HomeMy WebLinkAboutPermit Building 1989-3-10 (2)
r ~m~~mo,N LINE ., COMBlllm~NU~p~m~~\m~ERMIT .
~~ III"!PZJI' I A:717) / /112- E!lERGY SOURCES:
' Job Address -'-I-' ~ KI...tU../!.tU1L.-v WVI Heat
Le~al Oe~cription /' t Hater Iieater
/7-~'22.'2R azS"~ Range___
Owner ll--rSgjfi-emt!:- valU,'O?t,,:,g-O, ~D
Addrcs's j//A-I-'\' .J..~t;JJf I. (-~ Phone/-(J3 Buil{iinQ'.tPennit info: Oeser be Workli..e.. Build Single
I.f () () J..:JJ".1 ~/... CLJD. Familv l1esidence I'lith Jl..ttached Garaae'
4ft'{ YnE:/~ / Q12-,// O. j/ M""~~"AA/
constru~t'~ -L~der } ~) .~~ ~JC-
Addro'. U~ bu,lcLwf),~) I'hoo",' '/)l1r&-n Aajjl
DESIGN tl (name) -u..--- (address) L nics. no.) ~(exnires'1
INFUR/tAnON L,"t
726-3753
Sq. Ftg.. 1,1a I n
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep,
-Fence Demo Change/Use
Dther"'- -
~I
-Q
P
I~
.~
I
(ohone no. I
Primary
Structura 1
Electrical
f1echanical
CONTRACTORS
Plumbino
If/JJe ~/ I~~OA/')
_ _\.. v /
(~J- S f~
J'?Ud/mJ/U
(l ice;, no,l
(exni res)
(ohone no.)
Genera 1
t,g 3 -
/51&
Electrical
fo.1echanical
PLUIIBING
ELfCTRICAL
MECHANICAL
NO.
FFF [HARGF Jj(l~
FFF rH~ -pO.
~H r1.1ARG.(
Each single fixture
Residence of
SQ. FT,
furnace/burner to
BTU's
each
-1leWCircu~ts alts.
or extenslons
-:2 e>7? >'lh6Y<? (?
I SfRVICfS
I
~:?S'e
I I
I I
Floor furnace
and vent
Relocated building
(new fix. additional)
IS. F. Res idence
(I hath I
I Duplex (1 hath)
IAdditional bath
I~rater service
I Sewer
I Storm Sewer
Recessed wa 11
So~ce he~tpr ~~rl wpnt
I
-Ilj::z:o a-~r~
I . T .. I'
I I
I
I
I
IS.~
ITemporary Construction
Change in existing
rpsioPJ1ce
multifamily, COfl"f!1. or
Inrlllc;;:t.r;.::l1
IOf
IC0f111./lND, FEEDERS
IInstall/alter/relocate I
rli<;.t.rih. feeders
amps.1
Appliance vent
sp.oarittp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatiOQ or A.C.
Mechanical exhaust
hood ~nd l1urt
Of
amps.
I
I
~/ -",P N'Af L ,..?7 ~h';."'5I--1
:P~/'>>/7" ;;?F&J;??dP
'I' /fC I I
Wood stove/heater
TOTAL CHARGES
WHERf STATE L~W REQUIRES
shall not be vali1 until the
L<:;: O>i:> TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
I
I I ISSUANCF OF P<RI1lT
::2:2sz::.l TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I liME CAREFULLY EXAt11NED Ule completed aprl.ication for [lermit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel)on pertaining to the work described herein. and that UO OCCUPArKY 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 reC]uired by Or..S 701.055, that if exempt the basis for exemption .is-noted-hereon. and that
only subcontractors and employees who ~e in cO","liance with Or.S 701.055 '~jJsed on/hiS project,
IjAIIE(please prlnt)K1c..t:::- -Pr1.::.t0~Of\J SIGlIATURE/lmmv Dm3-/(}-P.7
Zone c: r:::.
Fi re Zone
Flood Plain
FOr. OFF I CE USE OIlLY( /
Type/Const,_~~ . Units S~. Ftn, Hain
Bedrooms Occy Load Sq, Ft~. Access
/ , B-2 Other mr.
Stories . Occy Group Sq, Ftg,
BUILDING PERI,IIT
Charges an~
Surcharges
. ':ZB2~' ~~~~R~~~
-----;~;S~ ~6~~B~~~
J;c-'~" Fence
-----~:---_.-
-;0-
_ n_ ~::5::.~-' Sidewalk
/./3IA!cpaVing
COnlnll nd
Ppr Fpe
Res
Per Fee
7:,-/0 ~'5q
'33//1 0' c-, syste. ms Development
\ <P / (l ...." Charqe (1.5~)
x Value .....
x Value ,
,T.""'h~~ Val~e:---5-q
TOTAL VALUATION
';y:~
"
PLU'1BING PERMIT
Charges and
Surcharges
D~mo
1I.tfN',?jk.///s ......~~
.#r;>~~' 75!./3
I
ITot~l Comb. r~rmit
iTDTAL ~O? b6 ,
ELECTRICP,L PERI~IT
Charges and
Surcharges
/lECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
.
t
-~
.
COMBINATION APPLICATION/PERMIT (CAP)
,..
,
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B, Legal Oescription
J, example- Tax Lot 100, Lane County Map Reference
II UJ 43
2, examele- Lot 1, Block 3, 2nd Addition to
, sprlngtield Estates
C. Name, etc. of owner and construction lender
D, Energy Sources
1.., example- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electr;cal/or solar
E. ~quare footage or valuation, etc. -
I, example- 1250 sq, foot house, 500 sq. foot garage
2. exa~le- 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. exam~le - 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 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 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, ---
Ill, 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.
I ) <-(0 7
3-(1~f f
V, FOR OFFICE USE ONLY
Permit Cl erk
&~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS,REVIEWED BY:
name /~N'<f: ?l~~
signature ~ -pa~ ~
- '" /, r - ./
....,
date
"3/'/-9''7