HomeMy WebLinkAboutPermit Building 1987-1-28
I INSPECTION LINE Cll'{OF SPRINGFIELD
726-3769 COMBIIIATION APPLICATION/PERMIT
O 11. . J S E!lERGY SOURCES:
Job Address 110 "If., SJ.. .f/-:J;rl")j,;'/,,;L Heat
LegaIDescription/1c../? 17-0",-Jr-4_1 I ~<'D0)liaterHeater
I \ ./ Ranqe
owner~kr pot,., /.{"y
Address / fJ.- (/'t>.fl. j?,..
& '-t~ D/M: c; JirO ~
Address Phone
Ut.~lbrl fE.Ar.' (name). fadd;eSS). (lies," n~.l (eXOlr.eS1. (o~ne no.
Primary LLJS (":,. Airh\.\Pr+d,~+-~ncL(r'("~nr+ 7.o-k>if ~(L ~;z..-'nl<:
Structural 1"'e;" V":> i< "'-0/ <.., Jt, /"e/,,,, 4~~~: tal.. A/.::>,..:: .4..1..-./<; ;?C l-:V-;;:& ..,..../V' 71'.,-
'/' ,
P~~.-") W",,/ ,,-,I-/.. hell/?.-/. ~/<"/-I-"';8. cE'77//:c//7c>,q;r/'.=-/?/'??--4<;
.). z>
Mechanical {JeJ'r '} U"":! lA_ dt.. I,t/,/J. htw_t,... /)r--r.PU/79~
::::::~TORS ?el:me~ '01,,, /-(....l (~;;~J (]ies. no.l (exnired rOhnn~ \
c.'A-c/ C- pc.., ..JC>IHj' SC'Vr-t,p .f'/72. 3 tOJJ.l/".!"., /".e j)p)<h.(i~,c.{ C"..~,j.f)91?Jrl.
..... -'
Electrical t?a....f.......c'<.~ i:=-l..J.....<.. t:...,. ~.,1LV~.JIg,;,.( nJv....~ {;:.-"<<..~ .L.j3~J?'r'r;?_
'lechanical &..~ f1IPI/JI'G.~'l!. .sfi:(-<{(<c.- /:>-,1,.. ;,.J,,~. ]."..<... ~"<'_ E-c....~,&,,<k.iJI.{'J.. f;-.'i
.; PLUrlBING
1] NO.
2.8 Each single fixture
Relocated building
\1 (new fix. additional)
,', 5.F. Residence
(] bath)
I Duplex (l bath)
, each
Additional bath
~Ia ter serv; ce
Sewer
I <:;'0 ,
Storm Sewer
'. ..
"
,.
,
Construction Lender
r
Electrical
I
,
Pl umb; no
.-
~.-te: S;tL P/o./;' /xI..o. beM(
~~.rtTi.f.n' P.!.Utll/>4s<t/J'
rnFORltATION LINt
726-3753
Sq. Ftq. l'lain_I';;~" ~
~q. Ftg. Access.
Sq. Ftg. Other
-1/ewllAdd_Al ter .....:~ep.
Fence Demo Change/Use
Other- -
<::xl
~
~
I
ValUE ~Work: ~
.q'SSDOO-:>-
Ph r.o.u....'C....Ifr3/o,.I....Buildina Permit Info: Oeser be Work{Le., Build Single
'1."_e .:..:. 1'-~1; :JamilY neSi~enc: With Attached GaraQe)
IId&Gt f/ {) '" 1-0 t?y,.I),.'$ ':>... ,(.f/~~
( r:t&Yr'~ /'"Id 5.-0,. r 1
\....' iJ /
ELECTRICAL
MECHANICAL
FFF
rHAR~F
lIP
ccc
rl-ll1RG.E.. NO
'~CCH
furnace/burner to t
BTU's .
. ...
.& -
. ISO 2,/~.""
Residence of
SQ. FT.
1::''2.5: .
