HomeMy WebLinkAboutPermit Building 1979-9-5
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'j IilSPECTIOlI L1IIE.....-- ' " CITY Oh SPRlllGFIELD
726-3769 ;;J .~~ c:....,,~ ~...,'>? .1;;;/ C .,COM611IATlON APPLlC^TIOtl/PERHIT
Job Address-?,,-n/O!..-Y.kP'cJ 5i'i?IA.!c:.P//.:t.J 10/1". ~~:~gYJ7~~S:.... C-,qS'
It trlater heater
Legal Description /) _();'/. -]0 TL '7 ~ ~ ,?'?r7'/~ hone _ _ __
L.:;rfi. oP M.? rf-,?l'3 I IOlue of work:I~~eLOjO
/.-? r 3uilding pennH info.: describe work (1.e.,
Owner (name/address/phone) fYFP,e IhJ!TT;IJl-7r',vtflU 1f/IfTT ';nnle fam. res. with detached oarane)
HllIf,R.Y /fv'fh "I WAy/vt:- c:.), I;/t.IOW.J.-1"7t \\o..J\Q "r,~\ ,C-I'L..I
.J- /01 tv. /1/ ~ E vf-l~l-:- od \ &~c. -J95C
Construction lender (name/addres~/phone)
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I (fit Y IHh/ Jr(ji';( !I,e5
lEt-Fe
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OI:.Sl{.ir~ T ENl
(namel
(address)
flics. no.}
HlfURl\A Tl 011 L IilE II
726-3753 ~
'sQ. tt. maln & accsy. bldg.
dl.. :sea ,
~ew _add _d Iter _rep, '- \
fence demolition ~
~change/use __other ~
build I~
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(ohane no.)
(exoires I
Primary
Structural E IJ 6- / IV E j:'j(
1? - ... ~ I
Electrical r ~N ,to Ld.{
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CONTRACTORS {name) \
General /-II ftrT e",',v<)TJt""'//PIv'
,
Plumbino Tw 1(./ ;i1";.~)(S' ;'ll.
Electrical IliipCj/~~ I/V
J;t ,
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~lechanical
(address'
~(v / tl',I!JTi!
(1 it:c;,. nn.)
(pxoirpc; )
(ohnnp nn \
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bit :L9->C
~,'p.cha ni Cd 1
PLUIIBIIIG
MECHANICAL
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'''_'.r.tJARG.E. .l!(l
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II
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ELECTRICAL
NO.1
I rFF
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furnace/burner to
BTU's
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Residence of
I ~n' 1J:.tiA&!iE.
tin I
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
Floar furnace
and vent
New circuits alts.
or extens ions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wa 11
<:;1';11"'" hp;ltpr ;Inri w>nt
SERVICES
-~f'~
r' w~
I Aopl iance vent
..,~ni'Jrrltp
I Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatinq or A.L
I ~lechanical exhaust
hnnrl i'lnd nurt
I \-Jood stove/heater
I
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II
II
-~~ !TempOrary Construction
/Change in existing
rp~ j dJ'.rlr~
multifamily, conm. or
Tnrlll'=.tr;ill
I,,,.....,,l
~;.;I.
I Wa ter servi ce
I Sewer 7/~.... ,
....~...~
IStorm Sewer ~~:;~.
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~~'1:>'
'::'(.)'-~'
,fL;.
from
Of
amps.
COHfI./IND. FEEDERS
Install/alter/relocate
die;trib. fpf"r1f"r.e;
Of
amps.
INew c)rcu~ts. alts.
or plo1tpne; lone;
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
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I SSUANCE OF PERtllT I
1/,:..., ..."" I TOTAL CHARGES . TOTAL CHARGES Ie:! -""
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division.
I HAVE CAREFUllY EXJ\JHNED the completed application for permit. and do hereby certify that all infonnation 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 Spri n9fi e 1 d and the Laws of the S ta te of Oregon perta i n i ng to the work descri bed herei n. and tha t NO OCCUPArlCY wi 11 be made
of any structure without the permission of the Buildino Division.
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tlAf.1E (please print) f)J:/vi//5 ~'-()(,/t=-/l.. SIGNATURE..I_o.......'z.'?l-t-? r~//'J( ~11
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DATE 1- ~J{ -/'7
CV:-,- ,\q
FOR OFFICE USE OIILY
6UILDWG PERI.IIT
Chargee; and
Surcharges
Bdrms Trpe Const. .7C" N
Stories I Units
All U U fl T ~ U n 1'1 A R Y
iI/<:J .~'" Plan CL CO","lIn.d I - 7:Z "S-
____..!_-!~____ 65'UBldo p.pr Fpp ^ ....
Plan n. Res 1_' ~'2 \ IU
30%/Bldo Per Fee ,"';.-r/J" ..:.,,)\_C\.
Fence r .
Sq Ftg. -:~ ~;}~"G::\
SQ Ft~.
Value
/.:.-~c:.,1.:..""',:t.
Zones ,vl..3. ....,....::. I.~'l Flood Plain
Deey Load ' Dcey Group i:".f;..:~
Value
Storm Sewer Connec.
It;. ;;r~
Other
PLU'1B HlG PERI11T
Charges and
Surcha rges
/lL').........!"oa
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(..; 'J.?
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Other
Sprinkler System
Other
ELECTRICP,L PERIIIT
Cha roes and
Surcharges
"'*"'. ,.,..,..
/'--" .Oemo:-
- ----- -~:::i::..;;:-I AIC Paving '/~'I'
Curb Cut
!(.IJ6",:, ~~C;;>:;>
jOr. ---
Total Comb. Permit
. 'c..., .............-:
-'..-: ~. *-'~
r1ECHAN I CAL PERHIT
Charges and
Surcharges
Sidewalk
SDC I. f"<;Y..:>
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I TOTAL
31S"/ . 1'-
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COMBINATION APPLICATIONIPERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax "Lot 100, Lane County Map Reference
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources \
1. examole- heat/electrical ceilinqjor forced air qas
2. examole- waterheater/electricaJ(or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- Tflnew project. check-wew - if addition,
check add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - convert single family r?s;dence into
restaurant (change of use) \
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. OESIGN TEAM AIIO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to cOIl,tact appropriate
persons regarding design information cr job site
corrections. etc. '
Abbreviated Plumbing. Mechanical, & Electr~cal Schedules
A. Except I'/here blank spaces occur ,in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only He 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
full schedules I
C. BUILDI1IG OIVISION STAFF WILL FILL OUT~LL FEES AND
CHARGES Oil THE SCHEDULES I \
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature ~y his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. Ii -\
Applicant to sign and date
Whenever possible. the initial application will be used as
a ~.lOrksheet 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.
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IV.
V.
FOR OFFICE USE ONLY
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PERMIT VALIDATION
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'TV OF SPRINGFIELD I
City Han
Springfield, Oregan
Department 01 Public Works
OFFICIAL RECEIPT
1
B 51421(1
C\... No.
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It Received ?)?;'\tJ,'\'U-, ('~
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- AUTHO".ZIEO SIGNATU'IIIE
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S"1[L TO".Tl>"N.l>~~ ....'..T1[..S . 1[l>GIN1[. G" ....01
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE.OGGUPANGV: 1~;~~/v,~-
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Additional Project Information:
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PLANS REVIEWED BY:
/ ",--,q~ ~"'-S~ signature /~-.--7~~-__
name
da te &"-?/':;:>"'3.
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