HomeMy WebLinkAboutPermit Building 1983-10-24
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I IiISPECTlOtl L1flE
726-3769
Job Address ItJ 77.. Ml'rlrJ fr.
Legal Description \~ ()~ ~~ "-\\
CITY UF SPRlflGFIELO
COHBI:IATlON APPLlCATlOtl/PERMrT
E!IERGY SOURCES:
Heat l.L.I"C.;n.IC
~ater Heater G~J
Ranqe_ AJ i1//!
04'\00
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INFORltATION lJilt II
726-3753
Sq. Ftg. '.Iain
~q. ~tg. Access.
Sq. Ftg. Other
..Jlew_Add}(AI ter -,~ep.
Fence Demo Change/Use
-Other- -
V()
(;\J
~
Owner CHV 4<01 UF THU 8 R ~/o{~ CtJ
Address It> ') 1. 1'1"!-''; 5'1'.
Val~, of flork:
I J6.7...lJP
BUllGlnO Permit Info: Describe Work(i~e"
Familv nesidence With Attached Garaael
Build Single
IOJ
('1
Phone7'~1273
Rf-'1 DO(\.
Construction lender
Address
Ul:.~llifj If.Ar~
(name)
F'''''A.''''/MC..-,rn.TJ
Phone
(address)
3 6 <{ f/tfr 11.4"""'IIY tv' ey"
Primary
Structural
"
f.
Electrical
VOJJ ,
Mechanical
CONTRACTORS
tnamel
(address 1
Genera 1
OWM1!f/,
Plumbina
l/ivDf(,D,rP
Electrical
~1echanical
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PLU,IB IIIG
ELECTRICAL
NO. '
FEE: . r.HARr.F NO
z.
Each single fixture
5~
Res idence of
'i).a:
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
$.F. Residence
(] bath I
Duplex (1 bath)
Additional bath
I~Jater service
Sewer
SERVICES
each
Temporary Construction
Change in existing
rpsidgnc:p .
Imultifamily, comm. or
lnrlll<:.trial
IOf amps.1
Storm Sewer
~"'-l>,>..,^ M:>,.J. ^~ ~ "m;..<<,Cor~'I.I1NO. FEEDERS I
. I, ~ I Install/alter/relocate I
~ ~c::'C::~C'"'\ar r1;c:.trin. fpprlprc:. '
~.::... ~~,~ I ' IOf amp~1
, I
TOTAL CHARGES
WHERE STATE L~fI REQUIRES
shall not be va1i~ until the
\a.cr:J
TOTAL CHARGES
-
M/IIIr-,,/ G',vr (,v71> f'1a'r,,,,,r; ftool't
\I,.
M
.~
(lies. nn.' (f1xnirpd
(exoi res)
(ohoM no.
flfcs. no.)
'CEL' J:lJABliE NO
\r::,rP \~ d)
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,
I
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(;rb -06'1'1
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(ohnnfl nn_ )
MECHANICAL
, 'CEL J:lJABliE
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
SOArp np~tpr ~nrl vpnt
I
I
I
I
I
I
I
-,
I
I
Appliance vent
o:;poaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood <lnd durt.
j ~lood stove/heater
-,
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ISSUANCf OF PFRllIT
TOTAL CHARGES
that tile Electrical work be done by an,'Electrical Contractor, the electrical portion 'of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXJV1INED 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 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 OCCUPAUCY 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 7Ql.055 will be used on this project.
fJIt '(I-/ufl.'", .; 't>1lr R(lfT"1ttcr" ,
IWIE(please print) DALlr R Sf:Elc:. [~~~,~. ';'...,'rr. SIGrlATURE }!).J ,( ..4---
FO~ OFFICE USE DIlLY
Sa. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
Zone cr _
TYDe/Const.~ "-\
Units
Occy Load "\~
Occy Group t::...-~
Fire Zone -
Flood Plain
Bedrooms
Stori es
'2
BUILDING PERf,1!T
Charges anc
Surcharges
\.\A ~ Plan Ck. Co,,"lInd
..~V4 65'.t/Bldo Ppr F~e
----- \-~- Plan Ck, Res
. 30%/Blda Per Fee
____~D. 00
. "-l.0 Demo
\ ~.c::O
------------
.c.,o
DATf Ocr' 2)1 ,"',
x
Value
Value
Value
x
x
TOTAL VALUATION
0(40'1{ f'a.Lf'.-~ syste, rns Development
rOC, ,On If)/J?/f? Charae (1. 5~) ,
,-
PLU'1BING PERliIT
Charges and
Surcharges
Fence
ELECTRIC~,L PERf~IT
Cha rges and
Surcharges
I Sidewalk
I A/C Paving
I Curb Cut
I
I1ECHANICAL PERMIT
.Charges and
'Surcharges
Total Comb. rermit
"
TOTAL
Co '\. CoO
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COMBINATION APPLICATION/PE~~IT (CAP)
PERMIT VALIDATIDN
~
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax lot 100, lane County Map Reference
11 o'j 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exa~le. heat/electrical ceilin~/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project. check-new - if addition,
cneck add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - 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 TEAfI 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 PI~mbing, 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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT 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. ---
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
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 Clerk
b
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
\.\c'\.p t'"e~\.re.~e.\.\~ e_~~~\.,,,,,'t--.P("'\. ~'\!o.. 9~" C'" ~ '\,..v....-4-
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;~~~ 'Qp~p ~ C:b:-\.\..~~~~ fC'i,. ~(,1.~ h~\.\
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name\')~\~-s.. "Y\.).~\-.~ SignatS~~e.u~
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