HomeMy WebLinkAboutPermit Building 1988-5-13
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J INSPECTION l..,_ _ CITY UF SPRINGFIELO
726-3769 COMBJlIATlON APPLICATION/PERMIT
/) EIIERGY SOURCES: ..
Job Address/~9 A-~ce"< r-A'R~A'Y' E~ Heat~ 1IV~
legal DescriPtion.a..."q'2':::_::?~ /9~.:2~ ":2/~ llater Heater~~
Ranqe
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INFOR/IATlON l.Nt
726-3753
SQ. FtQ. "lain~7. Y 'P
~q. rtg. Access.
SQ. FtQ. Other
XI/ew Add Alter Rep.
-Fence Demo Change/Use
AOther~~-"-,,,
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,Ownerlh.t:.L.h!?",p,N ~P6C?H'6S .j!fV' _
Address"" ~ / ...".., ~~/:':stG
.7'-"'" AZ /~~Wk' IS. /-"'iC -~f',:
~~2> ,LP7? <9?:Z/?
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Construction Lender
ValUE of Hark:
7~~
BUllrlinQ Permit Info: Describe Work(i~e.. Build Single
Farnilv nesidence With Attached Garaae)
~~e-//.......&- ~F ~r:-Ar.J~ S~
~ 7JijAlVEL ~ ~_Co/
Address Phone
UI:.~lliN rI:.Af.' (name) (address) flies. no.) Cexoiresl
Primary ~ h?~__-:-/V ?~~_ /'2:ZCl::>....v. ~j,#77€"'" ~;, ~A"~
Structura 1
Electrical
Mechanical
CONTRACTORS (name) (address) (1;('0:;. nn.) (pxnirp<:.\
General MC..f'<9Y2/<<;: ~..-..r:;r?~.-. ~~.~.,- Iv. ~~ G~~
PlumbinOr~( .P~.k-, 7dS"~ ItY: _7?2~1.. /, ~ / &..h:9,G
ElectricaIL.R-g7'f~~~..' /.t!:JIN:::--u ~.~~ ~?tj;::~..",.7)
~lechanic'al /IA.'71JtE:'Y .{ ;?b/~~.. ~~ ~~;r;::r ~r
I
NO.
"2
Each single fixture
PlUllBING
ELECTRICAL
FrF rHARr.F
NO
(ohona no.
::?~'22S"4
(ohnt1p "n. 1
~~7/~"r
r.::R~44f/~
?7'7-b(P~
7~./~2/
MECHANICAL
SQ. FT.
/
I
furnace/burner to
BTU'
H-VN<- '..IA~
F1 oar furnace
and vent
1G.,-
<<F
r'lARliE. ...lli'
7.S"~ ISat>
Residence of
Relocated building
(new fix, additional)
~ New circuits a1t5.
or extensions .~
-!Z <>R ~=
SERVICES
~
Recessed wall
So~rp np~tp~ ~nrl vpnt
S.F. Residence
(1 bath!
Duplex (I bath) each
Additional bath
Water service
Sewer
Storm Sewer
Appliance vent
c:;aoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood i'lnd durt
Temporary Construction
Change in existing
I"P,;.i dJ'.nrp
multifamily, corrm. or
Industrial
I
I r;~t:'
I'"
I
/PO
amps.
2Z.$
~......
COI~fl. II NO. FEEDERS
Install/alter/relocate
rlic:,tl"ih fpprlprc:;
Wood stove/heater
6#5 P/.P/nz,
<--
Type/Const.~~ ~Units
;
Bedrooms Occy load
Stories / Occy Group
::R-;Z
Of
Of
.......
ISSUANCE OF PFR!lIT
TOTAL CHARGES /!?-...... TOTAL CHARGES Y_'1. ""'" TOTAL CHARGES ..h0-,.y. /.<;;':"-
WHERE STATE L\l/ 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
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 oerformed 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 un OCCUPAI~CY 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 ZOl.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.
IIAf.1E{please print) \. s;,/.r-// ]/J~ SIGrlATURfL ~~1)
FOr. O'rFICE USE orllV
Sq, Ftg. 11ain ~;::>. ~lf1 >
Sq. Ft~. Access x
Sq. Ftg. Other x
Zone LL
Fire Zone
Flood Plain
BUILDING PERHlT
Charges and
Surcharges
PLur~BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
:
amps.
TOTAL V AlUA Tl ON
nAIF sh~,R,
,
Value
Value
Value
7~ CoO
Plan Ck. Comm/Ind
65%/Rldo Ppr Fee
Plan Ck. Res
30%/Bldo Per Fee
~//+,~.,":~'~
'/0 r=' syste. ms Development ..",...., ~
-r,.,,:,") Charoe (!,5~l?~ ~ -c. ,..,.
___JG~ 5"'"0
3'. 413
/c- t>C> Fence
___...LJ.J..=._____
-?S
~ ~ Sidewalk
___.:.'.U.:._____
"2, :zs- AIC Paving
L5; """" ' I Curb Cut
---- ~-7.?-1
D~A10
Total Comb. Permit
, .,
I
TOTAL
/-:>C?, Gf!3,.
. /$3.'/y
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
II oj 43
2. examele- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. examole- heat/electrical teilinq/or forced air Qas
2. examole- waterneater/electrlcal/or solar
E. Square footage or valuation. etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. example - 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
. ,; per:sons:~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' '.
ful" schedules
C. BOILDING 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
payable when the permit is issued.
If S-01
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V. FOR OFFICE USE ONLY
Permi t Cl erk
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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:
name
L6'Jli:NE Pc. f:"~ ~
signature
4...-e.-_~A~J?
date _)..;.~
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