Cl erk
.Cu
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REV! EWED BY:
.,
. name 'L.O.RNG R"<:~<5'K
'Signature~ ~~__
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. &?' .
date
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