HomeMy WebLinkAboutPermit Building 1988-2-24
~ CITY UF SPRINGFIELD
, COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
-:~
. I INSPECTION LINE
\ 726-3769
Job Address
t"IO t-#l"-'
Le9al omription/ '70 ~ 3S
q(
Owner <::E;LCO ~ I U~ Irll
Address
Construction Lender ~
Address
Ut~jbN .1 t.Ali
(namel
~'f' PJR7L~~
Structural ~ fl?d~V'
Electrical ~F
Mechanical ~J~
CONTRACTORS lnamel
Primary
General ~""'I lp~
Plumblno E.tJl~1 P VAil BY
Electrical P>1I11......,.,.&'-, l:=/ ~
lIechanlca1 bA~ Hth
PLUIIBING
..l!!h
ValUE of Work~~ ~
))1.. I '
Bu1to1nQ Permit Infb: Describe Work(i.e.. Build Single
Familv ttes1dence With Attached Garaael
/~DrlD tJf:U ~'i=-
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If) -S;zOO
Range
Phone
Phone
(address)
~,
2~
(addressl
ifJ:.tJ~iP.
~~eI
4-1..IL/JV r:,1tt
ELECTRICAL
.
INFORIIATlON LINt I
726-375~
Sq. Ftq. l'lain
~q. Ftg. Access.
Sq. Ftq. Other
lIew Add Alter r.ep.
-Fence Demo Change/Use
Other- -
.,..f)
~
~
=.
, .
E)
(Dhone no .Il
?'~~4~
flies. no.l {exniresl
~ nd>I?o/~
7ljq~ J1/~/~q
(}in. no. (pxl)iI"P~l
~-I1t>~ "I~fili
';U>-I'JC. IO-l-bh
4:;-u;\ 1'l.'I-~
1iYO.
(I)hnnp no
(!l8'2..,-~/_
4fj;;-dl~
::l.d4 - 2.4-8 I
MECHANICAL
Each single fixture
FFF f.HIlRGL.JlO I tEL J:llAI!lil NO, I
Residence of furnace/burner to
SQ. FT. BTU's
I FH Ir~~
I
I
I
I
I
I
TOTAL CHARGES 3&, d '1" TOTAL CHARGES -:;;;: :;?So TOTAL CHARGES /<t,-'.:>D
WHERE STATE L\l/ REQUIRES 'that the E1ectricall work be done by an' Electrical Contractor, the electrical portion of this pemit
shall not be va111 until the label has been signed by an Electrical Supervisor and returned to the Building Oivision
\
I MAVE CAREFULLY EXAflINED 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 Oregon pertaining to the work described herein, and that no OCCUPAlICY will be made
of any structure without the permission of the Building Division. I'further certify that my registration with the Builder's
Board 1s in full force and effect as required by ORS 701.055, that if exempt the basis for exemption 1s noted hereon, and that
only subcontractors and employees who are In compliance with ORS 7nl.055 will ~ed on this project.
nAlIE(p1ease print)~~ ~-6-5 ~-f):J~4;:;/..'/) OATE~h~/8t
FOr. OFFICE USE 01 y,7 .~' ~ -
Units Sq. Ftg. flain x Value
Occy Load Sq. Ftg. Acces, v Value
Occy GroupY-.2 Sq. Ftg. otherh7.!5<?""'A'k~alue$1~'--
/il .Q -12:- Ii: ~ 10'1 33 TOTAL V ALUA TI ON
. -::<~.,,;;J..o' Plan Ck. ConmlInY Systems Development
.6!'.s!2~ 65%/BldD Ppr Fpp Q"12..,;:)() Charpe (!.5~
;)., -- - -- - - - Pian Ck. Res
)'~. ~~ 30%/B1do Per Fee
, .... t2 -",('> Fence
____2~.1.~___
I ",- Demo
f. .,0
2-::?.::?p I Sidewalk
------/.-/.3--1 A/C Paving
(p ----.l~-B---: Curb Cut
~
Relocated building
(new fix. additional) 7.~ ?<?_
~
S.F. Residence
(J bath)
Ouplex (1 bhh)
each
Additional bath
Water service
Sewer
Storm Sewer
20ne Cr:.
