HomeMy WebLinkAboutPermit Building 1986-2-11
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INSPECTION LINE
726-3769
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Job Address 'I :$-" 11
legal Description Ii ();:)
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,,~50'{) rQ,2)L
C TY SPR NGFIElO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l4ater Heater
Range
INfORllATION LINt II
726-3753
Sq. Ftg. '.lain i'~ ':20
~q. Ftg. Access.
Sq. Ftg. Other
..!lew__Ad~A1ter"yep.
Fence Demo Change/Use
.1 Other-- --
Build Single
CX;)
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Address / ~ / 1IV,~~ $J ~
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Construction lender
ValUE of ,rk:, 0 e;J d
Ill" .
BuildinQ Permtt Info: Descrlbe Work(l~e.,
Famil ~esidence With Atta)~ed Gara~A
/J/1/1.f) rI./ j/ p/j'
~/
Owner'
Address
Ut>luN IlAl1
~--'.-fllIA~
Phone
Phone
Iname)P/, t V'I'JIJ a", A ,P'S"/Iaddress)
(lics. no.)
(exnires)
I
(ohone no. \
Structural
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Primary
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
{name}
(address)
(1;("s no. \
0tlllC :1'; ,~ ,I€
AI.'.c, 'S"'~$~"
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ELECTRICAL
Electrical
~1echanical
....l!Sh
PlUflBING
FFF I CHARGE J!(1
'2
Each single fixture
7.?~
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
l-Ia ter servi ca
I Sewer
I Storm Sewer
I
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IS: ....
~n 1...c..t:iARG.E. NO
Residence of
SQ. FT.
New circuits alts.
or extensions
SERVICES
(plCnirpc,'
(.,~nr'p ...., ,
~89'-,,!'~~
MECHANICAL
furnace/burner to
BTU's
~~~ rullRG..E..
Floor fu rnace
and vent
'2
:..---.; H",:,;4J11_6 /"'cS1
~n~("p hp~tp~ ~nrl ~pnt .c .
ITemporary Construction
IChange in existing
r~~ i djlJ1~p _
ImultifamilY,~ or
Tnd""tr;al
I I Of '1.t:? 0
ICOMfI./IND. FEEDERS
l~ns;alY/alter/relocate
1C, _rih fpprlp~c,
I IOf -;',,0 0 amps.1
I
h/p If?'")r
. I
" App 1 i ance vent
c;.eoa ra te
I Stationary evalJ.
cooler
I Vent fan with
sinole duct
I Vent system apart from
heatina or A.C.
I Mechanical exhaust
hnnd and du("t
I ~lood stove/heater I
I~ 1}p/~ I
I I I I
~~~~~y~1 I
I I
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-q'. ~~
____.J.s;._~~_ Fence
. ~O I DfjIIlo
'" . . .', I'Sidewalk
-------------
-...:' ';1.~.' AlC,paving
-----O.-~ Curb Cut
.68
amps.j
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ISSUANcr OF PFRI1lT
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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 Ore90n pertaining to the work described herein, and that 110 OCCUPAIlCY 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 701.055 will b~ used on this project.
IlAJ.lE(please print)
Zone ....L!!l#
Fire Zone
Flood Plain
BUILDING PER~1lT
Charges and
Surcharges
PlUI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI1lT
Charges, and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
M IJ,...TA itl L;q.WF.LLsIr.ll^TURE~ ;T'./?..n..r<--U
FO~ OfFICE USE OllLY
N Units Sq. Ftg. llain ~~':2t::'
Occy load Sq. Ft9. Access
Occy r.roupJ1- Z Sq. Ftg. Other
Type/Const.;zz::
Bedrooms
Stories
Plan Ck. Comm/Ind
65%/Blda ~er Fee
Plan Ck. Res
30%/B1dQ Per Fee
s-z- -,.'?
DATE .J.It /;Y c
x
Value
Value
Value
/a"<Jd. -.
x
,
TOTAL VALUATION
Systems Development
Charqe tI.5~) ,
/'5t.:J. C'Q
lTotal.comb. Permit
I
I TOTAL
1/ 7. t:7Ci
.I?/r. 33
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COMBINATION A~PlICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
II U3 43
2. example- lot 1. 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 Q3S
2. example- waterheater/electrica(/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check~w - if addition,
ehee k 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. example - 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.
