HomeMy WebLinkAboutPermit Building 1990-10-22
"INSPECTION LINE CITY OF SPRINGFIELD
726-3769 COMBINATION APPLICATION/PERMIT
. ( \. I~ ENERGY SOURCE.S: lL'A":.
Job Address /2/7./9 :2./., .2 3 ;e ????...:~ T Heat~~.r af'.A'<L
Water Heater ~~~
Legal Description /7~":Zb-/o// ~ 3'6C4:::> ,...
, Range
~_T/.$.P~?? :9psl
Owner - t/ ALA: L<,./A~/S?/RE
- . .
Address /0// MA"/# "57.
p . ~ ~
5,Prm;/ e::>,7? 9~;?
Construction Lender.
Address
DESIGN TEAM (name
Primary GO 2/~~~i/~.7
Structural
INFORl1ATION UN!:.
726-3753 -
Sq. Ftq. r.1a i n ~ ":37"",
:q. Ftg. Access. -
Sq. Ftq. Other
..c.r~e\~_Add~l ter _Rep.
Fence Demo Change/Use
-Other - - -.
~
~
~
ValuE of Hork:
l~~,~7S'. 30
BuiTcfinq Permit Info: Describe loJork(i-.e., Build Single
Family Residence With Attached Garaqel
7$1~'95'20 C~N-:;7?I{')C7" 7"~e.x ,40 _'
,A~~~.(:~~ _.;f;7:i:F ,M7J~~6?7i!)
Phone
(phone no.1
!1echani ca 1
CONTRACTORS (name 1 .I .. / (address).
7) /d -. ~ ' 2~""3 V/7/5,r:~1"" /(t/
Genera 1 f7k /.F/C. J?TV'/'77~ ~~R~ &:?f'. ~
Plumbinq
, S.. F. Res i dence I I
11 bathl
I Duplex (1 bath) each I' I
IAdditional bath I , I
<~rHater servi~e I 1:zS?o")'
/2.31 Sewer I I o/t?.. #t>
'19~ 1 Storm Sewer I' S~ 06ll
/ l&Hp~w tewJr- /,..~l
r ., ,
, I I 10f amp~1 I I
I I 1?~~~&=:cc-ee:V'-':/~C I
I I ~ft:)~7- ~~/8~ a. I-
I I I r , I I I ISSUANCE OF PFmm It?, 5&:1'
TOTAL CHARGES ., 2:7 r~ I TOTAL CHARGES J TOTAL CHARGES ':/d?,. ~t:>
. WHERE STATE L'loJ REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be valid 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 performed 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-NO OCCUPANCY 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 comDliance with ORS 701.055 will be used on this project.
- -"1M' -
~ -...)- \ 'vv WAy i'vJ t R ~ ()
rw.1E(please pri - /}{'~ - - . - SIGNATURE~ Viv'^~ DATE I oj:;.. 1./9.. j)
I ") ~ FO~ OFFICE USE OHLU U ~
Zone ft?z;Fj'( Type/Const. 5..../Y' Units~~~ Sq. Ftg. r1ain 3~"..;"c:;. x3B. 'ft::) ValueJ?~'2~):?~
Fi re Zone Bedrooms :'"'.........;J( ~ Occy Load~ Y //- Sq. Ft!]. Access x Va 1 ue
Flood Plain Stories 2. OccyGroup ~-/ Sq. Ftg. Other~h~ T~.~Value ~~.~~
.~ ~E"~~ ~CC' ~""i-i) ~ ~2~..?9: &~,~.tI:7-'.>""'. TOTAL VALUATION/~~7S'__~lf!:)
CBUllaILrgDeINsGanP.~RNIT - __ .~_/J~_'_J_~_~_ Plan Ck. Comm!Ind 1t{c!).Tn.t:5~ Systems Development I
:: .....-LV -;;i1 65%/Bld(l Per Fee In/&; .,7f89J. Charge 0.51,) - '26)?'S:/::j
Surcharges -Z!""": I L.I Plan Ck. Res I I
-~.I' / 30%/Bldq Per Fee
---?~~~~-- :::'1 5."~ ~'~'~-/~/:;'
____________1 Sidewalk /PO' I 2?... -- -I, I
INC Pavi~g~6,/SIJl6. .I S""6_ 5't::!>. '..Irotal Comb. Permit': I I t?/~. 9.,
-____2"4~~__1 Curb Cut '30" I'f. 5"'0
/.~~ I I
Electrical
Electrical
~1echani ca 1
PLUf1BI NG
NO.
I FEE CHARGE
I
Ii? ...... 2 6ttJ, "e
:7a
Each single fixture
Relocated building
(new fix. additional)
PLW1BING PERMIT
Charges and
Su rc ha rge s
ELECTRICAL PERrm
Charges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
39/-C?::<~~
(1 ics. no. 1
(expires)
(ohone no. )
-:<:;gt!'99
c~/
ELECTRICAL
MECHANICAL
NO
I FFF I rfjARGF t
FFF
rHARGF NO.
Residence of
furnace/burner to
BTlI's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
'TempOrary Construction I,
IChange in existing I
residence
Imultifamily, comm. or I
Industrial
'Of amps~
ICOMM./IND. FEEDERS I
I Install/alter/relocate .,
distrib. feeders
I
I
Ii
I
I~
I
I
I
I Appl iance vent I'
seoarate
I Stationary evap. I I
cooler
I V~nt fan wi th 1-2 QP I i'5 ~
slnole duct ;n f"
'Vent system apart from 1 I
heating or A.C.
" Mechanical exhaust lull:;t;J/ /j2e$
hood and duct r. ~ Ir~.
Il-JOOd stove/heater I I
, I ,
I I I
I I I
Recessed wall
S ace heater and vent
TOTAL
'1'2. <{I. 75" J
r,
l :.....'..~"
COMBINATION APPLICATION/PERMIT"(CAPY "
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
" "Springfi~ld~:Est~~es. " ' '. ,..... '. " ....,
C. Name, '.etc. "of owner and construction lender .' "
D. Energy'Sources ..., \ .....
:";1: example~~"heat/electrica'l ceii'inqior :'f~'rced air qas
2. example- waterheater/electricalior 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. .example - construct single family house with an
attached garage
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 Spec.ial.ty Code.. ~....... _ ~1 . ~.... -
H. DESIGN TEAM AND CONTRACTORS ~ .... r.
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
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 schedul es
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 b~ 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.
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.
II.
III.
IV.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMJl.V AL:IDAT.I ON
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, Permit appl i cant exemp,t fromre.9i s.tration with the Buil der I s Board because:
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