HomeMy WebLinkAboutPermit Building 1986-5-19
ValUE at Work:
J 70,000, 0';)
BUiltiinQ- Perinit Info: Describe Work(i--e., Build Single
Familv nesidence With Attached Garaae)
!
.
CITY UF SPRINGFIELD
COHBINATION APPLICATION/PERHIT
EIIERGY SOURCES:
Heat
Hater Heater
I INSPECTION LINE
726-3769
2"SOOL'jHp/c.. ~7:
Legal Description F70 '3 oJ I:) 31 tJ 17~ f)
Job Address
Range
Owner First f5qvrf1 ~JO/~tJ6U aANI<JfC-
Address q~ 1M fl"1'"1'NAN~11PU- "(,,12. Phono/lC.-At7
,CI'IIIJJt.fiM "'N(.. 1"17,0 CL't"'... J'? 9'14-7'1
,. . . > .
Construction Lender
..~~
. INFOR/tAT/ON UN.
726-3753
Sq. Ftg. 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Fence_oemo_Change/Use
_Other
~
I~
w
t:::::...
~
~1'fC?'7K- o"'IA.rf'I:e~a f'V~U' ~
fINO /l:P.I'/"1'/oN op At.JIoIJ4Ir. '/)v,tn. FNr~_
Address
DESIGN TEAH
(name\
Phone
.( a"ddress 1
Primary
~ ~SOc...
Z'l:l...~LJPAlIIS ~e-riAl? '724'
Structura 1
(lies. no.)
(exoiresl
(ohone no.
.# Ih '2-1
~yl1.t,l,-~J"}-t..
Electrical
Hechanical
CONTRACTORS (namel faddrflssl flirt:; nn.'
"" .... I BtfetI, iw,ArNd tN.
Genera 1 c-HHANIII5l (,6VtKmo ~~, r~~" -:';~'" ...- .4
PI umbi no '174-SJ'
I
I
I
I
I
I
I
I
I
TOTAL CHARGES TOTAL CHARGES ~ <' ...St!> TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical ~ortion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
, Electrical
~'echanical
PLUllB I NG
ELECTRICAL
NO,
FH fHAR(;F NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
V'
New circuits alts.
or extensiQns_~
'2 ~I? _-"""""
SERVICES
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp~ j rlynrp
multifamily. comm. or
Tnwtriitl
Water serviCE:!
Sewer
Storm Sewer
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
rlictr;h fpprlprc
Of
amps.
(pYo;rp~' (ohnnp nn,'
Sh3-74(. -771'
<<<
! HECHANICAL
r"~ ..1JO....1
furnace/burner to
BTU's
rlJAllliE.
I H~
:n.sd-
Floor furnace
and vent
Recessed wall
~nA~p hPAtpr Anrl vpnt
Appliance vent
f.~I)",r~~,:"
Stationary eva~.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
ISSUANcr OF PFRlllT
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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and em~loyees who are in compliance with ORS 7n1.055 ~~~ ~iS pr ect.
1lAf,IE(please print) "Z15&-,.rflr;r>>1AU/ SIr,NATU~&-'.;' DATE ~~~
.. .. FOr. OFFICE ui DIlLY
Zone c.t:. Type/Const.5'''t- J~Units Sq. Ftg. llain x Value
fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories I Occy Group$-::? Sq. Ftg. Other.Mr.)I?.!'~~' Value ~~.-
Rf. (., t.f 3 ~ TOTAL V ALUA T/ 011
..,"'.......ro...- Systems Development ~ / A
"0<0< ," Charoe t1.5~) . J1'~
BUILDING PERfllT
Charges and
Surcharges
~ ~/3 <)0 Plan Ck. Conm/lnd
~ 1r. 65%/Bldo Ppr Fpp
--- ---3--';;::'- "Pian Ck. Res
I ......... 30%lB1 do Per Fee
I Fence
I 011\""
'2Z.S0 I 'Sidewalk
-n----~9"-1 A/C Paving
I Curb Cut
------------
I
PLUMBING PERHIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERHIT
Charges and
Surcharges
I
I
I
ITotal Comb. Permit
I
I TOTAL
3$(/./2.
.
.
, .
\
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100; lane County Map Reference
11 oj 43
Z. example- Lot I. Block 3, Znd Addition to
~prfngtield Estates
C. Name", etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. example- waterheater/electrical/or SOlar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- 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. examEle - 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 (a) of the
Structural SpeCialty Code
H. OESIGN TEAM 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
Z. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 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
signa ture.
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.
;-
/~\\
\; \,~~ ~~
\5)'1
V. FOR OFFICE USE ONLY
Permit Clerk
Ij../ / .
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
PLANS REV.! EWED BY:
name
U~~ ;:t~~~
I
Signature~~~ - ~ d~~e~. :2-~~
-, 'p
,r