HomeMy WebLinkAboutPermit Miscellaneous 1983-11-10
"INSPECTION LINE
726-3769
Job Address I07l MAl';) 1'"
legal Description 17-1f)3-3S-'I1.
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CIlY Uf 5PRINGFIE~D
COMBIilATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Range
'1~~,' 1,I~0<:>
.
INFORllATION UNl
726-3753
Sq. Ftg. ',lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
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Owner, lI1V/..f,if ff' 'tlf( g~d1TIttF.'''
Address /081.. f'1",.,,J f(T:
rp(l..lY' F,aD
V~luE of I-Iork:
1/1.(/110
BuildinQ Pennit Info: Describe Work.(Le..
Familv Ilesidence Hith JI,.ttached Garaael
Build Single
Phone )j€-11711
Construction lender
PIIfl/<I,J" L",. II (fftC-f'J F,,~~'f br!\lEu/1fP
7 S?iOC-et /1I1"rt1M P~\I€"'C>o>T
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I ISSUANCE OF PFRlllT
-ZS: GO TOTAL CHARGES I TOTA~ CHARGES
tha t the E1 ectrica 1 work be done by an."E1 ectr; ca 1 Contractor. - thee 1 ectr; ca 1 portion .of thi s pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 Derformed 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 OCCUPAr~CY 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 ORS 701.055 will be used on this project.
, fli 7/1'7- '1fl~r;; ,
IlAI-lE(please print) CWQ.W <If' ...,.r 611"""'U" b- b4<. I( j.oo"',IGI1ATURE cf4-----d It~
FOr. OFFICE USE ONLY
So. Ftg.
Sq. Ftg.
Sq. Ftg.
Address
Ut:::d(,jN TI:.At1
Phone
(address)
'3,1' ['/Bfr M.'IIIJ,~AY 4CCJo/{
(name)
(11es. no.)
Primary F,,,,Il... /1JfI.Ci(IT~
n'lt.
Structural
Electrical
Mechanical
CONTRACTORS (namel
Genera 1 ~;- LlYtflrlJ Ye~
Plumbino ;Vov &IJJF.lI/ YFT
Electrical
~1echani ca 1
PlUilB I NG
(address)
f1 ics. no.)
ELECTRICAL
NO.1
-----lEach single fixture
I Relocated building
(new fix. additional)
IS.F. Residence
II bath)
IDuPlex (1 bath) each
Additional bath
I="H. ~HA.Rr;1=" fi{\
<<L J:I!AIlliE .1ll'
Residence of
SQ. FT.
New circuits alts.
or extensions
SERVICES
lTemporary Construction
IChange in existing
rPsirlJ')'\rp .
Imultifamily. comm. or
Indu"t.rial
Water service
I Sewer
''I(lstorm Sewer
I
I
I
I
I
I
IOf
ICOMfI./IND. FEEDERS
['Install/alter/relocate
,Hc:.trih fppdpr..
IOf ' amp~1
I
z,,-
amps.
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be vali~ until the
Zone <::: c_
Fire Zone
Flood Plain
Type/Const~'~~ .
Bedrooms
Units
Occy load
Occy Group
t1ain x Value
Access x Value
Other.l.<.P~"J'~ Value
TOTAL VALUATION
Il.ceo:f>.-
S tor.i es
(exoires)
(ohone no.,
~""-O<"
(pxoires) (ohone nn.)
MECHANICAL
t"t"t" ru~
furnace/burner to
BTU.s
,/
Floor furnace
and vent
I' Recessed wall
,~~rp hp~tp~ ~nrl vpnt
I
I App 1 i ance vent
C:PI'\~ rrtt.p
I Stationary evap.
cooler
I Vent fan with
sinnlp riurt
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood and duct
IliOOd stove/heater
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DATE MrV, '/1 IfF)
BUILDING PER~1lT Pl an Ck. C01ll11!l nd IShstems Development /'1."'1
Charges and 65%/Bldo Pj"r Fee C arqe ,I. 5%) ,
Surcharges ------------ Plan Ck. Res I
30%/Bldo Per Fee
PlUI1BING PERMIT _n_~~:"':.~__ I Fence I
Charges and
Surcha rges I. ..... I Demo I
ELECTRICAL PERIHT I'Sidew.lk
Charges and ------------ I A/C Paving
Surcharges 5"6. - Tota 1 Comb. Permit
MECHANICAL PERMIT I Curb Cut I sI? ~ Z . ""0 J
Charges and ------------
Surcharges I I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
III.
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examp.le- Tax Lot 100. Lane County Map Reference
II U3 43.
2. examp)e- Lot I. Block 3, 2nd Addition to
Sprlngt;eld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical cel1in~/or forced air Qas
2. examole- waterheater/electrlcal/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. examole - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. example - convert single family residence into
restaurant (chan'ge of use) ..
G. Value of work as defined in Section 303 (a) of the
Structural 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 infonmation 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 DUT ALL FEES AND
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. ---
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 penmit is issued.
"!~'l/g3
(p ;)01~
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V. FOR OFFICE USE ONLY
Pennit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
J 8 A~nt4lyA<' ?"ANk/,(/G;
~sr~~<. ~ 19;./~ 7.i.
L -v<.1RCH PA-4C/~h., ..w A
S-~F-s-
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i9:J..:.~~ -:.~~ 8E
,~ /.s>Solr~~~Y
~~ '-J;DA.-c" ~ ~
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Permit appl icant exempt from registration with the Builder's Board because':
Additional Project Infonnation: ~'~ ,
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...1P
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67Y
G'k,c... N"c-~,."., r.:-
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kC.E~ hp.R<!!l~EhT ~#:r
~v...~... ~ ~~DVH<-'.
PLANS REVIEWED BY:
name L.RN~ ~tEdi~
Signature.~~ ~....-,:,
date 11--:Z8~83