HomeMy WebLinkAboutPermit Building 1989-1-31
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I INSPECTl~N LINE,
726-37651
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Job Address 19> ~C\ y;~,^",_", ~~\wl/.I f..a.rt
Legal Description /7~::;'"21f!:'= /~, ':2~~ "2/=
CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
Ranqe
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INFORlIATlON LINt
726-3753
Sq, Ftg. 1,Iain
~q. rtg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Demo Change/Use
K..Other~~~
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'ZGl.
ValuE' of Hark: a2:1
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BullcifnQ Permit Info: Deser be Work{Le.. Build Single
Familv nesidence With Attached Garaae\
Owner \\'.,\ ""'OIV\ ~~o~<-....\\~
Address d ,... /:
9~"" .N. /~"'~";:~~ ~,
~~......J?_ ~R 97-:;Z/7
,
Construction lender
~PL _ .._._, ~ /~....;;.= ~.G"
~ i&i9/GF/.c/..K. I~. /y~
(OhOM no. \
Phone
Address
DI:~HiN H.Ar4 (nameJ
Primary ~c..",..r..C\'Ol\
Structural
Electrical
Phone
(address)
(1 ics. no.)
lY\a""'_5<:'W>'''-\ t.,,~? ').00 ~...",r:t.\~\ tt.V\\,...
\
Mechanical
CONTRACTORS (name)
General M~\.t'^'" ~~ t.~'Io\I\\.~~l\ \
Plumbino Iw;~ tt,'.... ~\'^"'\,.:..\
Electrical L.2. ~-r<>\'l;-,.o.""
~lechanical l\n...vc..... ~ ~'("~c..",
1
PLUI1BItlG
(axoiras)
~l'I\. 1 RI' \\~"\
(address 1 (1 iC!i. no.1 (exoires1 (ohane no. \
p,(,f)W ')"l-.\l\ C"'!.~~" '1".,,"!.~ l-R~ ......n"l141
-l.D-~v ~8 l.-&d) ("Q~ I~I'"
~().-'B1 C. 10-8<\ ,<\\\ -:I.-..t..9
11 \=,,-SII .,'!("HAI
EI.ECTRICAL
FEE CHARGE NO..
EEE f"~ NO
NO,
9 Each single fixture
Residence of
'7.$"&> 'Z2-:i;?
SQ. fT,
1 New ci rcuits a lts.
or ext~nsions
:;;( L7Ff fiU'flt::'
ISERVICES
Relocated building
(new fix. additional)
:n- :520
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I ISSUANCf OF PFR!IIT
TOTAL CHARGES 7! Z_t5"C> I TOTAL CHARGES S?S......, TOTAL CHARGES 6= e::>e>
WHERE STATE L'\H REQUIRES that tile 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
S.F. Residence
(1 bath)
Duplex (1 bath)
Additional bath
~Ia ter servi ce
Sewer
5 to rm Sewe r
each
ITempOrary Construction
IChange in existing
res i de.nce.
Imultifamily. COIlll1. or
Industriill
/ IDf /t:?t?
ICOffi1,/IND, FEEDERS
IInstall/alter/relocate
di~trih. fpeders
IOf
I
amps.l
amps.
MECHANICAL
H~ r.~
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furnace/burner to
BTU's
~T6'P NV.4.ir./~"?"'"""
'Floor furnace
and vent
~<>rrr-
Recessed wall
Sn~ce hp~tpr An~ vpnt
I
Appliance vent
seoaratp
S'ta'tionary evap.
cooler
V"ent fan wi th
sinole duct
Vent system apart from I
haatina or A.C.
Mechanical exhaust
hond and rlllr't
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Wood stove/heater
........... ~ Ji7H~
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I HAVE CAREFULLY EX~INED the completed application for permit. and do hereby certify that all information hereon is true
and correct, and 1 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 OrefJon pertaining to the work described herein. and that NO 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
IWIE(please print) c:. \'-'1:'1.,.\\... \3, N7i~W\""'-
~/ M.._
Zone
.cc..
Fi re Zone
Flood Plain
BUILDING PERfIIT
Charges anc
Surcharges
PLU'~BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surchargas
S IGIIATURE
FOP. OEFICE USE OIIL Y
Sf!. Ftg. riain x Value
Sq. Ft!]. Access x Value
$-2 Sq. Ftg. Other"..-;;_:e:v......"..~Value /g ~""'.
. - - ~
--" /J - TOTAL VALUATION
rl f<'J,oJu.._ .<-,,,-'IY-
. Q3 c<?-. ';"e~.~ "Systems Development. -?L""". /-'>
C 'oJ'" Charqe (J.5%):::('Al9b ~;J .c......
Tyoe/Const~~
. -
Bedrooms
Stories
~nits
Occy Load
Dccy Group
/
--_I..-:j'!?--~
b- <:&3
__n~~-:l2'!.?._
/.r?
_n_tfQ;~__
2-~S
/,<;""~
_____c;/....:_____
.7f)
l! :.)"<t
Plan Ck. Comm Ind
65%/Bldo ~er Fee
Plan Ck, Res
30%/Bldo Per Fee
Fence
Of/mo
Sidewalk
A/C Pavi n9
Curb Cut
DATE /- '3/-'8~
Total Comb. Permit
-;22/. S6
TOTAL
-::297. /& .
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COMBINATION APPI.ICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax Lot 100, lane County Map Reference
1/ uj 43
2, exa~le' I.ot 1, Block 3, 2nd Addition to
" >prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceilinq/or forced air qas
2. examyle- waterheater/electricol/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. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examele - 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, OESIGN 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.
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
full schedules
C, BUILDING DIVISION STAFF WILl. FILL OUT ALL FEES AND
CHARGES ON THE SCHEOUI.ES
O. 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.
Kec.#= 13176
V. FOR OFFICE USE ONLY
Permit ClerkdR ~
C2 - /D\..~~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name Lo.lSJ~ h- ~.G1'"
signature
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date --:::<-$5-;;;;<7