11. Abbreviated Plumbing. Mechanical. & Electrical~Schedules .')
A. . Exce'pt 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 o~ 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
,1" ,full schedules
~. 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
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
payab~e when the permit is issued.
PERMIT VALIDATION
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V. FOR OFFICE USE ONLY Permit Clerk
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. PROJECT CONDITIONS TO BE SATISFI~D BEFORE OCCUPANCY:
, .
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Permit applicant exempt from registration with the Builder's Board because:
" .
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Additional Project Information:
,
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PLANS REVIEWED BY:
..,.
name
~~n~~
signatur- ~..-~~.
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date
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.. R_uired
Inspecti.s ..
". IT IS THE RESPONSIBILITY OF THE PER!UT HOLDER TO SEE THAT ALL INSPECTIONS ARE MADE AT THE PROPER TillE.
THAT EACH ADDRESS IS READABLE FROM TIlE STREET, AND THAT THE PElUfIT CARD IS LOCATED AT TilE FRONT OF THE
j"PROPF.RTY. BUILDING DIVISION APPROVED PLANS MUST BE ON JOB SITE AT ALL TIMES.
:~'~. PROCEDURE FOR REQUESTING INSPECTIONS: Call 726-3769 (recorder) state you CITY DESIGNATED JOB NUMBER,
job address, type of inspection requested and when you will be ready for the inspection. Contractors
. ....or owners name and phone number. Requests received before 7:00 am,will be tr.ade the same day, requests
received after 7:00 am will be made the following work day.
"Your City Desig"ated Job Number Is:....B6<!;169_~
. .Job Address: ?€ 2~ /'5)L~h1J.P/<:::'
. -.-, - /
,';';.Owner: Ii=:/~ '" I4-c:.AY'4
>i:ontra;tor:~~~ J'" '+~~ (.
. ;Jj::......::\..,.I~ - ..-. ......-;- - - -
O SITE INSPECTtON: To be made .. 0 ATIIC ORAFT STOPS 6 CURTAIN WALLS.
. l' after excavation. but'prior
,;;;( ~O;:~~Bo:L:a,,;~~, ELECTRICAL ,0
.It MECHANICAL: To be made before
~:~;;'''':=-'i.-~':~Y work is covered. /r ;f'~.'
. r-:l..CONCRETE SLAB tNSPECTION: To be
~ made after all inslab building
-~~.;~i~ervice equipment. conduit. piping,
'{1~~'::~cc~ssories and othe~ ancillary
. .~~'eqU1pment items are 1n place but
.+::~~~~~~o~~ any concret~ "is p~u~ed~.;. ~
D FOOTINGS & FOUNDATIONS: To be made
after trenches are excavated and
. '-:,,:forms are erected, all steel in
,> :~"Ji'lace. but prior to pouring concrete.
D YNDERGROUND: Plumbing, Electrical.
Gas. Sanitary Sewer. Storm Sewer, ~
;:i '. ~:. Water and Drainage lines. To be l...CJ
". .' . . made prior to covering or filling r'Vl
. r trenches. LCJ
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UNDERFLOOR:, Plumbing. Electrical.
Mechanical. To be made prior to
installation of floor insulation.
decking or floor sheathing.
"POST & BEAM: To be made prior to
installation of floor insulation.
decking or floor sheating.".
FLOOR INSULATION 6 VAPOR BARRtERS:
To be made prior to installation
of decking or floor sheating.
MASONRY: Steel location. bond beams
grouting or verticals in accordance
with U.B.C. Section 2415.
'i
ROOF SHEATHING k~n NAILING: Prior
to installing any roofing.
ROur~ PL~mING. ELECTRICAL &
MECHANCIAL: No work is to be covered
until these inspections have been
made and approved.
FINAL PLUMBING
o
CITY'S SITE PLAN REVIEW BOARD INSPECTION: Must be requested 2 days in advance of the date you
wish inspection. All project conditions such as landscaping, parking lot striping etc. must
be com~leted before requesting this, inspection.
FINAL ELECTRICAL
00
[Z]
o
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o
Phone:
Phone:
1I1ffiS- 7?/h
FIREPLACE: Prior to placing
materials and before framing
inspection. "
facing
ISPECIAL INSPECTIONS: In accordance with
Section 306 of the Building Code a special
inspector shall be employed by the Owner/
Contractor during construction of the
following work. A copy of the special
testing reports shall be furnished to the
Building Division.
