HomeMy WebLinkAboutPermit Building 1985-3-13
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I INSPECTION LitlE
726-3769
Job Address /001
.
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CITY Ur SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E1IERGY SOURCES:
Heat
\~ater Heater
Ranqe
INFORltATION LiN"
726-3753
So. Ftq. t.laio
~q. Ftg. Access.
So. Ft9. Other
New Add Alter ~ep.
-Feoce Demo Cha0ge/Use
Other- -
Msin
SIr<.€.+
Legal Descriptioo 17~(?3-"!>-r:~/, Q';,y.oo
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Owoer 5priY1tfAeM L-!+i/ify BcerJ
Address 1001 l>'1ain sf. 5oriYld:",J) Phooe74t,.B15,
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ValUE of Hork: l3,o+'?':!'
BuilriinQ Permit Info: Describe Work(i.e., Build Single
Fam;lv ~esidence With Attached Garaae\
Construction lender
I ns-laJ/
~v BooI-h
,
N()r1~
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(ohane no.)
Address
UI:.~lliN lEAt1 (namel
Primary Mel1-hiwJ I HlElYlr7S A55ll':
Structural ~~~
Electrical
Meehan; ca 1
CONTRACTORS
Phone
(address)
(1 ics. no.)
{exniresl
0~'?J?fi7
A/A
~ OlIve
s+-
4
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<<:>1w1e
$&1'1-(..
(namel
(address)
(1 ir.s. no.)
(exnirl'>C:)
~nn.\ -----.....'........
( ~4~.1/M /'
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#:5.....)t; 7 6~
'"1~' //P~/
t!..cm fY1.p .truAJ
Genera 1
Mc.ku1ti./.
Plumbino
Electrical
~1echanical
.....1!Q.."
fJ~ W 5e.LJ.,Y/ L Ave_
:?Ti1s1.
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J'I.1J'Y11~ -
..J f- ~tk_
H~1"l/el.-1 fr mrtV', ~
PLut1B7 '
,~ Ore. 97~/
~q&i<..e. a. C?1M
EL~RICAL !
>>> r"I\IlliE.JlQ.....1
MECHANICAL
FEf
rHARr.F
Nn
1.il..E- I J:liARliL
Residence of
furnace/burner to
BTll's
Each single fixture
SQ. FT.
IRelocated building
(oew fix. additiooal)
Is.F. Residence
(] bath 1
IDuPlex (I bath) each
]Additional bath
I
I
I
Storm Sewer I jOt
L (fx7l9YL:> M~ ICOM1'I./IND. FEEDERS
.-'Jl__ IInstall/alter/relocate I
~ nKoS ~~65'1? rli,trih. fpprlpr,
;')~j;r€/n _ I 10f amp~1 I I-6R -pJpfi'l'P>
I I I I
I I I I
I I I I I SSUANCF OF PFIUIIT
TOTAL CHARGES ~ -- TOTAL CHARGES la -I TOTAL CHARGES n /N . /Q ~
WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pennit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Wa ter servi ce
Sewer
/ New circuits alts.
or extensions
I~OC
Floor furnace
and vent
ISERVICES
I
Recessed wa 11
So~~P hp~tpr ~"rl vpnt
ITempOrary Construction
IChange in existing
rp~; rteonC'P
Imultifamily, conm. or
Inrlustrial
4
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood i'!.nd duct
'/.~
amps.1
from
/
Wood stove/heater
;2"'"
I HAVE CAREFUllY EXAr1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that UO DCCUPAUCY 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.
Type/Const.
Bedrooms
Stories
(l..l7l\'1l:;,);. ~SIGtl^TURE .J1 If, -A
FO~ OfFICE USE ~
Sq. Ftg. ria;n ,x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other x Value
1# t,</'?,f/ ~ TOTAL VALUATION
"1"7 '''l fJ.n !J3"plS:Vstems Development f/ A
-.Ii "l'ro<OUZt:;1 dItharqe(I.5~) /)('/'r'
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NAt.IE(please prio~ .H\MlS:c,
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Zooe .....E...I.. ,
Fi re Zone
Flood Plaio
BUILDING PER~tlT
Charges and
Surcharges
PLurlBING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
~ ' (ll c. ,DATE~I h0
l- .:
Units
Occy Load
Occy Group
//8 <>0 Plao Ck. CorrrnlIod
---J.:-_~o-_. ~f:~B~~~ ~.=~ Fpp
/. /;;a 3D%/Bldo Per Fee
1-0. oc> I Fence
---- --~~o-I Demo
/a~ I Sidewalk
_____n~Y~-1 A/C Paviog
____Le"-~ Curb Cut
--70
ITotal
I iOTAL
Comb. Permit
I g /. /"2..
PI 8t:I<'
.
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100. lane County Map Reference
II 03 4J \
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates ' . ' .
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheaterjelectrlcal/or SOlar
E. Square footage or valuation. etc. - .
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project. check new - if addition.
check. add. etc.
F. Building permit information:
1. example. construct single family house with an
attached gan~ge
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
Structura). 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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULE5
0, 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. pajd. AI) other. fees and charges are due and
payable when the'permit is issued.
V. FOR OFFICE USE ONLY
" PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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,
. PERMIT'VALIDATION
Permit Clerk
Ju"
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:' Permit applicant exempt from registration with the BiJil"der"s Board' because:
Additional Project Information:
PLANS REVIEWED BY:
name~HC:;- ;Z>~C7-?
Signatur~.,..
,
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. ~ date? ~ -:; ,;:;'S"
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