HomeMy WebLinkAboutPermit Building 1986-9-10 (2)
\.
~ jINSPECTION lINE
i 726-3769
Job Address :::23':<D //141IJ sr
Legal Description /7-0$-'5<;;;-</1, o/_<;~J
, ";'JI"" i dr'lf}
J.! ~_.'/', -t..
.,r, ;/,
...! ~
IHfDRlIATIDN liNt
726-3753
SQ. FtQ. I,lain
~q. Ftg. Access.
SQ. Ftg. Other
..Jlew _Add.\(1l1 ter -,~ep.
Fence oemo Change/Use
Other - -
'~z; '7 -.7
--,
\"1'-11 ,:;,'
-- . I
CITY Of SPKHlGflELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of Work:
1J4tJOO
BuilriinQ Permit Info: Describe Work(i.e..
Phone '?';t.,..('1.; O"amilv l1es;dence Hith J'l.ttached Garaae)
Owner ,.IJ~1I I)
Address ~"J?'~
('.I /, /J.v,glt,
Construction lender
vIA
Address
DESIGN TEAI1
(name)
Phone
(address)
Primary
Structura 1
Electrical
f1echani Cd 1
CONTRACTORS
(name)
{address)
Genera 1
t'J1U1'/tfi!..
Plumbina
Electrical
~lechanical
PLUIIBING
NO,
FF"F rHARr.F Nn
Each single fixture
Residence of
\S)
E)-
O
E;;"-
~
I~
I
Build Single
IIJ<,7Ul. 12)(7 /:::AR ./J:BJJAi.', //}S'T.;?(..L
:'lITr/lJL)KK (;i) 5TA'B!"r. ;(Pl.a::~'T(.r 6!/5TJIJ<;
"
FIi'"ur ~JW.e
(lies. no. l
{exoiresl (ohone
~
P"\\
no,
(1 ics. no.)
(exoires)
(ohnne no.)
ELECTRICAL
MECHANICAL
rrr rHARr.r NO,
I r~~ rl-lARf.:r
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
~ New circuits alts.
or extensions
'2 t?;1f( !'n6>R €'
SERVICES
:;?Z::<'
Floor furnace
and vent
S.F. Residence
(1 bath!
Duplex (1 bath) each
Additional bath
Recessed wa 11
~n~rp hp~tpr ~nrl vent
amps.
Appliance vent
~eDaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C-
Mechanical exhaust
hood and durt
~Iater. service
Temporary Construction
Change in existing
res j d.ence
multifamily, conm. or
tndustri",l
Sewer
./
Storm Sewer
<~' Zo.-
Of
COMI1./IND. FEEDERS
Install/alter/relocate
di~tr;h. fppder,
I HAVE CAREFUllY EXN1INED 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 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 rm OCCUPAHCY 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 f~r ex mption is noted ~~on. and that
only subcontractors and employees who are in comoliance with ORS 722J;{ '. be~u;.ed_on,th' ;r~.2;Q"1<<lp.u
1IA1IE(please print) D.tTAA/ C:AU)IJ./€tL {IJIUUB;t?\ SIGIMTURE' 'l~ 'itfu," " DATE2b!XG.
, FOr. OFFICE USE Qiltv
Sq. Ftg. riain x Value
SQ, Ftg. Ae<;ess._MV/~-" Value
Sq. Ftg. Other~-:-;._..7 ~Value
J- TOTAL VALUATION
JY{ 1-' (.C... I
~q ~ e.u.oI
I
I
I
I
I
I /f).zf;"
1-
Of
TOTAL CHARGES
WHERE STATE lAW REQUIRES
shall not be vali~ until the
<2""'.,~ TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
Zone
Cor.
5-;Y
Units
Occy load
Occy Group 15"- I
Type/Const.
Bedrooms
Stories
Fi re Zone
/
Flood Plain
BUILDING PERfIlT
Charges and
Surcharges
-v= 5Q Plan Ck.
___..t.52:._____ 65%/Bldo
I S<-J' Plan Ck.
. 1 30%/Bl do
ConmlInd
Peor Fe~
Res
Per Fee
PLUt1BING PERMIT
Charges and
Surcharges
2'~ .-:>
Fence
.$~
-:::?:? ~SO
- --- -- --- ---
.'76
Demo
Sidewalk
:<-'" /
ELECTRICAL PERI~IT
Charges and
Surcharges
AlC Paving
(
Curb Cut '?")
!1ECHAN I CAL PERMIT
Charges and
Surcharges
Wood stove/heater
amps.
ISSUANCf OF PFR!lIT
27.S.!:>
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
/2=.-<>
:z8oo ."'"
7'=-"'""
Syste~s Development
Charqe (1.5~) ~
doh 6'7~/NI;P.;J
"""","y.
It?. --
/;3.==
-? ;<:>-0
...,0.
Total Comb. Permit
/3Z.99
TOTAL
/;5'0. '7'7
J
.
.
I.
I.'
i
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax lot 100. lane County Map Reference
11 03 43
2. ~xamp'le- lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin9/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I, examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition,
cheel< add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. examqle - remodel existing garage into family room
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. OESIGN 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
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
payable when the permit is issued.
-f'
,
~
~~t 1\
6&1\JD )11
t
~_l~-3b I
V. FOR OFFICE USE ONLY
Permit Clerk
cC/'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
C=.?r',C;yh'ATG :S:cT<!E /h-?P~&-C;:-/'>?=-/7;r /?~<-'/RE.I77C--h7Y fA/' /7'#
~R~ ~e>r-r C':>,Z: C:::://P H#-'VA//-,,"= ,Z;}Y/5./CY-"9.
~jf'.a-.-'Ar<? ?o./~/~ U-c-<<.>PA"".-9"C 7" /"?,;.o-~. .''':___~/Y75 W/T/Y'
.b=>.,.;/ fr~.,-;. C:::/77" :3}TB~?7_:-_":"::_~'::: ~!'fi7">~?-"'"i~.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: L?r.r~/A/
FA'c:/L/7Y r--~""'~/T ,~~/?;? ~7'<'<:
/-I-/~A""""AY p/v/"5/=-h- rD.<:"
U/bRK' ~Y=vz::> S.7A=>~=/ c::.~~L/#~.
.
PLANS REVIEWED BY:
name. U8 de /-t- cz;.c-.?
signature~ _~_~.--,
/Y ,..
date '=j-/:)-8C