HomeMy WebLinkAboutPermit Building 1988-2-26
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'1 INSPECTION LINE
"J )726- 37 69
CITY OF SPRINGFIEcD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranne
-'
e
INFORltATlON LINt
726-3753
Sq, Ftq, 1.la i n
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Rep,
--Fence Oemo ChangelUse
Other -- --
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Job Address
/ If!). AC>/V&:"R 7J??;'#IA?~~7'
Description /7- t)'3. 35"=';<;/ ~.~oo
Legal
Owner R A-L pf.I
Address 1 't L. - (,.,
Construction Lender
Address
Ut.SlliN H:.Ar.'
Primary
Structural
Electrical
f1echanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~'echanical
NO. .
~
Each single fixture
,
<If..1J1!'t'1/
c
Phon"M. ('t<t,
.,'if 7'
(name)
Phone
(address)
(name)
(address)
R /. L.t
. ,.
f\AL;-1..
ValUE of Hork:
';;'~-o_o-Q
Builciina Permit Info: Describe Work(Le.,
Familv nesidence Hith Attached Garaael
Build Single
If..e ,,/... c.e...
~.kI"r~/iJ .
I
I-l.e.......,
L......Ll SA.. .............,p
(li;! l "I).y~ f!...lll'-"''''
Lpd.-I~}4- L,.I r
flies. no.) (exnires)
(ohane no.
f1ir:~.nn.)
(pxnirp"l
(r')hn",p "n \
"'M'cE~
"~t!:"IC'" ()=-~...:2' );>EV/.c-",- A~~?)
PCUliBING
FEE . rHARr,F Nn
Residence of
?-~ 37. 9:
Relocated building
(new fix, additional)
EcECTRICAL
MECHANICAL
~~~ r~ _NO
n.~ ru~
SQ, FT,
furnace/burner to
BTU's
New circuits alts.
or extens..iQns
--:2 .pTof m~':;
SERVICES
./
S.F. Residence
(J bath 1
Duplex (1 bath) each
Additional bath
~Jater service
Sewer
Storm Sewer
Temporary Construction
Change in existing
rp~.i qPJ,rp
multifamily, COllTll. or
Tnl'llJc:.triitl
I
1
1
1
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3?~S'O TOTAc CHARGES -::('-:i?-or> TOTAc CHARGES ~_ /.J.,--
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 Install/alter/relocate
. dic:.trih. fppdprc:.
10f
1
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Of
CO~~,/IND, FEEOERS
TOTAc CHARGES
WHERE STATE c~H REQUIRES
shall not be vali1 until the
I HAVE CAREFULLY EXAr1INED 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
....~ Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAIKY will be made
of~~Y structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board~i~ 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 be used on this project.
HAfIE(please \~r\nt) 'Raj r ~ ); Meed SI"UATURE ~tf'tl./'/
FO~ OFFICE USE DIlLY'
,
Sq, Ftg. fiain x Value
Sq. Ft9. Access x Value
Sq. Ftg, Otherh,~ ?F~~c:.. Value ::;('S"~.-
TOTAc VALUATION
Zone c:c..
Fire Zone
Flood Plain
BUIcDING PER/lIT
Charges and
Surcharges
PCU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlilT
Charges and
SurCharges
/iECHANICAc PERMIT
Charges and
Surcharges
Type/Cons t. 5"-1./
Units
Occy coad
Occy Group~~~
Bec,rooms
Storfes
/
//) ~ Plan Ck. COl111l/lnd
___.../~:..._____~/Rlda p.pr Fpp
..-0 Plan Ck. Res
- w C> 30l/Bl dQ Per Fee
____2_-'Z-=;::f== Fence
/. :?~ 1 Demo
-"47'-5"0 I Sidewalk
------;_-~-I AIC Paving
IS. =e>' I Curb Cut
--n_-~;;s:--I
~:<>3'
Floor furnace
and vent
Recessed wall
So~rp hp~tpr ~nrl vpnt
;("
I
I
13-1
6.-
amps.
Appliance vent
~Pn;!r",tp
Stationary evap.
rnolpr
Vent" fa-n with
c:;inale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
tlnnd and durt
Wood stove/heater
amps.
ISSUANCE OF PFRflIT
DATE~-'?{
iPc/o/. #'/.09<:>";
Systems Development
G.S'O??" ~~!CharQ. (L5~)
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ITotal Comb,
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I TOm
Permi t
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COMBINATION APPlICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B, legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
'17 oj 43
2, example- lot 1, Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name. etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. examole- waterheaterjelectr;cal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq, foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition.
check add, etc.
f. Buiiding permit information:
1. example - construct single family house with an
attached garage
2. examele - 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 ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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
0, As noted on the CAP, the label must be delivered ta 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 b~ 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.
((0 (~ r
9-~~ -i
. '
V. FOR OFFICE USE ONLY
Permit Clerk
Q
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. PROJECT.CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
. '.
.... ..1
.....
,
. . :>
PLANS REVIEWED BY:
name / -8;G" :z:,Lez:r.4E?"f"signature~.......4~~J..date
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"2- -;;> 2- 81!S
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