HomeMy WebLinkAboutPermit Building 1983-2-9 (2)
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CI TV OF SPR WGF I ELD
COIIBI:iATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
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INFORl'ATIO~ Uilt
726-3753
Sq, Ftg, "'ain
~q. Ftg. Access.
Sq, Ftg. Other
Ue'<f' Add Alter Rep.
-Fence Demo Change/Use
Other- --
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IrISPECTIOIl LIilE,
726-3769
7000 lVta;",,_
legal Description I f( O~ ?J \
Job Address
r::l"J CC51l") I
Owner
1"'\.1(,.' ~
t:\, .\ +. :~
.-""",rlr. ,j
,
[) (;>'."'[
lender
Phone
Ranqe
Value of Hark:
dE ;S'OC+ =c>
Builriina Pemlit Info: Descrlhe Workli.e.. Build Single
Fa~ilv P-esidence With Attached Garaae'
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r;z;?A,/7u;;:- /At' ,. 5hcZ'/ /J'oc,/...... "")
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Clies. no. \ {exnires1 (ohane no. I
Address
a."t
Construct; n
7??,.. OJ 2.L.
Address
OESIGrl TEAI1
(name)
Phone
(addressl
Primary
wL
~~
Strut tura 1
Electrical
11echanical
CONTRACTORS
(name)
C:;~~F.
(address'
(l i~~. no. l
(exoirp~\ (ohon~ no.1
Genera 1
Plumbina
Electrical
"lechanical
PLUIIBIrlG
ELECTRICAL
MECHANICAL
Each single fixture
FFF CHARGE t.,ln el='l=' nIA~r.~ NO
Residence of furnace/burner to
SQ, FT, BTU's
J:'J:'J:' r~~RGF
'/.
NO,
Relocated building
(new fix, 4dditional)
New circuits alts.
or ex tens ions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snac~ ~p~tpr ~nrl vpnt
Storm Sewer
Of
-amps,
Appliance vent
c;e'laratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or J'.G.
Mechanical exhaust
hood and rlur,t,
Wood stove/heater
~!ater service
Temporary Construction
Change in existing
rpc;J den('p
multifamily, COfJl!l. or
TnrlU'itrial
Sewer
COMfl,/IND. FEEDERS
Install/alter/relocate
dic;trih. feeders
Of
amps.
ISSUANCf OF PFR!1IT
TOTAL CHARGES , TOTAL CHARGES , TOTAL CHARGES
. WHERE STATE LWREQUIRES that the Electrical work be done by an' Electrical Contractor, theelectr,;cal portion .of this pemit
shall not be va1iJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED 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 OreC]on pertaining to the work described herein. and that NO OCCUPAUCY 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 comoliance with O~S 701.055 IJil1 be used on this project.
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IlAlIE(please print) 0..".._ J'L1l.,~ SIGtlATUI\E..--"'---:::--~ ~~-v"""'->-- D~,TE V'9a-.7
Units
Dccy load
Occy Group
FO~ OFF I CE USE miL Y
Sq. Ftg. !1ain
Sq. Ftg. Access
Sq, Ftg, Other
--
x
x
x
5~.:9. co..""
Zone M-"3
Fire ZonE'
Flood Plain
Tyoe/Const. Z;Z;Z::-/V
Bedrooms
Stories
Value
Value
Value
TOTAL VALUATlOtl c:;-~_ e'>C-
BUILDIIlG PERfIlT
Charges an~
Surcharges
_____~_c:.:_
". -:2 t::>
I Plan Ck. ConmlInd
65%/Bldo Ppr Fpp
Plan Ck, Res
30X/BldQ Per Fee
Fence
--;c; -= <:>
ISystems Development I
Charqe (1,5~) .
PLU'1BING PERMIT
Charges and
Surcha rges
Demo
ELECTRICAL PERt:IT
Charges and
Surcharges
I1ECHANICAL PERMIT
Cha rges and
Surcharges
Sidewalk
------------
I A/C Paving
___________-' Curb Cut
I
-=<1=
Total Comb. Permit
8.
&1
8,
"<'=
"
TOTAL
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PE~~IT (CAP)
Clly Hall
Springfield, Oregon
Department of Public Works f
OFFICIAL RECEIPT
No B r.::n30.2
. -..", \wi f
Dale Fees <7, 19 9....~
( Rec'd From ~~/5 ~Z:>'1'" c::;;~?
Address /3c:. tV Cf? Hp ~ .
,
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III.
I. Appl icant to furnish
A, Job Address
B. legal Description
I. examDle- Tax Lot 100, Lane County Map Refer
11 03 43
2, examDle- Lot I. Block 3, 2nd Addition to
5prlngfield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced
Z. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examDle- 1250 sq, foot house, 500 sq, foot
2. examole- if new project, check new - if add (".
check add, etc. -.~.
F. Building permit information:
1. example - construct single family house wit
attached garllge
2. examole - remodel existing garage into fami ~or
3. examole - convert single family residence i
restaurant (change of use)
G. Value of work as defined in Section 3D3 (a) of
Structural Specialty Code
H, DESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, Buildin'
Division Staff must be able to contact appropri,
persons regarding design infonnation or jOb sit. (
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schel
A. Except where blank spaces occur in the descript.
portion of the Mechanical and Electrical Schedu' (
the applicant need fill-in only the No. Boxes a(
to the appropriate item(s) to be installed
B, Full Plumbing, Mechanical, and Electrical Schedl
are available at the Building Division (
1. To conserve space on the permit form the set
have been abbreviated
2, If the item(s) to be installed are not cover
the abbreviated schedules you should consu11 €"
full schedules .
C. BUILOING OIVISION STAFF WILL FILL DUT ALL FEES I . !:!.-tl
CHARGES ON THE SCHEOULES ."
D, As noted on the CAP, the label must be deliverec (~,
electrical contractor for signature by his elect la'
supervisor. The general contractor is .not authc., {zed --. . '11
to sign the electrical label_ ----
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.
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Received For.
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Amount Received
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V. FDR OFF1CE USE ONLY
Pennit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
//
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signature/ ~~V"~......:-
date
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DATE RECIEVEO ::(-..,. ~ 3'
ZONE
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OCCUPANCY
OCCUPANCY LOAD
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UNITS
STORIES
"2.
TYPE CCNST.
LEGAL DESCR!PTION
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JOB No, !33'c::.::z;:9'
GROUP /;"- ~
ADDRESS . 3"~ /?//I-/AI --,''7''''.
=OWNER 2l9'.dL~~_~€&.~fi'";?'ir' l;t-3U'0
T~'-:: C~NT~NT!;; HERE OF HA\";: er:CN A~VIEWEO. WITH
ALTr.RATIONS 'NOtCA7~O IN C"OLO~."O PENCIL.. CHANGES
OR /ILTC.RAT:OI~S '-1.'\OE AFT.'~ Of. r.: 9ELOW SHALL BE
APPROVED BY THE BUIl..OIN':> OFFICIAL.
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CITY OF SPRINGFiELD, OREGON
ApPROVED ~~&;:::.. _ DATE ;;>-'7-;::' ,:5'