HomeMy WebLinkAboutPermit Building 1984-2-27
I INSPECTION LItlE
726-3769
INFOR/IATION LINt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Range -Fence Demo Change/Use
.~cc ')o~, - - -
Valu€ of 1"or"i''';N'1'~ ~Ao..,tl';... _Other
Q l4, Ci,OO. CO .
Buiiri1hQ Permit Info: Describe Work(i.e.. Build Single
Family nesidence With Attached Garaae)
<5'~"'c.JP Mc.J.9....-.E' B-#N&' ~~IFS
~~~/~~ ~ PAl....&' .1;)...0$.40',-",,_ I
~Z>.N/I(Giv..-;" A-~. - I
flies. no.) (exoires) (ohane no. \
~,l';..
.
CITY UF SPRINGFIElD
COMBIilATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Job Address Il S.o ffill-;" <;{'~,.,}:M,,\Q OQch...........
legal Description I'.t?!I. '?!r--"/ _ 4':iI 4!J
Owner JOC;cPf.I Q
Address i'),f<o f\'l Al '"
SPR"l~MC.~O I
Construction lender
gA,' Dr\.
'111- 08'r;sPhone
o/Qc:t,,,----.
Address
DES I GN TEAI1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
"'echanical
NO.
Each single fixture
'lname)
'~-5e~1
, J I
Phone
(address)
(name)
(address)
PLUflB IIlG
ElECTRICAl
FEE CHARGE Nn
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
~ Water service
Sewer
1().4C
SERVICES I .
I
lTemporary Construction I
IChange in existing I
reo; j rlJ'flce .
Imultifamily. comm. or I
Tncfll~triill
IOf amps.1
ICO~1./INO. FEEDERS I
I,Install/alter/relocate I
rli~trih_ fppcfprc;
10f amps. I
l-s~w~~
I A0-v:t'~p
I
.
75 Storm Sewer
- M.H. ~'lVpJlil
, I
-=:;-"'N'. -5"~.....i:!lo-~
#~R~~I .
. /'!f5CJiSD I
I
2~-
(~-
.
\J>
~
....
~
(l ic~. no.) (pxnirpc;) (ohonp nn.
..~.
.~r
"4
MECHANICAl
"F r':lAB.liE. NO. FFF rHAJ!liL
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sni'lCP hptltpr tlnrl vpnt
Appliance vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust I
hood and duct
I Wood stove/heater I
I I
ltP.- I
~ca, I
ISSUANCE OF PFRlnT
TOTAl CHARGES
. WHERE STATE l~W REQUIRES
shall not be vali1 until the
'1"5':- TOTAl CHARGES ~ Got 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 EXA~1INED 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 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 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 are in compliance with OP.S 7nl.055 will be used on this project.
SIGIIATURE '0.r""QIQ . O. 9-....."C. om2!-;;n I&-<L.
FOR OFFICE USE ~. - \
Sq. Ftg. liain..H#. e::>~JIt/<iF' Value~O~-.
Sq. Ftg. -. FO~N..pA-"-_ Value ;!.~I!JC.-
Sq. Ftg. Other.$,n:F /.Jo2lil~. Value /;;/1 ~.-
TOTAl VAlUATION
1lAJ.IE(please print)~O<;"'(.l\.l Q BA,'D0
Zone
~~
Fire Zone
Flood Plain
BUIlDING PERIIIT
Charges anc
~
PlU'1BING PERMIT
Cha rges and
Surcharges
ELECTRICAl PERtHT
Cha rges and
Surcharges
MECHANICAl PERMIT
Charges and
Surcharges
Tvpe/Const.
Bedrooms
Stories
5"-/Y
Units
Occy Load
Occy GroupJ- ~
I
..,_ _ Plan Ck. Conm/lnd
4c;,..oo; 65%/Blda Ppr Fpp
--------~6D ~~~~B~~; ~~~ Fee
_____fS7 4IID Fence
/, S(:) I Demo
_ ___ _;;;Ct:>. ~ Sidewalk
.80
A/C Paving
I Curb Cut
~:N. 7c-r
,,,l
/~."O Systems Development _'~_':>.~_
~ Charce (1.5~). ~...~. :;0"-
1&'1. - Total Comb, Permit 1'5'<:. ~~
,~
_ _I TOTAl 'oqD,Rl
~.;;J.
4~u&'/;) ~~,:T/~_"'t&'''' ~...-....,
#.h'r !l-.Z1A1'~~"c.... /~".,,~
~ ;;r~""/l!iFZ> 21..".... /~F 7t.~'-A7/."fi"-
6~_'f<'c:>'- <.<<,., ~_ ~ .....-~~~~/~ ~7A:r.
-. -
Permit appl icant exempt from registration with the Buil der I s Board because.:
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
11 U3 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/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. exa~le- if new project, check-new - if addition,
check add. etc.
F. Building permit information:
1. example - 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 (change of use) '.
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, OESIGN TEM~ ANO 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
#D7"E ~ 7AI/,,: PE"'..hUr /5
~
VV'N4H AI7",..y
, - .
c.v_~ ~"""'C::>~ .
.
PERMIT VALIDATION
~ (7L
5-2;0 .
? ldL6zD
.
Permit Cl erk
~\tt0
Additional Project Information: ~Pe::.. .c~I;r~dF ,~F" e>.;V
~:YCl-P..- il~/tzu_~ V4~",&' ;ze,,:s "-?....--.-;;- M~/.....~
.", p~~~~~",/~,~eo.- <',T~n__p~DV~~~........ .
PLANS REVIEWED BY:
name ~~ ?tL~,=.~signature
date 3-~-B~