HomeMy WebLinkAboutPermit Building 1986-1-17 (2)
I IrISPECTION LINE
726-3769 ,
Job Address IClt)) ?;t ();V\V
Legal Description /7- 03-35-tj-/-.7'100
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INFDRrlATION liNE
726-3753
.Sq. Ftg. l'laln:Z~.";~"":"
~Q. !=tg. Access.
Sq. Ftq. Other
)0lew_Add2(AI ter _Pep.
Fence Demo Change/Use
-Other - -
I
CITY OF SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
\~ater Heater
I
Ranqe
Address
Owner .s PI!)(Jb FI ELf) UT ILl TY
.pO Boy 300
Phone
ValUE of I-Io~:
.p~)~06
BullciinQ Permit Info: Deser be l~ork{Le..
Famil y l1es idence l'lith J'l.ttached Garaoe)
Address
UI:.)lliU H.Ar-1 (name)
Primary l'\or ( l So J\
Structura 1
Electrical ~l?::D f.'~'TrK~p. 2'9"" M':>h'."""'~, ::t...J~E~ cJ-<? 7/>"0:;:
, y,
Mechanical W~~V ?.NE("'>h7A>,~/~.5 ?..o..z;,.~ ?c>/:ii?<\. tF(..Jt::;.E*5'_~;;:. "77"7':'/
CONTRACTORS wme f ~ (address) "! 1; c<:;,. no.1 (f'!)(O; rps)
6, r"_ ~ ~ "'S31 H/~"'5'B .
General 1JIe.."" r"""C~-CR - _- ,7". i!) ,f'!O' ~~ ",iiV' HP. L ~~, ...
Plumbina
Electrical
~lechan; ca 1
Construction lender
7'1b-&:'7"5r '7<><:
tld',-/, ;-; ') '- ;; tl14~...{ 4P r,
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~" h:<.t.-C- q --&of 1.& (......." r
fI -
Phone
(address)
(l ics. no.)
(exnires)
'f2.ecIe(e,u " ~ CiS-50S., /-g/t} UJ5m::r:- 0 .EUG:E..I'-~,
PLUllBIrIG
rm,l
~ lEaCh single fixture
[Relocated building
(new fix. additional)
Is.F. Residence
(] bath)
IDuplex (1 bath) each
jAdditional bath
Hater service
I FEE I CHARr,F
1;7.5"<<> f$:AO
I
I
I
I
1-0 <'.'
" ,
..,.~, Sewer /.v.:~ /~'"' / -a I. ,.n)
~,.Jl.J ( ~_/...,., I ~~""'P'.y
. ~' I Storm Sewer I
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2~.""
.
ELECTRICAL
MECHANICAL
Su; ld Single
~
(0'
()
L~
-......
Nn
~~r I rHARh~ rm _ I
- " _ c;J-.-
(ohane no.
-:;' 0/.::> -c.,,":"'- /1
~ ~:?- ~/)?~
'16/ - :?~o
(ohnnl> no.)
7 Sf7- 23":? 2-.
I ~~~ I rJ..lAQr.~
v"" New circuits alts.
or extensions
'"? fS?,.."",~;O;::.:
..... - "..
2'2.s:,
I
I
I
I
I
2
Recessed wall
Snn~P hPntp~ ~nrl vpnt
k~: /2-
1Ic,;.:/,~-'>-7.-'"
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hond and duct
,,6'7. 50
TOTAL CHARGES
ISSUANCE OF PFRtHT
Units
Occy Load 6'? ~r.
Occy Group 8-.2
.
x
x
Residence of
furnace/burner to
BTlI's
....,.:.~ "::'.-
,. /,
..:;>.- -":' TOTAL CHARGES
_'O).'
WHERE STATE l~W REQUIRES that tile Electrical work be done by an Electrical Contractor, the elettrical rartion of
shall not be. valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that 1m OCCUPAIlCY 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 OP.S 7nl.055 will be used on this project.
HAlIE(please prlntLV,{L(,fL S (j,LprJSO SIGIMTURE_M~," y::r-
FOr, OfFICE USE OlR y'
Sq. Ftg. r1ain
Sq. Ft~. Access
Sq. Ftg. Other
TOTAL CHARGES
Zone
cc;,
Tvoe/Const.~-~
Bedrooms
Fire Zone
Flood Plain
'2
Stories
"
BUILDING PERfIIT
Charges an~
Surcharges'
SQ. FT.
Floor furnace
and vent
SERVICES
ITemporary Construction
IChange in existing
rp<;idpnrp
Imultffamily, comm. or
TnolJ':.t.ri"l
I
13
I
I
I
Wood stove/heater
-:?
IOf
I COI1I.1. /IND. FEEDERS
I Install/alter/relocate
oi<;t.r1n. fppopr<;
IOf ,,:?.:;o amps. ::ZZ..S"t:)
'-I~'
"".
amps.
TOTAL VALUATION
,Plan Ck. Comm/lnd
65% Bld P r Fee
Plan Ck. Res
~n%/Blrlo Per Fee
___~_?~-;~!~l ~nce .
-;-. '/DI Demo
_ ___.6. Z.2~-'~i~ewa~
, 2. 7~ I A/C Paving
:2 j, c:)o I Curb Cut
___u_ ~&r-I
_ n:?Z:Z '- ~~_
, S. -::t5
PLUMBING PERMIT
Charges and
Surcharges
ELECTRIC;,L PERI:IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
~",<.yS-I".o 1.",>~Systems Development
'P~.;!7"-J:1?~~~ lCharCle (1. 5':)
I
1-A-.1 n ~ 1
I ey lit' 1Ie/!IP/)
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Total Comb. Permit I
I
I
I TOTAL
'2/,"'"
thi s pemit
DATE / //7 Itt
value-66. <"4:3~
, -
Value
Value
129 7.r~
/?~,)
~90. ere) ~
I, 9tJI \~$
I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County"Map Reference
'J/ 03 43
2. examole- Lot I. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/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,
checl< add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - 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 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. 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
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.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"!:':...":,, .
, .
-..;. .=-:'. ~~~ ..2.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
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PERMIT VALIDATION
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