HomeMy WebLinkAboutPermit Miscellaneous 1984-2-27
Job Address IZ SO I)),h" <)('<?,.S,=1<=I'), Oach.........
Legal Description 17.~~. ?s--~/. eJi? a 4!J
Address i 'AXe /\'11'\\ r'
<:irR,(I~MCd) I
Construction Lender
I INSPECT 1011 L1flE
726-3769
Owner
Toc,c-p'-4
Address
, DESIGII lEAf1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General
Plumbina
Electrical
~lechanical
NO.
.
, ..
.
INfORlIATIDN liNt
726-3753
Sq. ftq. 1.lain
~q. Ftg. Access.
Sq. Ftq, Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other- -
CITY Of SPRillGfIELD
CmmIilATIDN APPLICATION/PERMIT
E,IERGY SOURCES:
Heat
!-Iater Heater
tJ>
~
.....
~
Q
GA.' Or,;
'M1'~,,\'2,Phone
O,~c.t:c-----..
Range
'l...~(:~ ~.:,
ValuE of Horki'~ '1.:c.. ~""..,';...
QKl CWO. CO .
BUli61ha Permit Info: Describe Work{i.e.. Build Single
Familv ~es;dence With Attached Garaoel
S~.rUP .MOl!l/lI.e" RPM&" SAI:-~
~;::'.t,,~~ ~ PAl&t~ ;r;j'o#k,.I'r~
-Iz:>;/v~iv;':" #~.
~ nics. no.) (exo;res)
(name)
~~
Phone
(address)
(ohane no.
{name}
(address)
f1 ;C<i.. no.'
(pxoiresl
lohnnp no,)
.,....jL
~.
PLUllBlNG
ELECTRICAL
MECHANICAL
FEF l":HARr.f' Nn I
Residence of
I ~~~ I r~ARr.r: ~m_ I
'r:r:r: InIARr.1='
furnace/burner to
SQ. FT. BTU's
Each single fixture_
Relocated building
(new fix. additional)
I'S.F. Residence
(] bath 1
louplex (1 bath) each
IAdditional bath
~IWater service
I Sewer
75'1 Storm Sewer
-iM...v. ~Vp;G
I .
K''''.N'- ..,~~~
~~R6~~1
_~eJfEZ;> I
I
.'
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~r.p hp~tpr ~nrl vpnt
/O.4<l
I!emporary Construction
IChange in existing
r"'s.jrjp"nr_p
Imultifamily, comm. or
Inrlu"'tria1
10f amps.1
I C011l'1. /I NO, fEEDERS
IInstall/alter/relocate I
distrib. fppders
Of amps.1
oS t51'!i Y/ bS;-
A'6~l':J"eJP
I
VP.-
~4
I
ISSUANCE OF PFR!IIT
'Z~-
I'~ 0.
I App 1 i ance vent
spoarate
I Stationary evap.
con1pr
I Vent fan with
sino1p r1urt
I' Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood and duct
I \'Iood stove/heater
TOTAL CHARGES
WHERE STATE L'U REQUIRES
shall not be valiJ until the
'l"$:Oll TOTAL CHARGES ~ - TOTAL CHARGES
that the Electrical work be done by an'"Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division "
I HAVE CAREFULLY EXAtlINED the completed apr1ication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore!Jon pertaining to the work described herein, and that NO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
e~,)O(L-
om 2\';;n I ~"'L
q'O. ~C,
IWIE(please print) (lC.S..I'H 0
Zone ~ G
Fi re Zone
Flood Plain
BUILDING PERfIIT
Charges anc
~
PLU'lBIIIG PERMIT
Charges and
Surcharges
ELECTRICft.L PERf~lT
Cha rges and
Surcha rges
/IECHANICAL PERMIT
Charges and
Surcharges
S I GilA TURE
FOR OfFICE USE
Sq.
Sq.
Sq.
Oi~ Y
Ftg. rlain MH. &>~$/<iF Value~c:>c:llO.-..
Ftg. -""'_rC:>---9A-f'#lI,n, Value 2. 4LJa.-
Ftg. Dther-<<)'~ /~jP. Value /;j~ ~_-
TOTAL VALUATION
Tyoe/Const.
Bedrooms
Stories
5'-/'Y
Units
Occy Load
Dccy Group 11 - ;;z.
....
I
~-. _ Plan Ck,
4,""",", 65X/Rldo
---------;;;...;:Pian Ck.
.~ 30%/Bldo
_____tS7 -=a I Fence
/. Sol Demo
~~.~ I Sidewalk
- --- - -~~-I A/C Paving
I Curb Cut I
------------1
, /1.fI. ~~I
COilllllI nd
Ppr Fpp
R"es
Per Fee
/~. ~O Systems Development
~ Charqe (I.5~1 .
_ ~P.:s-. <S't:>
bo/. oe:tlD Total Comb. Permit
I
~s: -I TOTAL
1/'$""<.'1t>
oq~ qq
.
.. .
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot laO, lane County Map Reference
II 03 43
2. exa~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air qas
2. examole- waterheatertelectrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house" 500 sq. foot garage
2. exa~le- if new project, check new - if addition.
cneck. add. etc.
F. Building permit information:
1. examDle - construct single family house with an
a ttached garage
2. exam91e - remodel existing garage into family room
3. examele - 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 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 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 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. ---
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 is issued.
V. FOR OFFICE OSE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
..
PERMIT VALIDATION
~
3-U~Y
? Ld2,6B
'.
1
Permit Clerk
~~
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Permit appl icant exempt from registration with the Builder's Board because':
Alc~.' p/",> PEAlhUr /r
<::.V_~ At......,., .'4::>V;9C .
F
VV"H/e.u /'1?A.y
Additional Project Information: '!5Z?t"':.
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#;.,pdll/;?J ~eo.- C;;;7? n.P/,?e>Y~~__,~ _
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PLANS REVIEWED BY:
name~ ?t~,~signature
date 3-c-BY
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