HomeMy WebLinkAboutPermit Building 1988-6-22
I INSPECTION llNE . CITY UF SPRINGFIElD .. INFOR/lATION llNl
. 726-3769 COMBINATION APPlICATION/PERMIT 726-3753
,- ! EilERGY ~URCE~ Sq. Ftg, 1.lain
Job Address /~9 -71.?/Yc~ ~h"~r ..:;-_~; \ Heat C;o;1"5 rLf/- ' ~q, Ftg, Access,
legal De<cription Ilater Heater ~ . Sq, Ftg, Other
~ -1lew_Add_A1ter-,~ep,
Range ' __ Fence Demo Change/Use
ValUE of Hork: ~Other /~7'cl!'TE
Owner \(.f:\)U,) F ItJ~WlI\~ ?~ S~. ""'" ,"~-S -:.. -~,-
Address D.O. DO\!' "'$'1 r)~ I--.. "p Phon""'" l'tI/;. BUil!;nQ P~rmit Info: DescrIbe Hork(Le,. Build Single
f I 0 ~ c- ~ t::::l\.I[;;t,.. \J.... "f~'" ~ I Famllv ~esldence l~ith Attached Garaael
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Construction lender H lu...W1^)J .fR9~fS
AddresstlOo t!;-OMAIM~IC.1)u.iVfl ~~ho~-'1111
DESIGN TEAM lnamel (address) - flies. no.l
Primary H(~~J AtM_. L2..Z.(iloO .;, S'll,vrzf0~,E:. p~ ~"12.li
Structural ~~t//FAJ.l.,f,f., e.lh-. Wt.. 701 C;,~. mlL..L..f:.e. ~ Of.i'u:n-
Electrical n4.f=,LA. M.. 2.00'7 ~.e. ASH POftf. tf72../t.t
Mechanical I' · If". If
CONTRACTORS lnamel (address]
General s:u.tJ rf\~sr ~. B~v 702.'16 E./Jf.; Of~l
(exoi res)
(ohone no.
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2"iI-0711
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(~)'I)irp,,'
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lohnnp nn )
4t<X.. i f?lL
!SJ '52..1
Plumbino P
Electrical P
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<2..00 'I
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ME~~ICAl
PlUl,lBI NG
ElECTRICAl
NO.
HF rHARGF Nn
!:'~L...cHA.RG.E. Nn
g
Res ir~cOe OOf
/A. SQ, FT,
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furnace/burner to
~,)t..,:- BTU's
Floor furnace
and vent
Each single fixture
7.'"::C @ ~
Relocated building
(new fix, additional)
New circuits a1t5.
/ ~ extensions
'L c--.<ro '""~ (0
SERVICES
f'22.~
S.F. Residence
(1 bath)
Duplex (1 bath) each
Recessed wall
~o~rp np~tp~ ~nrl vpnt
Additional bath
Appliance vent
s.eoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond and duC':t
I Hood stove/heater
I
I
I
~/ater service
Temporary Construction
Change in existing
rp} i d_p.nrp
multifamily, camm. or
lndustrial
\
Sewer
Storm Sewer
Of
amps.
COMl.!. lIND, FEEDERS
\
,.
crr rUq&GL
(.... cb
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I:\cc>
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~ I 1 1 Install/alter/relocate
d A (Hctrih f.:.pdprc;.
-b 7, I I IOf' amps.!
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- , ISSUANCF..!!. PFR!IIT
TOTAl CHARGES '(q'l.~ TOTAlCHARGES 2?,.5\:> TOTAl CHARGES\\~\).~.A\o\:7 \~~
HHERE STATE lAW 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
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 UO OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if~xemPt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Ql.0 will be used on this project. .
1lA/'E(please print) J\AlJll\ RAPKJtJ SIGII^TURE j~~ DATrUk/~
FOr. OFFICE USE o;~LY !
Type/Cons~\\ \,,\_~-,lQ.Units ~q, Ftg, Hain x Value
Bedrooms Occy Load Sq. Ftn. Access x Value
Stories \ Occy Group \~.'I_ Sq, Ftg, Other x Value
ttJ.' '-"'-Kg!1i 1171?
1'<5: S"c:;
Zoner" .
Fire Zone
Flood Plain
~\
1D
\( l-:t C):) Plan Ck. Coom/Ind
?- __l~~'-~5--- ~~:~B~~~ ~':; F..
-, , 30%/BldQ Per Fee
PlU'1BING PERMIT Co'1. s::> Fence
Charges and r---' --------
Surcharges:> ~,~ Demo
ELECTRICAL PER.m (Z2. 'd:> I Sidewalk
~~~~~;~g:~d 1../ - --- - \ ~\~ ---I A/C Paving
,'ECHANICAl PERMIT \ t::.. ex::> I
Charges and l,o _ __ "'- .::>L._ _ _ __ _ , Curb Cut
Surcharges . '1 '5 I
I
I TOTAl
'<)\f2, , C\\
155. "'lL
BUILDING PERHIT
Charges and
Surcharges
.-rOT^l VAlUATION
c)"1l
Sys terns bevel opment l.\L) r\ ~
Charqe (!.5~) .re...
ITotal Comb. Permit
it
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
1, Applicant to furnish
A, Job Address
B. legal Description
I, ~xample- Tax lot 100, lane' County Map Reference
II U3 43 '-,'
2, examele- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D, Energy Sources ,
1. examole- heat/electrical ceilinq/or forced air qas,.
2. examjJle- waterheater/electrlca(/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house. 500 sq, foot garage
2. example- if new project: check-new - if addition,
cneck add. etc.
F. Building pennit informatfon: . ....
1. example - construct single family house with an
attached garage I . . .
2. example - remodel existing garage into family room'
3. exa~le - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
$tructural Specialty Code '
H, 'DESIGN TE~1 AND CONTRACTORS
To avoid design or construction delays, Building
~ivision 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 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 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 permit is issued.
"
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V. FOR OFFICE USE ONLY
~ ~ 1177t/-
Permit Clerk rJ ,GB. J.u nJ
, 'o-.iil.~-~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: <7\\1\ \. ') ~~ \.. y...,\- "'\.. 'Ie\., 'C'\..(:>('\
~s.~n\- c,"...- ~~\~~,,~~ -
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PLANS
REVIEWED BY:
'~
~V' '\ \ .H'\. \~
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Signatur:~ _\ ~_"-
datec.,-'(l-~ X-
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