HomeMy WebLinkAboutPermit Building 1986-5-19 (2)
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, IrISPECTlON LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
t~ater Heater
Ranqe
2~SO oL'fHf'1c.. ~?:
Legal Dmription /'10 '3':>531 0 17() 0
Job Address
Owner Fiest e:qllrf1 Cdloup/ t:oLPtJ~ SANI<J$L.
Address 9'~ 1M r~"f'IVN.f..,I'/PI-L IV6.I2. Phonei'1l.-).;t7
t:./'.lfIA/I.P1M 11Nt.;: /e:; 1-<> tJt!fl'fl' or?, 9'14-7'7
Construction lender
Address
DESIGrl TEAr1
(name)
Phone
(address \
~12.-,.,UPA/lS t/;Jt,"t'V'W!' '72.<"
Mechanical
CONTRACT~R~ (~l (address) (lies. no.)
General r::HffANblSll../9fI&urL ~o~, ~~~~
Pl umbi no e; 14-SJ'
Primary
~ /(C)$Oc.,.
Structural
Electrical
E1 ectri ca 1
~1echanical
PLUflBING
NO. .
INFOR/IATlON L.Nt
726-37S3
SQ. FtQ. 1.lain
~Q. Ftg. Access.
SQ. Ftg. Other
New Add Alter pep.
Fence_Demo_Change/Use
_Other
~
\:::)
w
-t:::..
~~
~
ValUE ot Hork:
.$ 70/000,0';)
BuilGlnQ Permit Info: Describe Work(l~e., Build Single
Familv nesidence With Attached Garaael
&no)7fA..- of /~,.,J'Z rv/]Ut. ~
/Jt.Jo A:/?,J'/-t'cH oy A(,JNl4It tlvpZ tvr4-1.
flies. no.l
I
'ohone no. I
(exoires)
.,F Ih 1-1
.5>"'-Zl.'6-~J").t...
(pxnirp~' (ononp nn 1
.503-741. '771'
ELECTRICAL
MECHANICAL
Each Single fixture
FFF . CHARr,F ...1./0 t't,LI..c.t::lARG..E. NO cct" 1..c.HAB.G.E.
Res i dence of furnace/burner to
SQ. FT. BTU's
Relocated building
(new fix. additional)
New circuits aIts.
or extensiQns ~
'2 ~.12 _A;:!
SERVICES
.....-
S.F. Residence
11 hath \
Ouplex (1 bath) each
Additional bath
:n..9 .
Floor furnace
and vent
Recessed wall
~n~rp np~tPr ~n~ upnt
amps.1
" Appl ianee vent
'ieOilratp
I Stationary evalJ.
cooler
I Vent fan wi th
5inole dvct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood And du~t
I ,.Joad stove/heater
I
I
I
Wat.er se:rvic.t:
Temporary Construction
Change in e~isting
rp~jqpnrp
multifamily, camm. or
lnduc:;trial
Sewer
10f
ICOHfI./INO. FEEDERS
IInstall/alter/relocate I
rl;~tr;h fpprlpr~
IOf amps.!
I
I
I
Storm Sewer
I
I
I
I
I
TOTAL CMARGES TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I ISSUANCf OF PFRrtlT
~ <' ,S<=> I TOTAL CHARGES
I HAVE CAREFULLY EXM1INED the completed aprlication 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 UO 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 ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 701:055 ~~ us on this pr ect.
1IA1.1E(please print):;;::;:;:{r.-r~ .~ ,,,Au / SIGII^TU~.t6 . DATE -d~c:.
. . FOP. orFICE lurr- OIIL Y ...
Zone Coc..
Fire Zone
Flood Plain
Tyoe/Const. '51);. J'~Uni ts
Bedrooms Occy Load
Stories I Occy Groupfi~::?
BUILOING PERNITJIL"
Charges and ~Ilar"
Surcharges )Url'
? _/':2 00 Plan Ck. COIm1!lnd
. ~ 7 -' . 65%/Blda Ppr Fpp
~.::-- -/3~-?~- ~b;~B~~~ ~:~ Fee
Fence
PLUI1B ING PERMlT,.L '
Charges and ~
Surcharges ~U'_
q
0_
ELECTRICAL PERlHT, ,.
Charges and :l1ar
Surcharges )'!:""(
MECHANICAL PERMIT'"
Charges and l.
Surcharges
_ __ __ ~ ~.~C;?_
.9c:;)
C'
Sidewalk
A/C Pavi ng
I Curb Cut
I
Sq. Ftg. r~ain x Value
SQ. Ftg. Access x Value
Sq. Ftg. OtherJJI(r?~~~.:; ValUe
Bt:. (" '-f '3 '2...." Tom VALUATION
o:><;:)'~.qS-
~.~. -.,
Syste~s Development
Charoe t1.5~)
AlA
I
i
I
!rota,
I
I TOTAL
Comb. Permit
390./2
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example~ Tax Lot IDD; Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prfngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- 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,
cneck add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - 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. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Buildlng
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
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. ---
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.
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V. FDR DFFICE USE DNLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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, PLANS REV I EWED 8Y:
name
L&xw~ ;:t~6~
Signature~~ -,?date ~.2-~~
* , . ~
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