Fire Zone
Flood Plain
5';'';(/
Tyoe/Const.
Bedrooms
Stories
/
BUILOING PERIIIT
Charges and
SurCharges
PLurlBING PERMIT
Charges and S
Surcharges
ELECTRICAL PERrHT
Charges and \ J
Surcharges i
MECHANICAL PERMIT
Charges and
Surcharges
/' New cfrcults alts.
,..,. or extensions. ~
-;z a:ol" ....~..,."
SERVICES
Temporary Construction
Change in existing
rps11.;:nre
multifamilYt comm. or
Tnrlllc:.trhl
Of
amps.
COMH,fINO. FEEOERS
Install/alter/relocate
dhtrih. fppdprc:.
Of
amps.
I
&
/J/1'
I
'1
I
<".7.$"C
Floor furnace
and vent
Recessed wall
So~,.p hp~tpr Anrl vpnt
~.
-
Appliance vent
~f10ari!t~
Stationary evap.
cooler
Vent fan with
o;inn1i!! dur:t.
Vent system apart from
heattnq or A.C.
Mechanical exhaust
hnnri ..."ri t1l1rt
Wood stove/heater
..- ~ T$<? ",,Ii? €.x ?;!F"....'O I >
7:>,.I.GT lA.....~A.k"'" . M..w. /~ ~
I
I
ISSUANCf OF PFR!tIT
Total Comb, rermit,
I
TOTAL i ~ 78.2'8
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~pr1ngtield Estates '
C. Name, etc. of owner and construction lender
O. Energy Sources
'I. examyle- heat/electrical ceilinq/or forced air aas
Z. exam~le- waterneater/electrlcal/or solar
E. Square footage or valuation, etc. . - . .
1. example- 1250 sq. foot house, SOD sq, foot garage
2. examp-le- if new project. check new - 1f addition,
check add, etc. .
F. Building permit information:
I. exam~le - construct single family house with an
attached garage .
2. exam~le - remodel existing garage into family room
3. exa~le - convert sfngle family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specfalty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buildfng
Oivislon Staff must be able to contact approprfate
persons regardfng desfgn information or job site
corrections, etc.
II. Abbreviated Plumbfng, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applfcant need flll-fn only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Buflding Of vision
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the ftem(s) to be installed are not covered on
the abbrevfated schedules you should consult the
full schedules
C. BUILDING OIVISION 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 1s .not authorized
to sign the electrical label. - ,
Applicant to sign and date
Whenever possfble, the initial applfcatfon will be used as
a worksheet only. Where possible, Bufldfng Divfsion Staff
will prepare a type written copy and return it to the
applfcant at the time the actual permit fs issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the tfme 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.
.
COMBINATION APPLICATION/PERMIT (CAP)'
111.
V. FOR OFFICE USE ONLY
c
CITY OF SPRINGFIELD
. CltyH'" .
Bprlngftold. Oregon
OffIce a. C~mmunlty end Economic Devetopment
OFFICIAL RECEIPT
/
..,
--
10991
,
,
. .
" Date Fe-B. :2'''1/ 198a
. Rec'd From ~N,r/N'r'-'u~ ~.
- ::(9 e'B /1'I-+p/.)~1Y
Addre.. k'~e: ~c,' ~. 97 V...,)
. I
'Received For:. JD'B#:;:sft..>C>//!C.. / /~...... .
. - - ~
'$88 .....
(y.re
. ~,~ '
, '1?~e>
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.--.
J~50
7<. $C:':>
, ,-
, ",."...,
I~-
.75
t/ 78, -::;8
l' r f
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J>,7'.
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M.P
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7;, r~c
.
C:<<# /679
.
41~<8
Amount Received
I
//'~-e7"~ ~""-----
ff AUtHOFOzeO SIGNAtURE ./
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8USINESSfORMS.INC.
15031,.2-11"
"
[, ,
Pennit Clerk
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 L<!'RHG ~G~
signature
date'::2'-:z <z"'-~
,