HomeMy WebLinkAboutPermit Building 1987-8-16
INFORllATIDN liNt
726-3753
Sq. Ftq. 1,Iain "'NO<::
~q. Ftg. Access.
Sq. Ftq, Other
20lew_Add_AI ter -,~ep.
_Fence__Demo__Change/Use
Val~*2.~()V =- _Other
.l'\ojL-PhoneD>]. Buil<iinQ I"ermit Info: Oescribe Work(i.,e., Build Singlej..9
v..... ", '(3tO ,~-""..., Ilesidence. With Attached GaraQe)
J to-/O/~ ~~ElD ~ -:':PJ\b - f"J Iml\Jlt::>U r;
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Address Phone ~ f!:l"'C15.
Ut~ll:irj It:AI''' (name) (address 1 (lies. no.) (exoiresl (ohone no.)
~~~~;i~:::;:~:::~::~~.~:: :::+
CONTRACTORS (name) (address) (lies. no.) (pxn;rp~) (ohonp no.)
Hde....
I INSPECTION LINE
726-3769
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CITY U~ SPRINufIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat ~1" e..5.
Water Heater ~~
Job Address 1100 f\t\AlN "OT, ::PZI~eLD,C1l.
Legal De<cri~tion IA.X LOi # 4SOD 1.
MAP 17 03 % 41. ~"II ~~.t.I~~*
Owner "'V dt-.... .? <>1, ., k "'1 /
Address If') Cr..jt '1)".. E~
Construction lender
Genera 1
, Plumbina
r/-'n
k~'11
Electrical
7>c...J,.../ dc...
t:~L.eJ.,.-, d
~1echan; ca 1
NO.1
~I
Each single fixture
PLUf1BItlG
I FEE I rHARr,[
!:- ZOS'""
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
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Additional bath
Water service It),~
Sewer -;;'S-~.! M:-
Storm Sewer~'t ~
liii<KFC~W ?kF~ eN,); '<!!##
'pG'/, etS' 5:-
Range
eX)
(}J
v
Ifr(~J. V.-- ~-...~~ n~
~., GO<S Plan Ck. Comm/lnd
~~. 65%/Rlda P~r Fp~
-- ---------Pl'an Ck. Res
~.O", 3Dt/BldQ Per Fee
__"J!..'~~__ Fence
11.60 D~mo
____~$7-Sidewalk
I. lit> A/C Paving
S' '< . -0 Curb Cut
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~ . C,a.
:r "" c..
P.:J, i'3 CoY;
ELECTRICAL
NO I
Residence of
SQ. FT.
New circuits a1ts.
or extensions
SERVICES
, Temporary Construction
Change in existing
rps j q~nq:
multifamily. comm. or
Induc;,trial
I Of "'200 amps,
COMM,/IND. FEEDERS
Install/alter/relocate
rl;~trih fpprlpr~
Of
amps.
77ti";
t;~k-t Ollte-q 7(,1()/ ~~1'1~.~
MECHANICAL
I i=H. I rl-lARG.E. NO.
I
furnace/burner to
BTU's
Ii=i=i=
I r"A.RIi.E.
./
Floor furnace
and vent
I
IliI.-
I
I
I~-
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Recessed wall
SI)<I~P np;ltpr ;lnrl vpnt J
tI ~'--J/ /SI" -11) tJ /1"' 'If.
Appliance vent
s~oaratp
Stationary evap.
cooler
"? Vent fan with
""" sinale duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust I
hood ilnd du..t.
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>-' C$A-J 71p/1'Ji'<4 I
I
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13;-
6.<<>
Wood stove/heater
-:il,-
:r.(':..::.:::=-:.:--~
TOTAL CHARGES "Z~t),- TOTAL CHARGES ~S':- TOTAL CHARGES S"<. ....
WHERE STATE L.'li REQUIRES that the Electrical work be done by an,.Electrical Contractor, the electrical portion.of this permit
shall not be va1i~ until ~~e label has been signed by an Electrical Supervisor an~ ~e~urned 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 1 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 OCCUPAIKY 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.
IWIE(please print)~V ~
1/
Tyoe/Const. ~~
Bedrooms~~.
Stories I
Zone . c:::<::::: -.
Fire 20ne .#>4 .
Flood Plain 8.4.
BUILDING PERf,1IT
Charges an~
Surcharges
PLUt1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
i< ""'-Vl SIr.iIATURE.~ J- /1.,1 DmJt;(;/P;7
~ FOr. OFFICE USE OllL Y v .
Units N A . Sq. Ftg. llain_ ~~ x Value.~~.-
Occy Load ~S- '.' . ...." .4!:c:s;lu.....P~~... Value~.~.OCl
Occy Group K-"2 Sq. Ftg. Other i'!9YIhG.. x ' Value~~.."
TOTAL VALUATION~~'''''
U.., oU'-=, Jystems Development
7 . 7" Charoe (1.5~) .
'~~ (.01 Sl q. 8-1170
6t:)t:). ",,0
zs.~c
/ 'I, B8
ITota' ~omb.
I
I TOTAL
Permi t 5'1 'I. 00
Y .~}t';~ f
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COMBINATION APPLICATION/PERMIT (CAP). .
.'
I. Applicant to furnish
A. Job Address
B. Legal Description "
1. example- Tax lot 100, lane County Map Reference
II UJ 43
2, examele- Lot 1. Block 3, 2nd Addition to
')prlngt-ield Estates '. \
C. Name, etc. of owner and construction iender
. 0... Energy Sources . .... '.' f'
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheatertelectrical/or .solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. .foot house, 500 sq. foot gara.ge
2.. example- if ne~ project; check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. exam~le - 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 (al of the
Structural Specialty Code
H, OESIGN TEAf1 AIIO 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
fu II 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. ---
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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'PERMIT VALiDATION
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
Sig~~tur4~~~
..name~~?2~6T'
d~te A~ -:;t::>-B ~
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