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STRUCTIJRAL CONCRETE:
P.S.I. (306 a.l)
In excess of 3000
INSULATtON 6 VAPOR BARRIER: To be
made after all insulation and
required vapor barriers are in place
'. . but before any lath or gypsum board
interior wall covering is applied.
FRAMING: To be made after the roof.
all framing. fire blocking and
bracing are in place and all pipes.
chimneys and vents are complete and
the rough electrical. plumbing and
heating wires. pipes and ducts are
. approved.
FtRE 8 SEPARATION WALL: Located 6
constructed according to plans.
LATH AND/OR GYPSUM BOARO tNSPECTtON:
To be made after all lathing and
g)~sum board. interior and exterior,
is in place but before any Plastering:J
is applied or before gypsum board
joints and fasteners are taped and
finished.
WOODSTOVES: After installation is
completed.
SIDEWALK 6 DRIVEWAY: Required for
all concrete paving within street
right.of-way, to be made after all
excavating complete & form work &
sub-base material in place.
CURB AND APPROACH APRON: After forms
are erected but prior to pouring
concrete.
PARKING LOT: After gravel
place but prior to placing
or concrete.
is in
asphalt
STRUCTURo\.L WELDS: Preformed on the
job. (2722 f)
HIGH STRENGTH BOLTING: Ouring all ,
bolt installation and tighting
oper3tions (306 a.S)
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SPRAYEO ON FIREPROOFING:
Standards 43~8)
(U.B.C.
SPECtAL GRAOING. EXCAVATtON ,<NO
FlLLlNG: During earthwork. (306
& Chapter 29)
a.11
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GLU-LAM BE~tS: Inspection Certificate.
by an approved agency. furnished to
the City's Building Division before
beams are placed. (2S01-U.B.C. STDS.
25-10,11) .
*In addition to the inspections
specified hereon, the Building
Official may make or require other
inspections of any construction
work to ascertain compliance with
the Building. City or Zoning Codes.
FINAL BUILDING: Must be requested after the final Plumbing. Electrical. Mechanical and Fire
Department inspections are made and approved. No Occupancy of the premises can be made until
a Certificate of Occupancy has been issued by the Building Division and posted on the premises
FINAL ~IECHANtCAL
FtNAL FIRE DEPARTMENT
SIGNATURE
OATE
*ALL MANHOLES ANP CLEANOlITS MUST BE .\CCESStBLE. ADJUSTMENT TO BE MADE AT NO COST TO THE CITY,
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I INSPECTION lINE
726-3769
'_._-,.~..-.,-_.. ..
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CITY Uf SP~NGFiElD
COMBINATION APPlICATION/PERMIT
EIlERGY SOURCES:
Heat
liater Heater
Range ~__ _ ___
Job Address
INfOR/lAllON LINE
726-3753
Sq. Ftq. Hain fI~:2.o
~q. Ftg. Access.
Sq. Ftg. Other
--1lew__Ad~Alter--,~ep.
Fence Demo Change/Use
Other - --
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Oescription 17 ();:) ~17 50 0 rq:2
Owner. ,n # -P
"".' ,,?f,.,, ,;.,(,.':,_ .',' .A ( .... _
Addres. / " I l' . ..,1--. ." 51 /I
I ;
1'J,,/td........'...:I rAUb' ~1"'"
Construction lender
legal
Address
DESIGN TEAH
tJ-
Phone
(ohone no.-l
Build Single
/
Phone
(nameIP/, / D/II.) .a":Acf.('f'/(addressl
(l;cs. no.l
(exni res)
Structural
Electrical
/r//Vr;" l.frA/?//Yr;- IIY'-- ':<S'/f>' AI"" N/uU.A(
MIt..i~A/ L- r::'oW,c,.!.l- (t(6~AlT2
-:7rfrp1~1 OrJ (3(ACq/0'- 1--1 S; 0 e.~' vK.- t;lJlrer-r;.'W -iqU..
<:r ~A'r.tAN~'
4- F.r ::z.?/I'
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Primary
Mechanical
CONTRACTDR~
General
Plumbina
'~I
(address)
(lies. no.)
(exoires'
(ohnnp I'l:n l_,
PlUIIB I NG
4/;v;P~~ ~L-<,
119~ ~S~-- """
ELECTRICAL !
<'I-.J:JJAllli.I: ,.llll....J
furnace/burner to
BTU's
I IOE.E...J.lJiARliL
~Jt.~iC r; ,tJ@p,/~
AJ.t~ ~1lf~&:,.A c:.
