HomeMy WebLinkAboutPermit Building 1984-1-17
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1-1 IrISPECTION LIIIE Cl TV UF SPRINGFlElD
726-376g COMBIIIATION APPLlCATION/PERMIT
Job Address ?2~ "/ :,. <' +- (? .,~~'~;~GY SOURCES:
legal De.criptiont/4 '>." -:If /1.% 2 S4 2. I/ater Heater
I # ~. .. I Range
(J'3YCP Cl/uQ) Vall/!J.ofHork:
Owner a.. II r;.. h'1 60:- 1P I~06
Address rv'It"I L'1. . i - j -r-: rf"l/ Pho ,y/dr-~uilti.ino P~rmit Info: Describe ~orkl;.e.. Build Single
nl"'>r<. \:'ir~oCIsr"rf' L5_ J<C\. n....,o;;>,:, . mlIv nesldence l~lth Attached Garaoe)
F~ {)(? . 8(..f; lJ madJv. 1101-1" uea~a
ConstructioJlender ~'<. </.u,p EgIY" (...,aU ~/p/..,.Jv-rcaJl tJo.f/~t~
1 - ~ q~ .
Address 8BR GCI4:l ~ ."d.. V~ Tl:. lB. Phone:JD 'To
Ul:)llir~ II:.Ar1 (name) ~ (address)
Primary P rd.c, .P~tW 4.- D...~I~:)J., 8~~
Structural AloVl . .<:::tV~A c+..... r- a I
Electrical tV <ta"),,,1-t,Y1 ;2Jf>O iluck
Mechanical ./'10 -n-. p~ h"'", ;;' ::ll
CONTRACTORS (namel
General &m)..~ .<;~ r'di.,
Plumbino A(lJ ()/U,joy<o{ll'lMj
Electrical' <' 1-t'I '/O-l? I~VI c./~_c J
~Iechanical nO 'W\l'~h. 'a") r"A1
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JNFOR/IATION LINt'
726-3753
Sq. Ftg, 1'lain
~q. Ftg. Access.
Sq, Ftg. Other
Ilew Add Alter Rep.
-'Fence Demo Change/Use
=:Other- -
~
--t.
~
~
~
(lies. no.l Cexoires1
~. g.,rTh.I<PJ? ..Z....lJ3'23
I
rohone no.')
~- 31 ~g~-'
3-Jf>-@</ 1
-PI 2.-65-6"J
\
~~s-- ~-=r8
(address 1
~ G~c..W~
(lies. no.)
(pm; rp..l
Cohnnp nn \
~~J>
4 A':;- - ./.0 ~l3
"2 {5y\
~J<
~Ar~.n"
~I '8 '/ - y-zz.8-
PlUIIBI NG
ElECTRICAl
MECHANICAl
NO.
Each single fixture
FEE 'rHARr.F Nn F<< 1J:lJARGf: JID......I
Residence of furnace/burner to
SQ. FT. BTU's
~~~...cHARG..E..
Relocated building
(new fix. additional)
New circuits alts.
~ or extensions
r:...t5'
\.).
Floor furnace
and yen t
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recesse,j wall
~n!'lt":p hl~"tpr !'Inri vpnt
Sewer
ITemporary Construction
IChange in existing
rps i riynrp
Imultifamily. COTml. or
Tnduo;.trial
Storm Sewer
2. Of
26
amps.1
I Appl iance vent
o;.~D~rtl.tll
StatiOni'lry evap.
cooler
V"ent fan with
sinol!:! c'uct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust I
hood i'lnd riud
I Hood stove/heater I
I I
I I
I i
I
.Iater service
COMfl./IND. FEEDERS
I Install/alter/relocate I
rli~trih_ fppripr~
10f .mos.1 I
I I
I I
I I _I ISSIJANCE OF PFRIIIT
TOTAl CHARGES TOTAl CHARGES \ ,;).~I TOTAl CHARGES
HHERE STATE lW REQUInES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do her!:!by certify that all infonnation hereon is true
and correct. and I further certify that any and all work perfonmed shall be done in accordance with t~e Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that /10 OCCUPAIICY 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 ORS 70.1.055 will be used on this project.
BUIlDING PER/lIT
Charges an~
Surcharges
SIGIIATURE
FOR OfFICE USE ONlY
Tvoe/Const:U'L,\') '5~ Units \ Sq. Ftg. 11ain
Bedrooms ---- Occy load Sq. Ftg. Access
Stories \"'''''~77ll.\\\\'\l:iOcCY Group~?~ Sq. Ftg. Other.E;,'k\'>--'t"
?'~I.)C.'( rE.€ ..~\:'1Od~
Plan Ck. Conmllnd /'1/";; oil .f:t.... .1. .ystems Development
65%/Bldo P.l'r Foe )_ -.. ~tharoe (1.5%)
Plan Ck. Res
30%/Bldo Per Fee
l")lll/'tft.:H
~ ~\frJ;Y
DATE/-I 7- S- t
NAHE(please print) 0> '"
Zone C-L
Fire Zone -
Flood Plain -
x Value
x Value
x__Value \. ~
TOTAl VALUATION
\ B c::ro
________\0..___
'12.
\.')\~
Plur1BING PERMIT
Charges and
Surcharges
Fence
------------1 Demo
\~. O? I SIdewalk
------ -.-G.C5-1 AIC Paving
I Curb Cut
I
I
I
I \ZF.f.t)IJD_
-I
I~~.~
":\ Co. O~
; & 2" '10
ElECTR J CAl PERI:IT
Cha rges and
Surcharges
ITotal Comb. rermit
L
/IECHANICAl PERMIT
Charges and
Surcharges
I
I TOTAl
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I
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'-
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
(.p;) 3 3Q.;
I I I.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examol~. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrica(/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house. SOD 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 garoge
2. example - remodel existing garage into family room
3. exa~le - 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. DESIGN 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
fu 11 schedu 1 es
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. ---
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.
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V. FOR OFFICE USE DNLY
Permit Cl erk
/ -$D/g~
rLnrJl ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit app 1 i cant exempt from regi strati on with the Buil der' s Board because:
Additional Project Information:
~LL ~\\)~ I\R-.YC--(1\<'\l"f. \(') ~ 0nti\?l r:=\tt-\') ~Up
~'9 Q()\l6D ~ t=o 'Q F:. No.)"~. 'Y
PLANS REVIEWED BY:
name\7A.V\O-r \~ Signature}.JJl>L..c\.~~~'--
date \-'7) - <t..\..l
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