I
I
I Temporary Construction I
IChange in existing I
rpc;i df'nrp .
I. Imultff'amilY, corrrn. or I
Tnduc;,t.riil.l
I-;~. ~.'" I Of '2.00 amps.1 I 37.X:
I CO~1./IND. FEEDERS I I
I I Install/alter/relocate I I
rli~trih_ f~prl~r~
I IOf amp~ I
I I
I I
1 I. I ISSUANCf OF PFRtHT
2::?O""" TOTAL CHARGES b'0,"...",1 TOTAL CHARGES '/6. ap
that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
,/
New circuits alts.
or extensions
2 ap.M.~A...~
Floor furnace
and vent
SERVICES
Recessed wall ~.
Snu:p hPillr jlllrt y~_n
1) ~ ~.I<,A>""'?7~ /1 lu,/"l::'
7 ::"I:':""~. j./JSer..-='P70 7'
. Appl iance vent I I
"eoarate
I Stationary evap. I I
cooler
I Vent fan with I
sinnle rluct
I Vent system apart from I
heating or A.c.
I Mechanical exhaust I
hood and durt
I ~Iood stove/heater 1
~-I~;p~- l;;'/~/.'>~ 12. ~Q
I I
I I
TOTAL CHARGES
WHEnE STATE LAW REQUIRES
shall not be va1iJ until the
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 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 NO OCCUPAI~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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who ar~ in compliance with OP.S 701.055 will be used on this project.
IIAHE(please print)
2one-.kt'::
Fi re Zone
?ekv
Flood Plain
/
t.I,Jr ",r::>D~ #7<'7
Tyoe/Const.
Bedrooms
Stories
,-;-:'A/
11 ....L SIGNATURE ,~_? ~. _
V' .fOr. OFFICE USE OtlL Y v
Units . Sq. Ftg. 11ain IBOOr4;Pl'.:V7//.0".. value_..5?~~. "'!-,,'
"' y"rq,y C
Occy Load~f~:q./...~. Sq. Ftg. Access.t:::aLl/Ph'1gh/~ Value /a~Qd.
Occ.Y Group 1f-"2 SB Ftg. Other Blv,~. x /'9a.:::>f' Value / 9::70. ~~,
Gt~~9Rt.{ 'is, 1./3 ,;:)T~Ld~lf/tfOrl?~l/oc:>..'-
(~ !_.?t:o ?1 syste.rnsDevelopment. -::>...../ e...
,. - ~ '- 1.>-1 CharQe (L5~l ::.."....c..
BUILDING PERfllT
Charges anc
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
/lECHANICAL PERMIT
Charges and
Surcharges
J-on..,
DATE //2.. oj??
-,u ~C> Plan Ck. Comm/lnd
/' 1'. 65%/81 do Ppr Fpp
------------ Plan Ck. Res
:? ~~ 30%/Bldo Per F~~
____?2g~~_ Fence
'7. ;;:0 Demo
b2. <>" I.Sidewalk
-------.;~.y:;-I AIC Paving
'fc;. co- I Curb Cut
----- -/~g~-I
I
I I
I I
I ?/.4:> ITotal Comb. Permit 7':57. '92
I 1 7(;,3. 'Ie. I
l I TOTAL
.......
.
COMBINATION APPLICATION/PERMIT (CAP)
J. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
17 03 4J
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
"I. example- heat/electrical ceilinQ!or forced air Qas
2. exa~le- waterheater/electrical/or ~
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. examele - construct single family house with an
attached gar~ge
2. examele - remodel existing garage into family room
3. exam~le - 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 TEM4 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) tp be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
C. BUILOING 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. ---
111. 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 penmit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
'.,
~
PERMIT VALIDATION
~
Permit Clerk
<
\n'i> ?)
b
.~
j
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~77,y~ Pc.E'T~ Signatur~_
//
~
/'
date S-;:?S-::57
~,
,,~
IINSPECTlim LINE 'CITY Uf SPRINGfiELD
7~6-3769 COMBINATION APPLICATION/PERMIT
. 11. ~ J S..1 EilERGY SOURCES:
Job Address 1100 <It ('1 SJ.. 'P,,",:~.t:.;;'~d.- Heat .
