HomeMy WebLinkAboutPermit Building 1988-8-11
..
.......
\
I INSPECTION LINE '
726-3769 "
Job Address 35'20 OLYMPIC
Legal Description l') 0 ;;2, 3 tJ 00
.
q 4- 5"- "
CITY UF SPRINGFIELD
COMBINATION APPLlCATION/PERMIT
ErlERGY SOURCES:
~ea t et...ee::..
CO ( ?z t I"~ater HeaterEU3C
, Range t-JA _
~lUE of l'lork: ......
~ /97 '202. -
Phone~U1 SBuilliino Pennit Info: Describe Work(Le.. Build Single
crrr Familv nesidence With Attached Garaael
//1) ~ rfJ Jl vt I.J II"I/) 0 .J, tf'w J:1~
(J
,
INFDRlIATIDN LINe
726-3753
Sq. Ftq. '.lain
~q. Ftg. Access.
Sq. Ftg. Other =,~.w
--1lew__Add~lter-"~ep.
Fence Demo Change/Use
Other -- --
i1?
C3
~.
(2;
~
E
Owner UP5. % PA~1.. +l~~f1-
Address G."'~ '2. OllJEJ...lS 0/2.
p~~ ,CA.
Construction lender
(41'7')
Address Phone
Ut.::dliN ItAr.1 (name) (address) flies. no.)
Primary MOIZ.fZ-IS, JZc::vu=oJ ~ -."..-+. ''3'0 ~~ (Z..V. ~45
\exniresl
e1
(ohone no. \
~,-"'5( I
Structural ~~6
Electrical ~6
Mechanical ~ ~.,c
CONTRACTORS (name) {addres~) ('i~~. no. \ (~xDirp~'
General C)~LL ~nf-.l:,. 2~ 6A'4'~/ ~'.,~ ~'&:.N,e:
Plumbina C '
(ohnnp M 1
<<8.<:;:- SI? //
Electrical
"
~'echanical
PLUI1BltIG
ELECTRICAL
MECHANICAL
NO.1
;3 Each Single fixture
Relocated building
(new fix. additional)
I FH I fHARt;l=
NO I
Residence of
I lILIJ:I!AB.IiE..llll....
7.50 :?z:!2
SQ. FT.
furnace/burner to
7 ~a> ~ RTll's
I,d(/ nt.........-;, ~ ---::""
Floor furnace
.~-05' .,/ i;!ld vent //
"" o/;P/:f'''''''''''''~~
Recessed wall
~~~~p kp~tp~ ~nrl upnt
I.E" I r"'1BliL
I
~ 7~ 7<'~52
S.F. Residence
(l bath)
Duplex (1 bath) each
.........-New circu!ts alts.
v or extenslons
..,.:>,I? ~/'5~
SERVICES
~.,.. :3'.<.-
Storm Sewer
Of
amps,
Appliance vent
~.poar~tp
Stationary evap.
r.nol{!r
I V'ent fan wi th
",inale duct
j Vent system apart from I
heatina or A.C:.
Mechanical exhaust I
hood and durt
I
Additional bath
Water service
Temporary Construction
Change in existing
fPS- j rjp.nrp
multifamily, corrm. or
Jnc1ustrial
Sewer
COffi1./IND. FEEDERS
Install/alter/relocate
rl;~tri~ fpprlp~~
Z Of /4JC>?n ::>= amp~ :<.Z~ 7"5""'
I
I
I
TOTAL CHARGES ::?::? 'SO TOTAL CHARGES C:;;?, SP - TOTAL CHARGES 9< ~
WHERE STATE L\I~ 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
Wood stove/heater
/:3 I a......./.?"'YC~
I
I
~.s<s
ISSUANCF OF PFRfllT
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 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 UO OCCUPAHCY 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 employees who are in compliance with ORS 7Ql.055 will be used on this project.
IWIE(please print).:::n ~ ~~ SIr.IIATURE~ - - ~fJ.
FOn OFFICE USE OIIL Y
Zone MAl Tyoe/Const. :2-,,</ Units Sq. Ftg. flain x Value
Fire Zone Bedrooms Occy Load ~J Sq. Ft9. Access x Value
Flood Plain Stories / Occy Group ;;?-? Sq. Ftg. Other8?"~<:..~. .::<><;"~Value 199. 2"2.~"
^ -
7:),/ &;......- c- .4 '2> c.' ~...' c> t'. TOTAL VALUATION
r.~./ "'= ,~#~oc...;;J ff4('/~ (,..Jl=.l5'y .'7~.~ ,...... ,,-({-..I<"
BUILDING PERHlT /".e:' Plan Ck. Corrrn/lnd {-? fll tl
Charges and __Il?~."" 8,_'.:'~__ 65%/Blda P.l'r Fpp ",0 "l.1_ 57.7/
Surcharges <0 ~ Plan Ck. Res
:/ 2. 7'0 3D%/Bldo Per Fee
___-;;:??::..~=:.__ Fence
/./3
____~?::_~__ Sidewalk
:3'.,;?~ AIC Paving
____?J2::~__1 Curb Cut
r:?S- I
DATEe,-Ii-f>!!.
PLUHBlNG PERMIT
Charges and ..-.'
Surcharges'
Systems Development ,J ~
Charge (1.5~). ~ ~ -
7J",,,,,, L".Q=<- '" ~~ "'#.AJ'~ 7"
~t/N2lGIi'?~ d27.?'-. 0;'9 _
DIIflIO
ELECTRICAL PERI~lT
Charges and
SurCharges
ITotal Comb. Permit
8&'''5. /6
1/58'/~.1
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
-
'-
COMBINATION APPLICATION/PERMIT (CAP)
.,1
\
j
.;
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 43 '
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole- 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. example- if new project. check new - if addition,
cneck add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
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 TEAfl 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
8. 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. ---
Ill. 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.
.,.
'.
,j
j
V. FOR OFFICE USE ONLY
.PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
i,
.
.
.
PERMIT VALIDATION
.)-
(rvV~
qAo
.
Permit Clerk
LY
JI
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
".
PLANS REVIEWED BY;
name LO/7/9'"-= h~~
signature~~,
'/
._..
-~--?
, P'"
da te .B . ':? 9-8'Sit