HomeMy WebLinkAboutPermit Building 1988-8-17
Owner IlII..U'1Ptl ~Ieh N,j.,j.
Address~Ol? t-l. 1~~ l~l.At-I PfZ.,
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INFORl1ATION LINt 'I
726-3753
Sq. Ftg. 1.lain ,""\..-..
~q. Ftg. Access. -\,j-
Sq. Ftg. Other/7'<='t'_ ('\.....,
Xtlew Add Alter Rep. -'J
Ran~e -Fence Demo Change/Use r---....
ValuE of Work: IS; c/!)(!) ~Other./'.-'>",,:,:ZV~E '-'
BuilriinQ Permit Info: Describe Work(i~e" Build Single ~~
Fam" v nesidence \~ith Attached Garaoel _
-- ~~~~
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'1IN3PECTION L1I1E
726-3769
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CITY Uf SPRINGFIELD
COHBIIIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat~At~
Water Heater~~~/'~
Job Address I ~3 f'l0I-l1:!~ r"'~Y' 6,,/'57
Legal Oe'cription/~3_~.'2"'3 ~,!Z_"'2R.:i1i!>
,
Construction lender
Address Phone
UI:.~llm TE:.Ar1 (name) (address) flies. no.l (exnites) (ohone no.)
Primary DvlD ~ ~ 1I1J2a7r4, ~~, or'lf- q71..17 II Ibl I 'Un -1.1..% .
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Structura 1 I
Electrical
"*"
Mechanical
CONTRACTORS (name) (address' (p)(l)it'pd '. (':l~I'\np nn l _
General wt~~~...... I~/~:
Plumbino 11'-111-1 f1~ ftUMetk1l'O ~ J.<..I, ~ f.tJE. ~J 0'2. w.%fff (p~ J-
Electrical ,~~ ~ l~. 't! ~~/ '2o.'li!t. Jf},.fiJJ/1i9~ ~8
~Iechanical (...:>01" '1~ ~1t:".:J
PLUJ1BIflG
ELECTRICAL
MECHANICAL
-1!Q.,.
FfF rHMU~F
Nn
~~~ ...c..I:iARG.E. Nn
~!:'~ 1...c..I:iARG.E.
furnace/burner to k
I BTU's -
&7~// /~~~
Floor furnace I'
and vent
:z
Each single fixture
Residence of
7.-SP ~
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
~ or extensions
"2. d>P ~&
SERVICES
-z.:;?-.:'j2,
ITempOrary Construction
IChange in existing
rp$ j dJ'Jlf'.P
Imultifamily, camm. or
tnnuo;trial
I IOf /..?b
ICOMfl./INO. FEEDERS
Iln,tall/alter/relocate
rlic:trih. fppdprc:
IOf
I
I
1 I I I ISSUANCf OF PFRlIIT
TOTAL CHARGES /:r:~ I TOTAL CHARGES ~~I TOTAL CHARGES ~./A_, Lt::;;-
WHERE STATE L'W REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Is.F. Residence
(] bath 1
IDuplex (1 bath)
IAdditional bath
jwater service
I Sewer
I Storm Sewer
I
I
I
Recessed wa 11
~n~r.p hp~tpr ~nrl vpnt
each
amps.1
I
I
I
1-:<'.7-62 '
I
I
amps.
----I
I
I
Appliance vent
SP03l"'atp
Stationary evap.
cooler
(Vent fan wi th
sinole duct
Vent system apart from I
heatina or A.C_
Mechanical exhaust I
hood ~nd dud.
I
I
I
I
Wood stove/heater
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I HAVE CAREFULLY EXM1INEO 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 Spri n9fi e 1 d and the laws of the Sta te of Oregon perta i ni n9 to the work descri bed herei n, and that UO 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 ons 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.
Zone
........../
TYOe/const.~~ Uni ts
Bedrooms Occy load
Stories I Occy Group
SIGI~
FO~ OFFE USE DIlLY' ,-
Sq. Ftg. r-\ainx Value
Sq. Ft9. Access x Value
Sq. Ftg. Other~-""6~~:S.- CPlalue~ ~--.
TOTAL VALUATION
a ~ ~ ruOA.JJATF [,/%b
11AHE(please print) fA1l1lJ6A. ~-~
/
Fi re Zone
Flood Plain
~2.
BUILDING PERIIIT
Charges and
Surcharges
Plan Ck. Comm/Ind
___//.t2:..S??___ 65S/Blde ~pr Fpp
Plan Ck. Res
30S/Bldo Per Fee
/5= -- I Fence
------~;;s=-I O~mo
____'Ys:- I Sidewalk
-::i? -::25" I A/e Paving
___/.JS?~___ Curb Cut
- :;::5'
7/,fi3
IUJ~t/ ~f-88'
Systems Development
CharQe (1.5~)_.o':b
C::!- -
5-=5:3
PLOt~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:n
Cha rges and
Surcharges
Total Comb. Permit
/9"/-78
257 7&
liECHANICAL PERMIT
Charges and
Surcharges
I TOTAL
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.
,..
.,.. .
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDArION
III.
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference
11 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sou~ces
1. example- heat/electrical ceilinqjor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exam~le- if new project. check new - if addition,
chee k add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. example - conve~~ single family res1dence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code '
H. DESIGN TEAll 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
8. Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the penmit 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 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 penmit is issued.
,
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8 - n--Kf
V. FOR OFFICE USE ONLY
. (r__
Pennlt Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Pennit appl icant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
I
name /~,,-::.'~ ;z:,.~,g;;p
Signaturv-::2. __ ?e.. -..,
'// -' /'
date ~-%'-Bf5>