Legal Description/1~It? 17~0",-Jr-lI_.1 I 4 <'DO}liaterHe?ter
, \.... ./ Range
ValuE :2tHO.;y.snO o~
Pho~QV~~3/0 ~uiltiinq Permit Info: Describe Workli.e.,
I~n_e 'r':"'~ >>Iamilv rlesidence Hith Attached Garaael
_ _'h"~_ .'
tlcId.J f/ 0 I? 1-0 r?Y,J!t-JI- 1:>... .rJ/~~
Su;>., r 1
/
no-te: 5tJ1, P/o..rl hao tx:Mt.
~.d.....tn p.wu.I1J4011'it7
..- - mFORllATlDN liNt . /
726-3753 . "\..
Sq. Ftq. 1.lain /RtX>'"
~q. Ftg'. Access'.
Sq. Ftg. Other. ~
-'~e.w LAdd _AI ter --,~ep. ---.J
Fence Demo Change/Use
Other- - d
Build Single ~
~
owner~kr ;Jot,,., U"y
Address / Pr (,ul. j?,..
D/M: q Jiro ~
&'-t~
Construction lender
( ~I;?Y'." ;!.;,/d
'-.... ' IJ
"71~ ( iV6
)
Address Phone
UI:.~H.iN rt.Af1 (name) (address) (lies. no.l (exoiresl
Primary I.L's' n. AirJ,;,.\Pr!- aJ, ~+- ~ncl lrMt;lr+ ~{.. ~;z..-,nl <:\
Structural 1"'e;".,.)- i-<"'-o/ ...,it, hellA' . 4~~~;k<k A/O?"E: PCA..v<. A"~~..4LA/ /!for
v., I . .
Electrical p~.-). t(",/ ....,1-/.. hell/? o-l ~/~~/-"'~"8' E.J??N,r.~;r/~_,.?-2e:.Af<;
Mechanical fe-frr ? U"":! "'-' Jt., I,t/,,,, bk-t,... ;3'FG9U/79~
::::::~TORS ~l:m}-ol,,, k~l I~~~J l1ics. no.1 (exnires) Inhnn:,'
Plumbino CA-c{ C- Pc..,,-I,,IHj' .[C'Vr-ItP .f'/72.J tOJ/.Vtil..., (".(j)p)tW~,<..{ Co.,.,.j./.)71?Jrs4_
'- -'
Electrical t?a....f.......Ct<L El.,J",'<..t:'h'. ~"1LV~.JIg"J nJv...dti:~~ .J"j3~J?'r'r;?_
~lechanical &..~ f1lp..,I, G.~<.L .s<<(.<{(<.e-- /'$~'1.- ;,.J,,~. ].".-<'" ~"<'- t:....~A.<.lc.i JI.{'J' liS'
PLUI.IBING ELECTRICAL Q,<S')1vMECHANICAL
....llihl FEE rHARGF Nn I...EEL J:IJARG.E "n I I OOF 1.J:liARliE.
28 Each single fixture ;lSO '2./tJ..... Residence of SQ. FT. furnace/burnerB~~'S~'. -/
Relocated building /' New circuits alts. Floor furnace . ~.". ''',-
(new fix. additional) or extensions ~.s. I and vent ~
2 DPM....J:I&;. ""..
Recessed wall V I .
SERVICES S.,:.rp hP~=itj:l}-~'1fi_ "en.L_
'I s'/~. ~:/7S::'~ J I lit ct."".
Appiiance vent I I
,,-eoaratp
I Stationary evap. I I
cooler
I V~nt fan with I I
slnole duct
I Vent sys tern apa rt from I I
heatina or A.C.
I Mechanical exhaust I
hood "nd dllr.t
I \'Iood stove/heater
.....-IGA-S" l'l?/hiC.
