HomeMy WebLinkAboutPermit Building 1988-7-18
lINSPECTION LINE . CITY OF SPRINGFIELD .
726-3769 COHBIrIATION APPLICATION/PERMIT '
Job Address &</1 PAi>,.y~ ~A"kf,<vA"~ _. .' ~~;~GY SOURCE~~
Legal Description /7-,,3-2(;-23. '~_.:2'~41~= II~ater Heater ~.....
Range .yir
Va,laE of Hork:
4" Z. '5 cZ> D
Bui1'tiinQ Pennit Info: Describe Wor":.(Leo.
Familv nesidence IHth Attached GaraQe)
INFORlIATION UNo
726-3753
Sq. Ftg. I.'ain 11(,,0
~q. Ftg. Access. ----
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other - -
\IV
~
I~
--
-....Q
Owner tl"lUN\AI,J 'fMf'et2.-'7~e;" ~~~
Address4lO>O l\l.lAJ.AA IM".J\L.. kLllkJO ~ PhoneZ$!'..<llll
~-rIJ\>.J.o ,,[L, "I1",11.1'i1'1
Construction Lender
Address
Ut~HiN I tAH
(name)
~~~A
~- rL. 17401
Mechanical
CONTRACTORS Iname)
Genera I (-r&", 1N\'11 ~ ~"
Plumbina \foe.:. Lpw^,,~
Electrical GiS ~2L"TI2.l':"
~Iechanical .tft{z..\I~ ~ '1"/UU':.
Primary
Structura 1
Electrical
-
PLUIIB I NG
NO.
?
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
11 bath 1
Duplex (1 bath) each
[Additional bath
I ~Iater service
I Sewer
I Storm Sewer
Build Single
-;~ '~AP~~
Si'A~ t/I:- 1b4-'S
Phone
(address)
(lics. no.l
rexo;res1
fohone no.)
~'_~7.~_~~
~
4-1;'<:;;' 51 So
(addrE~ss l
llie,,_ no. \
(p)(O;I"P<;. ,
{OhMP nn \
,4<\-~ 1"~ SP(l.oJ?"fi~ 'll2.. "114-11 (,7'2- ~f:>~
"" 110 N I>J AA ,....j..I\'l,,,~ 't~l2l..U ~c.vu.., <>'L "I, <\-10 A _ .
<.r.-::.S 'D5<; I
?44--~t..~
(4(., - It. Zl
ELECTRICAL MECHANICAL
FEF CHARC,F Nn FFF r~AQ~~ NO "F r~AQr..~
Residence of furnace/burner to
?5C; 7;?fil; SQ. FT. I ~_ BTU's 7.S-e:>
, ;;~ ",-,,4,7"..
~ew circu!ts alts. 1001" fu rnace
or extenSlons and vent
? .:>~ ~&>J1tc5' <~.
I SERVICES I Recessed wa 11
~n~~p "P~tp~ ~nrl vpnt
I I I
ITempOrary Construction I Appliance vent I
seoaratp
Change in existing I S"tationary evap. I
rp$.i~PJH'P cooler
multifamily. COI1111. or I ':< I Vent fan with I~"'IG."""
Tnrlllc::tr;al sinole duct
I Of Ie::;-&> amps.1 ~7~ I Vent system apart from I I
heatina or A.C.
COMl'I.IIND. FEEDERS I I Mechanical exhaust I
hood "nd durt
I Install/alter/relocate I I ~'Jood s tove/hea tel" I
rlic;,trih fpprlpr~
IOf amps.! I ...-- I 6~ 73->>#.;0, '2.-
I I
I
ISSUANCF OF PFR!IIT
TOTAL CHARGES ::<::?,.>P TOTAL CHARGES ~.,..;;o TOTAL CHARGES /5:. ,5"'.0
WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
shall not be val;~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED 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 Springfield and the Laws of the State of Ore~on oertaining to the work described herein. and that 110 OCCUPAIICY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderls
Board is in full force and effect as required by ORS 701.055. that if exempt he basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OPS 7n1.055 wil be user Aln this project.
NAlIE(please print) ~ ~ SIGNATURE ~u.v. DATE 1/''$./s'b
FOP. O'FFICE USE QijLY ~
Sq. Ftg. Hain ,x Value
Sq. Ftg. Access x Value
?-~ Sq. Ftg. Othe,,'j;: '-'~x_/96::0PValue :2~~
TOTAL V ALUA TI ON
Zone L/
Fire Zone
Type/Canst. ~A~lJni ts
Bedrooms Occy Load
Stories / Occy Group
. I'//> "'" Plan Ck. COlllll/lnd
./e.-'. ""~ 65%/Bldo Por F..
------------ Plan Ck. R-es
".' B.:5'3' 30%/BldQ Per Fee
'27- 5i:? Fence
------------
/./? Oemo .
~~.ore> ISidewalk
-------:?~-I A/C Paving
.L s: ",s-c> I Curb Cut
--- n~-78--1
Flood Plain
BUILDING PERfIlT
Charges an~
Surcharges
PLUl1BING PERr-nT
Charges and _'~'
$urcha rges
ELECTRICAL PERIHT
Cha rges and
Surcha rg~s
HECHANICAL PERHIT
Charges and
Surcharges
I
I
I
I
\\'1'2.-"1
(10 "" '=' ?_(~.."..lSystems OevelopmenL
.0-,> , ~CharQe (1.5~)-::?~
I
I
I
I
tJ:1!...5:-
!Total
I
I TOTAL
Comb. Permit
-::<ZSI.9'(
3$6.9'7.
.
.
,
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot 1. 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. examole- waterheater/electrical/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 pennit information:
1. examJPle - construct single family house with an
attached garoge
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 ANO 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 OIVISION 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.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
PERMIT.VALIDATION
1? go> E:\ tP r -t:t
Permit Clerk
I
1;2..0 0./
A: CR O.D~~
~-A--~
Permit applicant exempt from registration with the Builder's Board because:
. Additional Project Infonnation:
'.
PLANS REVIEWED BY:
name
~73'He-fl~~ signature ~,...--. ~ date /5' ,'::::--B
~// ,.