HomeMy WebLinkAboutPermit Building 1990-1-26
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I Q \~ \ J' \ J\J '- EIIERGY SOURCES:
Job Address 1 Q, '-1:' \ fJ\\QO r- 't' (\ "'\1>. T ~ Heat
Leaal omriPtion(j)1\ ll.~' . U ::~:: Heater
Owner ~\\~ V ~~3
AJdress:qm t\). \/'1 ClIP)~one41\(
Y()\-t\() rY-\ ~ C{'t~ II
Coostruction Lender. - / - .
I HFORHATlOH LI HE
726-3753
Sq. Ftq. l1ain
~q. Ftg. Access.
Sq. Ftq. Other /'2~7.~
-'lew-^ddKAl ter -Yep.
Fence Oemo Change/Use
Val't\~ 't)(n,ro. Other- -
BufldlnQ ~ennlt Info: Describe Work(he., Bulld Single
Familv Residence With Attached Garace)
.
Address
D1:.~lliN I t:.I\r~
Phone
address
\ \S, VIXvcxn-"J
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lies. ex ires' (ahont! no.
name
Primary
Structura 1
Electrical
Mechanical
CONTRACT'pRS name (address \
General\-fi pi' G\\\('~\() 'i\ '\.J~ D.U.. \
PI umbi no
(lies. [lQ.. \. (exoires'
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(ohone no. \
Electrical
~1echan1ca'
PLUIIBING
ELECTRICAL
MECHANICAL
N .'
m
'CHARGE r.
Resldence of
?5<<P '
'New circuits aIls.
or extensions
r-LHARUl7
furnace/burner to
BTU's
10
Each single fixture
7.s
Floor furnace
and vent
SQ. FT.
Relocated building
(new fix. additional)
$.F. Residence
(] bath\
Duplex (1 bath) each
AddItional bath
Recessed wall
~n~r~ h~~t~r ~nrl vpnt
SERVICES
Water service
Temporary Construction
Change in existing
'"$ i ~e~cr,
multifamily, COIlll1. or
:nduc;trial
I (7/,f~.
Appliance vent
c;~p<lrate
Stationary evap.
~ooler
I Vent fan wi th
!j;in9le d~ct
Vent system apart from
heatina or A.C.
I Mechanical exhaust
hood (l;nd duet
Wood stove/heater
Sewer
Storm Sewer
Of
amps,
COHl.I.II ND. FEEDERS
Install/alter/relocate
di.::h.ih I'ft!l't1ftl"t:
~>>h~
Of
amps.
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I ,. I . ISSUANCE OF PrRllIT
TOTAL CHARGES 75:'.,p TOTAL CHARGES' .', TOTAL CHARGES '2/-.S-0
WHERE STATE LW REQUIRES that the Electrical work be done by an,-Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building,Division
I HAVE CAREFULLY EXAMINED the completed app 1 i cat i on for permit, and do hereby cert ify tha t a 11 i nforma ti on hereon 1 s 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 110 OCCUPAIICY will be made
of any structure without the permission of the Building Division. 1 further certify. at my registration with the Builder's
Board Is In full force and effect as required by ORS 701.055, that if exempt the b is for exemption is noted hereon, and that
only subcontractors and employees who are In compliance with ORS 701.055 will e se on this project.
,SIGIlATUR,Y
FOr. OfFICE US! OIlLY ..
Sq. Ftg. Ilaln ,Value
Sq. Ft9. Access x Value
Sq. Ftg. Other.l;;>.g7.-,r~~ce-a;value /~~-
,
HIa.qO ISleS1 TOTALVALUATlOtl
r.J Q I'-<!..-:l ax 'Systems Develop~ent , ~"7-'>._""
T)0. ';: f1W..k: fIlarqe tl.5~ -" //;../.
V ;/!td,Q'/ :;; c1rCh:1-L
IlAI-IE(please print) ..."
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;
OATE /-2G~
Zone
c:<::::
-=?'-/Y .
Units
Occy Load
.Occy Group?? - 2
Type/Const.
Bedrooms
Stories
Fire Zone
Flood Plain
/
BUILDING PERfllT
Charges and
Surcharges
. Plan Ck. Conm/Ind
__/2I!J:,.S~_ ..ill/R.1da Pj'r F..
/ u Plan Ck. Res
~ . !':;r 30%/Bldo Per Fee
____7~_~ Fence
,'.1, "'-:p."?!?,'O(JlflO""':
PLU'~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERlm 'Sidewa 1 k
Charges and ------------
Surcharges Ale Paving
Total Comb. Permit
'2 ?b ..2'~
HECHANICAL PERMIT
Charges and, 'r-.
Surcharges
_ . ~1:-6(:::>-
I' _________'='__
1_ &8>
..
Ciirb Cut:" "
TOTAL
:>C::>~ :2'6
..~
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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COMBINATION 'A~;~~'CA;;iNi~~RM!T~~~;) ....- .. h, ~'.,j; :;: : ':: I" ~._~I~" h.-:~+-:'.~~E~~T ~~LI ~~T'iON:,;,i:~;:!:~ ~>'\,.;,
. 'i' _,,",,' "...' ~ rl"..f,;".! "'r' .~......_-.,_. . ..-.......-...-r---.....--:-.- n
L Applicaot to furnish' .,. . , ..
:: ~~~a~d~~~~~iPtion.__'lS:'>:':... " .\ ;;,:.''1' 1.( ,iC .;l:~)i:f;~n,:DIP;'i;;-;;)V.//./(...
L. examele-,rax.'Lo.t 100,'Lane.Couoty Map' Reference ')111" ;:~:::;.: -, '.j': ,.r'-r: IT"~ .')"
II U3 43.1,.... ~-: .0.J.... ".. \ ',..jl) ,1 I', ~'V"I() \./1\ I ] ) ,
. '.:. .,....' ,/ .~ -f- f "J. ... , ..
2. exa"JPle- Lot L Block 3, 20d AdditlOn to \- 1\\---"" ,,\ ,~,',,'(-}'-_"I;"/':/ 1 ,: i
spr,ngt.ield Estates . ., \ .. 1,1{) ,I -'. '- ..1' " , I ,
C. Name, etc. of. ?Wner and"'cons,t'ju.cti?n lenjder) L
D. Energy Sources' , .I Ii ' j. I,,],"
I. exam~le- heat/electric.l ceilinq/or forced air Qas
2. examyle- waterheaterjelectncalJor solar '
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, SOD sq. foot garage
~.' example- iTnew project, check new - if addition,
check add, etc.
F. Building permit information:
I. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examyle - convert single family residence into'
restaurant (change of use) ,
G. Value of work as defined in Sectioo 303 (a) of the
Structura 1 Specialty Code
H. OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persoos regarding design informatioo or jOb site
corrections, etc.
II. Abbreviated Plumbiog. Mechanical, & E)ectrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical aod 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
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES .
D. As noted 00 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
Wheoever 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 uotil these
fees are paid. All other fees and charges are due and
payable when the permit is' issued.
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Permit Clerk
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Permit applicant .exempt from registration with the Bunder'.~ Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
/ A"J9H.d"
,.,
~~~~~signature
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