I
I
fnhone no '\
$.F. Residence
(1 bathl
I Duplex (1 bath)
IAdditional bath
each
Sewer
Temporary Construction
Change in existing
rpslrlj>JU"p
multifamily, COntTl. or
TndlJ<;.trial
J
Storm Sewer
<5C'
::2b..... /
Of
"2~
amps.1
I
I
13'7.~
I
Water service
COffi1./IND. FEEDERS
I
I
TOTAL CHARGES ;? ::10. <<:> TOTAL CHARGES It O. -- TOTAL CHARGES L/h. c>p
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an,:Electrical Contractor. the electrical portion -Of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
[Install/alter/relocate
nic:.trih. fppnprc;
IDf amp~1
I
I
I
2.0>'"
ISSUANCE OF PFR!IIT
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 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 UO 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 ons 701.055, that if exempt the basis for exemption is noted hereon. ~nd that
only subcontractors and employees who ar~ in compliance with ORS 7nl.055 will be used on this project.
NAME(please print)
?ekv
JuJ.,..,
11 "...,(
V'
SIGNATURE ,U-']- ~
FOP,..OFFICE USE DIlLY v
Sq. Ftg. 11ain /Bc:o'lAZ>D/'UbGLyalue ..g~~. C:>J.
Sq. FtQ. Access,(Epu/P""'SN7" Value IO<!)C>4
SB F~J" Other ~V.I"""" __x_/9t:JO'/' Value /9<7.0.':>0
Gt ""'~ t.{?>, 1/3 c5T!:Ld~~tyON~~+'co.-.
(Ifi '17 I~ syste.rns Development -::>A/ eo
, - '" ~ Charoe (J.5~) :;">V't>.
DATE 1/2. 0/<1"7
I
1/1ECHANICAL PERMIT
Charges and
Surcharges
Zone C--:: Type/Const. _~J(/ Units
or Y"Q~
Fire Zone Bedrooms Occy Load~r....~~,...
Flood Plain Stories / Occy Group 8-2
tiS.. cc:.?:>& #7 <:' 7 7i)
BUILDING PERflIT 7U -;<:> Plan Ck. commlIna.1
CI d 7. 65%/Blda Ppr Fpp
larges an ;).. ------------P"fan Ck. fes
Surcharges -, ~~
.. .,.~ 3D%/Bldo Per Fee
? 3C1. - I Fence
-------?:-~o-I D6A10
GLJ."'" ISidew.lk
-------;~~~-I A/C Paving
. '1.6. co I Curb Cut
~ ----- -/~&~-I
PLUi1BING PERMIT
Charges and '6
Surcha rges
ELECTRICAL PER/lIT
Cha rges and \ J
Surcharges ,
~
I I
I I
I I
I '5/. 4=:> .ITot~1 .~omb. Permit '127. 92
I. I ~
I I TOTAL 7~3.'lZ
~
,
COMBINATION APPLICATION/PERMIT (CAP)
j
, ....,P"
~
/
r- -
.; . ,.
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription ,
1. example- Tax lot 100, lane County Map Reference
11 oj 43 -c'
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates .
C. Name. etc. of owner and construction lender
D. Energy Sources
"1. example- heat/electrical ceilin~/or forced air Qas
2. examDle~ waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exam~le- if new project, check-new - if addition,
check add, etc.
F. Building pennit information:
'1. example - construct single family house with an
a~tached garage ,
2. examyle - remodel existing garage into family room
3. example - 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 TEM1 AND CONTRACTORS
To avoid design or construction delays, Building'
Division Staff must be able to contact appropriate
persons' regarding design infonnation 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 fonn 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 SCHEOULES
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
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.
"
.,~,
n~~
\j .~
III.
V. FOR OFFICE USE ONLY
Permit Clerk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
(
. ~~
p\.o
.~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name f-cp77#E Pc:..~~ Signatur~~
// , .
date :;---:::?S-g7