-
Electrical
, ~'echantcal
NO.
~8c;t-....c~
MECHANICAL
ffF I...QJARGF NO
7.SZ' 0-
Residence of
Each single fixture
SQ. FT.
'2
Relocated building
(new fix. additional)
Temporary Construction Appl iance vent
~eoar~tp
Change in existing I', Stationary e\lllolJ.
rP'i j dypl'"P coo 1 er
ImU1tifami1Y.~ or I I Vent fan with
Innuc::.triA' ..inale duct
I 10f 'U;;V \"-7.'~' Vent system apart from I
amps, 'r:J,..,J" heatino or A.L .,
ICOM/"./lND. FEEDERS I I Mechanical exhaust I
- hnnd and dUl'"t
I ins;alY/al ter/rel ocate I Hood stove/heater I I
' <: r; h fpprlprc:,
I IOf "7.-00 amps. ?ZS''t IG~ 1}.P/he'-. '_Rr-
I I I I I I I
~/P 8'-::- ~.::::~~._I I I
I I I I
TOTAL CHARGES /5: - TOTAL CHARGES 6L>. - I TOTAL CHARGES /7.-
WHERE STATE l~W 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
S.F. Residence
(1 bath)
Duplex (1 bath)
Additional bath
Iwater service
I Sewer
I Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
2
:.mm_ .._..;''4J1'6/iI'.6
~n"'rp hPAtpr ~nrl vpnt
/2....
I
i
each
~--
ISSUANC, OF PFRlnT
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 Derformed 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 110 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 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 701.055 will b~ used on this project. .
flAt-IE(please print)
20ne .../!'lH
Fire Zone
Flood Plain
BUILDING PERfllT
Charges and
Surcharges
PlUHBING PERMIT
Charges and
Surcha rges
ELECTRICAL PERllIT
Charges. and
Surcharges ,
MECHANICAL PERHIT
Charges and
Surcharges
M /I-.TIf.it/ L .hW:E..u-sIGIIATURE~~ .:T'PA""Z..r'-I.J' DATE :J/I/Nc
FOP. OFFICE USE mIL Y
Type/Const.;zz:: N Units Sq. Ftg. r'tai" 1./?2t:' ,. Value~"<Jr!J_ ..
Bedrooms Occy load Sq. Ftg. Access x Value
Stories Occy Group.1l- 2 Sq. Ftg. Other , Value
TOTAL V AlUA II at!
c....., C"'c:::> Plan Ck. Conm/lnd
___~,-q':__~/Rlda P.I'r fpp
or:? ., Plan Ck. Res
~ . ... ~ 30%/Blda Per Fee
/ c:'.se;> Fence
____J~~____
. ~() Iletno
Systems Development
Charqe tI.5~) .
$""2- 'Y'7
l~tJ.
~
I
I
I
'Sidewalk
-<". :;.,~ I AlC Paving
/"'7. -=-0 I Curb' Cut
-----l-"~6-jfl
ITotal Comb. Permit
I
I TOTAL
1/7.(}(j
? If. :3 3
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COMBINATION APPLICATION/PERMIT (CAP)
/
"
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
I, example- heat/electrical ceilinqJor forced air Qas
2. example- waterheater/electrlcal/or ~
E, Square footage or valuation. etc.
I. example- 1250 sq. foot house, SOD sq. foot garage
2. examDle- if new project. check.new.- if addition,
cneck add, etc.
F. Building permit infonnation:
1. examDle - construct single:family house with an
attached garage
2. example - remodel existing '.garage into family roo.,
3. examJPle - 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.
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
. .'. ,." full schedules . .
:...:' BUILDING OIVISION 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.
.11.,
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III.
V. FOR OFFICE USE ONLY
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.CITY OF SPRINGFIELD
City Hall
$prlngftold, Orogon
Depertment at Public Works
OFFICIAL RECEIPT
No.8
Date FIIr ~ 19 -g~
Rec'd From _~...,ur....)I"-- ~~,,_
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Address - V~dT'...;' 6X ~
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Received For:r~'Z'" 96<t!::1C>83 /C:-.P~A'-
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Amount Received
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--,{',.II AUTHORIZED SIGNA TURE /
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Permit Clerk
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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:
'"
'..:'
PLANS REVIEWED BY:
., ,.
. .
',.
~'a~e~n~~
signatur- ~.--.'
'l-;- -,.
date -:2~
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