HomeMy WebLinkAboutPermit Building 1986-9-10
CITY Uf SPRINGfIElD
COMBINATION APPlICATION/PERMIT
EtlERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
'84"00
BuilriinQ Permit Info: DescrIbe Work(i.e..
Phone ~<oo~ e:::Familv I'l.esidence Hith Attached GaraQe\
I
, jINSPECTION lINE
. ~ 726-3769 .
~-
Job Address
nJ4/JJ
sr
::J3!<D
legal Oescription /7-0$-'5C,,-<-/1, 01.<:=1-
Owner' .II~ACJ
Address :SAm~
(,"~~.IfU
Construction Lender
~,4A
Address
DESIGN HAI1
(name)
Phone
(address)
Primary
Structural
Electrical
r1echanical
CONTRACTORS
(name)
(address)
Genera 1
d /l,).1 Ji.Ie.
Plumbina
-
Electrical
~lechan; ca 1
PlUI1BING
NO,
FFE rHARGE Nn
Each single fixture
Residence of
~{/J
(2 I 12-1 'B ZZ,. kl-U q
JIir; INFO~lATION LINt
. 726-3753 '
Sq. Ftg. I"ain
~q. Ftg. Access.
Sq. Ftg. Other
tlew AddX7\lter Rep.
--Fence ~o Change/Use
Other- -
\3J
E)-
O
E;"-
I~
I~
Build Single
1'I1S7illt.. /2.)(7 6A#! ~ 1!,1~'M~L
~/Tr/LKJLK t:P _~~N'r. /tFi.b:'AnE I:If/S"~
r
FRI'Jv"r _l1dP2
fiies, no.)
(eXOire~hone 00,)
.~
(l ice;.. no. \
(f'!xDirpc;.)
(ohane no. )
ElECTRICAl
MECHANICAl
~~~ rHARr,~ NO.
F"FF rHAP(;F
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
~ New circuits alts.
or extensions
'2 p7fr hM:>??tE
SERVICES
:::?Z5'
Floor furnace
and vent
S.F. Residence
(j bath)
Ouplex (1 bath) each
Additional bath
Recessed wall
SD~ce heatpr and vpnt
amps.
Appliance vent
s~oarate
Stationary evap.
cool~r
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud
~Iater servi ce
Temporary Construction
Change in existing
res.l de,nce
multifamily, comm. or
Industrial
Sewer
/'
Storm Sewer
,~~' Z'o.-
Of
COffi1,/IND. FEEDERS
'I nsta 11/ alter Ire locate
di,trih_ fpprlpr,
Of
Wood stove/heater
amps.
TOTAl CHARGES
WHERE STATE lAW REQUIRES
shall not be vali~ until the
ISSUANCE nF PFR!IlT
Ze:>. ~ TOTAl CHARGES "27. S.t:> TOTAl CHARGES
that the Electrical wor'k be done by an,'Electrical Contractor, the electrical portion of this pernit
label has bee~ signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFUllY EXAtlINEO the completed aPr1ication for permit, and do hereby certify that all information hereon is true
and correct. and 1 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 fm OCCUPAfKY 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 ex mption is not;;;&d her on.-and that
only subcontractors and employees who are in compliance with ORS 7~055 . be sed on thO p oj t .
'. at 1P/iIt.
tW1E(please print) DffAU L'AL.()/lit!:I!L @.u~\ SIGNATURE ~ DATE~'i<t.
~FOR OFFICE USE DillY
Sq. Ftg. tiain x
Sq. Ftn. Aeees.. ~ V/...v;: x
- "7 ~
Sq. Ftg. Other/,'_,-=-/~ ~Value
.J- TOTAl VAlUATION
..JY{ "ne"-, I
k q iuol
.~,~
Zone
c;c
"')- N
Units
Type/Canst.
Bedrooms
Fi re Zone
Occy load
Occy Group 8- /
Flood Plain
/
Stories
BUIlOING PERmT
Charges and
Surcharges
-:;>= SO Plan Ck.
___,.t52:.._____ 65%/Rldo
I S<-J Plan Ck,
. / 30%/Bl do
COIllllII nd
Ppr Fpp
R'es
Per Fee
PLU'1BING PERMIT Z~ -.? Fence
Charges and ------------
Surcharges .$~ Demo
ElECTRICAl PERmT -::?2' ~SO 'S1dewalk :<.:::> I
Charges and ------------
Surcharges .'70 A/C Paving
MECHANICAL PERMIT Curb Cut "55'
Charges and ------------
Surcharges
Value
Value
/2ao. ....
:z8c.:>.......
'tI= ......
Systems Development
Char~e (J.5~) ,,,>:"
C/Y 6,7.1= //W;p.~
....,.,.y.
IR..'->
I
I
I-
I
/3."""'"
:<'0.;::'-0
IS: z5"
Total Comb. Permit
/32.99
TOTAL
/;50.7'7
.
.
,
r-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT. VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examRle~ Tax Lot 100. lane County Map Reference
II U3 43
2. example- lot 1. Block 3. 2nd Addition to
Springfield 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. -
1. example- 1250 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. exam~le - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ 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. I f the item( s) to be ins ta 11 ed 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
O. 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.
lkei-u1
~---;rr ~
! 6&1l~ (
~~. ~/
V. FOR OFFICE USE ONLY
Permit Clerk
CL/
1
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Cc:es7i"~/n9TG ::S/;r-;E /b?PAZ>~fi?C"--h".T /?C-;:S;~/RE~h7Y fA/' ./7'#
C:;R~ ~r-T' e>.z:- C:;//"r' H"JlVA.//~ Z:;;-Y/s/c>-"9.
_~;v Ii?'-A,"'-r: ~l? Cl/':"y:-,:,",-' r").-:::- - ,P"""'/.9'c"" /:;="C"-~/A>~~/Y7 5 W/ TH
~ fr~s-' C::PT7' 5m/~-=-:r-="-:-&$..o~'7~" .
Permit applicant exemRt from registration with the Builder's Board 'because:
Additional Project Information:
01"5/,y/,T./
FA'.::::/L/7<'-- ""'.<5'-f',K,n/;r .~~.h?
~~
1.,L-/~A)"vA-Y- p/v/'5"-",,,.-v FOil?
"'/~v- ~Yai<'v'Z:> :;;7;p~-=/ c::..'"-'~L/#?'.
PLANS REVIEWED BY:
---
p"""",,'
----~ ')
....-
"
" '
naineU.77~ (T-lcz;.e/?
.signature ~
/ b/
date 9~/?-&'?: