HomeMy WebLinkAboutPermit Building 1989-3-2
CITY Of SPRINGflELO
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat R'p~t.,...i/"!i+'v
Hater Heater GaS -
Range None
ValUE of ('Sorle I f}JilI/)
OwnerS~field Church of the Brethren I / (Tl/V ,
Address 1072 E. Main St., Springfield Phone746-227 3 ~~~lnnRe~~d':~~~ Inf~~ ~~~~~~~~er,~~~~~l.e..
.f;--- "'-
IINSPECTION LINE
726-3769
.
.
INfORllATION liNt
726-3753
Sq. ftq. I'lain
~q. Ftg. Access.
Sq. ftg. Other
Ilew Add A Iter Rep.
--Fence Demo Change/Use
Ot~er- -
~
\:::)
Legal Description
Job Address 1072 E. Main Street
~rJ ()~~S4-1
(")4~r{)
Construction Lender
Address
Ut~ HiN 1!=.Al'1
Primary
Structural
Electrical
Build s;ngle
Remodel bathroom into handicap toilet
~d....~.t.?~:>J. .-:... ,'"'" u ~'<V"
t
............
~
...........,
(name)
Phone
{addressl
(ohnnl'l nn
(lies. no.)
{pxniresl
~
Mechanical
CONTRACTORS (name) laddress\
General Church -(~ic' ",I ~"'$ 6.., ~l), "","'w 7
Plumbino RO<Mr Kokotan 162'i Henderson. E-9.
Electrical Ralph Vetter 3660 Harlow Rd, Eugene
Mechan;cal Churcll
NO.1
f1 ;r:o: no.'
(PXI);rt'l.;)
17fo.~n~~_ol>~1
, __f
747-4406
687-1.292
I' .:<..::; I-fGd,J =-.s: ""Z.:::;E::,,,, Co'" t'
I 1
EuRene ~~22 JP OR
20-110-0
Pl.lnIIIIIIi
ELECTRICAL
MECHANICAL
I rrf I CHAJlfif NO I
I ~~L'-.C..I::IARG.E. ~Jn I
1!:'~LI.tI:!A.R.G..E.
7-~'?9- -
Residence of
furnace/burner to
BTU' s
Each single fixture
SQ. fT,
Relocated buildinq
(new fix. additional)
S. f. P.esiclmce
11 bath 1
Ouplex (1 batl11 each
Additional ioalt!l
,.M/h'. ,/&):..-e>
WHERE STATE L'\ll REQUIJlES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this pemit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfUllY ~'INED 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAr~CY will be made
of any structure ~thout 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 comP:iance with ORS ~~ be ,used ~ t~ project. .
NAI'iE(please print) '( / b'5S L. .Onll'?l r7 "'J SIGII~C/~,f~~ OATE ~~2-tt
fOr. OffICE .usVOiTLY , /
/~, Ftg. 11a;n x Value
y Sq. ft~. Access x Value
sq, ftg, Other~r.~y........P62: Value, /~_-
:;J- (J-y; 9 TOTAL VALUATION
Iii '2 <7 !'2/Y17'Systems Oevelopment . r /_~
4-LL-' :.lrLL;J Charoe (1.5~) /y,.
.
:z
Wa ter senice
Sewer
Storm Seer
TOTAL CHARGES
Zone
Fi re Zone
Flood Plain
BUILOING PERI-1lT
Charges an~
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
~'New circuits alts.
or extensions ~
'7L>,,;;'~=
SERVICES
;;Z~
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing
rpsjrly.rrp.
Imultifamily, corrm. or
Tnnllc:trii'l.l
10f amps,1
ICO~1./INO. fEEOERs
!Install/alter/relocate I
rli dri h fppnprc:
IOf amps.1
1
Appliance vent
seoar~tp
Stationarv evan.
r::nnler ~ ,
Vent fan with
sinole durt
Vent system apart from
heating or A.C.
Mechanical exhaust
hnnrt and durt
Wood stove/heater
I
I
I I
?5",
I
I
::?:::;;>~
ISSUANCE Of PfRr1lT
..-0
TOTAL CHARGES
TOTAL CHARGES
TV!>C/Const.
Bedrooms
Units
Occy Load
Occy Group
Stories
/'? Plan Ck,
___.../_c::.?E__ 6s%/Bldn
~ Plan Ck.
_,pB 30%/Bldo
/:5: e:-t:>
---L'-~7S--1 Demo
--=?<-se:> ,I'S1dewalk
---ui:;::?--I A/C Paving
/ t::>---:-- I Curb Cut
n_L-.-;7.5"--1
Conm/l nd
Ppr Fpe
Res
Per Fee
Fence
I
I
I
ITotal
I
I TOTAL
Comb. Permit
J
7.? 5'"1, '
,
.
.
,,;0,.--\.:0
COMBINATION APPLICATION/PERMIT (CAP)
,PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II U'j 43
2, example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilin9/or forced air Qa5
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq, foot garage
2. examole- if new project. check new - if addition,
check add. etc. '
F. Building permit information:
1. exam~le - 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. OESIGN TEAM ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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. ---
Ill. 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 paid. All other fees and charges are due and
payable when the permit ;s issued.
/')/~
~/ rf
V. FOR OFFICE USE ONLY
Permit Cl erk
cC
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name L&>..;:;>~ ?LCZ;;~ signature
af7--~-'-~'
.... -/ . -- /,.'
date "3'-r-t="-;>