HomeMy WebLinkAboutPermit Building 1986-1-17
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'1- IrlSPECTIOrl LIrlE
726-3769 .
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Job Address 1(0) '/)1 ~
Legal De,cription /7- 0'3 ~3s-tf -1- 5'100
CITY Uf SPRlrlGfIELD
COMBIllATlOrl APPLICATlOrl/PERMIT
E!IERGY SOURCES:
Heat
l~ater Heater
Range
Owner .s P!Z.)iJ (, F'I ELf) VT ILl TY
Address .pO Boy 300
Construction Lender
Phone
7tfb-t?Y5r '7'0<
Address
Ut~lbN H.J\I.' (namel
Primary 't-\or r, S. "
Structural
Phone
f address)
.
INFORlIATlON liNt
726-3753
Sq. Ftg. 1.lain-Z.z. ' ....
~q. Ftg. Access.
Sq. Ftg. Other
trlew_Add}(Al ter -,~ep.
Fence Demo Change/Use
Other- -
Valuj of Ho~:
~~JtJ06
BUilGino Permit Info: Deser be Work(i.e..
Familv nesidence l'lith Attached Garaoe)
Build Single
~
10
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~L tJl Illt.:c..t. 4-;o~
;b...n~ cP ~ ~ '{;:.-(('
V
(lies. no.l
(exoi res)
,
f.edele,U <I "I-' Cl $SOS . . I?lM UJBoE?r-. ~ EU6.~,
.
PLU!IBItIG
I FEF I CHARGF
Nn I
Residence of
Electrical t::J:?€D (p,~rK~p :299 .Mt)NJfb~ €u~ t!J,;?, 9:/~c:S<.
, - ., . ., ~
11echanical WAl>';~ &Et.Jh7.-#//":.5 ?..o.~~ ?OH2~/ F(.J~~.~, ~~
CONTRACTORS name . (address)_ _ {lire;,. no.1" (j:>xl)irp'"
~ .,'t~31 1I/~fi'5"B
General ~R ._~_7.Ct!!J J"'~P.W 1/141.
Plumbina
Electrical
~1echan; ca 1
NO.
Each single fixture
7-st:> 'IS:~
6
Relocated building
(new fix. additional)
~ New circuits alts.
or extensions
'2 iSle ~
SERVICES
I
each I
1
I
'5'6' Sewer (VER/r"- ('.eYcI>~)
I
1
1
1
1
1
1
S. F. Res; dence
(1 bathl
Ouplex (1 bath)
Additional bath
Water service
iO' Storm Sewer
ELECTRICAL
1 tn
SQ. FT.
Temporary Construction
Change in existing
rpc; i dpnrp
multifamily, camm. or
Indllc;tr;<'Il
~". 0"
241. 00
Of
amps.
COMM./IND. FEEDERS
Install/alter/relocate
r1ic:.trih fpprlpr<:.
~~,..,'"
r~llli..G..E. Nn I
furnace/burner to
BTU's
122',5;
I
I
1
1
1
I
Floor furnace
and vent
.." ,9-
(ohone no.
-::? ~2 -r;.s- /1
-::J 112- ~S- /~
'16/- ~~t:>
(I)nrln~ nn \
7 Sf'7-Z.3'=I,-
j ~~~ I r~AR.G..E..
1
\6.-1/2.-
1
1
19:-1 ",-
1
1
I
1
1
1
Recessed wall
~nacp hp~t~r <'Inri vpnt
'2 II~T ?~p
Appliance vent
seoarate
Stationary evao.
cooler ~ ,
~ Vent fan with
.:;;1 sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hnorl il nd dud.
Wood stove/heater
'IS:- .
ISSUANC, OF PFR!1IT
.x
x
x
TOTAL VALUATION
1:2~:z. 'liS: Pp /..o,o!il';Systems Development
~P~..<r-~"_"""" Charqe 0.5%)
amps. 22,S"<>
fY IIH 'I R)ltPJJ 1
\....- .
Total Comb. rermit
TOTAL
TOTAL CHARGES .95,"0 TOTAL CHARGES 67. 5<> TOTAL CHARGES 2/, ....
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an 'Electrical Contractor, the elettrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
-z Of "2~
;)\~c;,(L S
Tvpe/Const.~-~
Bedrooms
Units
Occy Load ~ :l1:.r.
Occy Group 8- 2.
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 OCCUPAllCY 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 compliance with OP.S 7Dl.055 will be used on this project.
tl Cb-tr~.. , 0'
1lAf.IE(please print)
Zone
cc:.
Fi re Zone
Flood Plain
BUILDING PERmT
Charges and
Surcharges
PLUt1BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcha rges
MECHANICAL PERMIT
Charges~ and
Surcharges
A LoI0so SIGIIATURE
, Fbif'6'FFICE USE OIIL Y
S~. Ftg. liain
Sq. Ft!J. Access
Sq. Ftg. Other
Stories
?
"
~c..I..... Plan Ck. Co""'/Ind
. "'_L-L~ 65%/Blrla Ppr Fpp
--- -, L'-~- Plan Ck. Res
V" ~ 30%/Bl dq Per Fee
, f?~~ I Fence
---u-~~i{ol D~mo
____b 7. 5'~ I Sidewalk
,2,70 I AIC Paving
;Z./. "'.... I Curb Cut
_un_ ~&1-1
DATE / //7 /tt
Value
Value
Value
~5""""''''
I 2"17. r~
I"?~;)
~~. 'a c)
I, 9tJI ,~$I
.
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, Lane County Map Reference
17 03 43
2. exam~le- Lot 1. 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. examDle- waterheater/electrical/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,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garl!ge
2. exam~le - 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, DESIGN TEM1 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
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 ~ivision 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.
V, FOR OFFICE USE ONLY
Permit Cl erk
y
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name L&>RNtG
nE',",~ Signature~____-;4_
date 1-2/-1I!i'~