HomeMy WebLinkAboutPermit Building 1987-9-4
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IrlSPECTlOil LIIIE
726-3769
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JOb Address
CITY Uf SPRINGFIELD
CDrIBIilATlON APPLICATlON/PERMIT
EIIERGY SOURCES:
Heat
[-Sa ter Hea ter
Ranqe
I Valu, of 7'6{J,()tJcJ
Buih:ina Permit I"nfo: Describe Hork{i-,e., Build Single I( D..
FaJ:1iJv nes;dence l'lith /l.ttached l1arane).. U}
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(exnires) A (ohone no.)
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Legal Oe.cription /7-<>~'JJr.:...;3I. ,,~.,.,.<:X:>
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Owner ()IJ;I~JC ~
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Address ,/~.= ~ .--
Uo .. '"' /y /4/A/ ~ '7 "
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Construction lender
Address
DES I GII TEArI
Primary
Structural
Electrical
/fLWd
7~~eR<=:<I/
9?,-/:??
(name)
Phone
(address)
t1echan;cal
CONTRACTORS Inamel
( ~tfJ1At!;)jid~
Genera 1
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tJ
(address)
{-1, .T
(1 ir:" no.'
(2,/l-/h:JD
(1"1<0; fPI;) (ahone no -)
Lj IRK (::?OC:;)h9L/- '1/6'9
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IrlFORllATIOi, Ui'~t. I
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
So. Ftg. Other
-1le",,_Ad~Al ter --!o.~p.
Fence Demo Change/Use
--Other - -
C:>SJ
"-::J
G
(lics. no.)
, ,
Plumbina ('r/",*.&'",,,,,__ 7c.i9"o?
Electrical ~;t;>c"..r~ FCFl:~
'lechanic'aI6AR/.Rct,..#~- _ 'Y2~1 W2'57' h-....7# ~vE ?,~::::;;.:...-
110.
PI.U1IBItIG
ELECTRICAL
FEF I rHARr;F
~Jn I
I Residence of
SQ. FT.
~INew circu~ts a1ts.
or extenslons
"'7 ",,e J'>QL>/r G
SERVICES
Each single fixture
7.~
15:-
'2
Relocated building
(new fix. additional)
S.F. Residence
(l bathl
Duplex (1 bath) each
Additional bath.
~!ater service
Sewer
Storm Sewer
Temporary Construction
IChange in existing
rp<:idpnrp
Imulti"fami1Y, comm. or
InnlJ<:trial
IOf
I C0I11'1. !IND. FEEDERS
I Install/alter/relocate
rli<:tritL fpprlpr<:
/
Of '200
I
I
15. Ot< TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
TOTAL CH~,RGES
WHERE STATE I.~W REQUIRES
shall not be vali1 until the
YY9'-~/
MECHANICAL
ccc
rHjjQr:~ tlO_
~~~ I rljjjRr:::~
furnace/burner to
BTU's
225'
I
I
I
Floor furnace
and vent
amps.
Recessed wall
Snarp h~il.tpr ann vpnt
/ I h"&T 1i-~.P
I Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct.
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and du('t
6.....
amps.
I
I
:<es<ol
I I
I
Wood stove/heater
ISSUANCF OF PFRtllT
~s~~
TOTAL CHARGES
MhY,
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Electrical Contractor. the electrical rortion of this permit
Supervisor and returned to the Building Division
TyoelConst. J<;-j\!
Bedrooms
Units
Occy Load
Occy Group
I HAVE CAREFULLY EXN1INED the completed application for ~ermit, 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 Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that 1m OCCUPAIlCY ,...ill 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 e~ployees who are in compliance with OP.S 701.055 will be used on this project.
IWIE(please print)
Zone C.C
Fire Zone
Flood Plain
BUllDlIlG PERI.IIT
Charges an~
Surcharges
PlU'lBING PERMIT
Char..ges and
Surcharges
~
ElECTR I CP,l PERr:1T
Charges and
Surcharges
I1ECHANICAl PERMIT
Charges and
Surcharges
S IGilATURE
Far. OfFICE USE OillY
Sq. Ftg. f1ain x Value
Sq. FtCl. .Access x Value
8....2 Sq. Ft~. Other~~LX Value ~~_..... 0<<>
5<;-10''(;'7 TOTAL VAlUATlDrI
. "l()? ,Ie- ';)(U71'-1 Systems Development ,I A
0" <~. '1'-> DI'P _ :? Charoe (1.5~) /Y.R .
Stories
/
, ~/-:::<,;><> ' Plan Ck.
__L_~~_____ 65%/Bldo
~ Plan Ck.
/5. be;> 30%/B1da
/ C ""eo I Fence
--_../-""'~7"?--1 D~mo
n__f'~:,,~__1 Sidewalk
'2.25' I A/C Paving
~ -..p "I 1-7'(' ""/11>1';:<;
___./~____ Curb Cut(_~7'w~"'''';&L
. <" I 1-1*>'/"';:'44
~ 7:,,; .I.. ~".. ....v~-::J.'.....I
.. , ,(,...., _<I. "
Conm!l nd
Ppr Fpp
R..
Per Fee
D~.TE
Total Comb. Permit
:U.IO
I?"'t;
1'(.:>':;
,""'" I~
,-..1,___
I TOTAL
'/75./5"
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COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Leg~l Description
1. examole- Tax Lot 100. Lane County Map Reference
17 U3 43
2: example- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates ,
C. Name. etc. of owner" and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examale- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project, check new - if addition,
check add, etc.
F. Building -pennit information:
1. examole - construct single family house with an
attached gar~ge
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 (aJ of the
Structurel Specialty Code
H. OESIGN TEAN 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.
Abbr~vfated Plumbing. Mechanical.. & Electrical 5cfiedules
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 ;tem(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 ANO
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. ---
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.
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. .
. " -II.'
III.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
LttJie//e: /1EC;: ~R
signature
/::;?~Y~,.e..; .. date
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9-7/-&'?
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