HomeMy WebLinkAboutPermit Building 1985-8-26
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CITY OF SPRINGFIELD
1,~~~~~r~ON LINE COMBINATION APPLICATION/PERMIT
'(tli~~) - EtlERGY SOURCES:
Job Address \501 'b1. \~'e5A~l:IZ t.7T. 3Ot>-:7t1,M- 0\. Heat
Legal Description n-07'7b l1rJ- wr -'700 Hater Heater
Ranqe
Owner toN ~lN6J ~LATlC1"
Address \i;O\ 7-0,'/\ 0'r.
~vlHBtrtap I ~ Q'1t.l1l
0*Il-'~ f <<e. ~&,
Address H\~V, MlCk\t.c..,N-.l
DES I GN TEAr4 (name)'
, ,Primary \Yl~0 ~ * trx; y..... '
~~rret-T7) ~Jf COO'ULtH:
Structural ~bULMhW 'i,,&.b'?Aot)('~
Electrical HO~l \X~ tL~(l~H:..... Co.. 31qb Ft'lNllU4 6t.vP
Mechanical ~"t"\7Ot.11l. ~ 1 ~C/
CONTRACTORS (na~~\"
General M~~ ~~ ~~ A-?~.A1)I;o~.
Plumbina ~~~
Electrical .~~~'~c:::..;;r-:>
~lechanical € MK
'5' Each single fixture ~-~ "2'5"
I
S.F. Residence I -1 SERVICES ~ Recessed wall ,
(1 bath) . S ace henter nnd vent
IDuPlex (l bath) each I-I:z r~ U#//iY 4!;"" /Z,
IAddition~l bath I Temporary Construction '~ I ~~~~~=~~e vent I
~/Ad'IHater service I 2tP ~~:~a:n~~ existing III ~~~i~~nary evap. I
:~Slsewer I If) I . ~~~~:~~~~g'::' or I I I z I ~~~~l;a~u~ith 13 I t;
'I "r II - Of- u~ amps.1 14i:i' I'" I Vent. system apart from I~ ~ 0
}tItf; Storm Sewer /.;;J -.J' ,~ "heatlng or A.C. .- I /
I COI~r'1.IIND. FEEDERS I , I " I Mechanical exhaust lu'a:P 4
-~ hood and duct Jr~~-I /.
I I I I Install/alter/relocate I I I I \100d stove/heater I I
distrih_ feeders
I ~.lo Off. ~ amps.iI~ I Yo I~ 1~'~r",A-~IJI,P~02 /2.
I I-~ / ~S- I I.lS I ~/h--f,-J
I I I (I '2 st:::> I 12.)1 I I
I I I I I I I ISSUANCf OF PFRr1IT
TOTAL CHARGES o/'7$:-4IOJ TOTAL CHARGES 1l!iJ::;. .0 I TOTAL CHARGES C'I. .60
WHERE STATE LAW 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
Construction Lender
NO.
INFORllATION Li,'jt.
726-3753
Sq. Ftg. Hain
~q. ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other -- --
!~
\)i
~~
N
00
ValuE of Hork: _
~58'(),)" t:fO, 00 L~-l:;
Builc:ina Permit Info: Describe Work(i.e.. Build Single
Phonl!}4lo-1b1' Fami 1 v nes i dence Hith /I,ttached Ga raae )
~W7lL&- /ifaJ(l....( i V-}-\, 0W,)HIlt~)
~, ~ * ~ l1Ma}/i.Qt:~ErZ..- )?l\1b7
Phone (':5l37[~ it>) { 4\w tp ) "
(address) \ ~ ~c~~~ (exnires) (ohone no.)
~/) (d!dtA' \4-7C( ?1Z.-/~?11
doklH G. SI~1
~tI""l..t:;
Eroo )>-1C~t~lbf ~o~
(lies. no.) (exoires)
Ev.t;E;rE
(address)
7Zb":'7/Pt!f1
b lX:r 0 tJ 'h
(ohone no.)
687-:<:<8"/
, I
PLUflBI NG
ELECTRICAL
MECHANICAL
FEE
rHARGF~ NO.
CHARGE
I FFF
NO,
I FFF I rHARGF I
Residence of
furnace/burner to
BTU's
,r
SQ. FT.
6.~ ~.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
I HAVE CAREFULLY EXAllINED 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 oertaining to the work described herein, and that flO OCCUPAUCY will be made.
of any structure without the permission of the ~uilding 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 compliance with OP.S 701,055 will be used on this project.
rW1E(please print)
Zone .." H-
Fire Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLW~B ING PERMIT
Charges and
Surcha rges
ELECTR I CAL PERI~IT
Charges and
Surcharges
I1ECHAN I CAL PERMIT
Charges and
Surcharges
Tyoe/Const.y- H
Bedrooms
Stori es
SIGtlATURE
FOP. OFFICE USE O~LY
So. Ftg.
Sq. Ftg.
Sq. Ftg.
DATE
Units
Occy Load
Occy Group
rlain x Value r~'t/1.B.
Access x Value
Other-iiitY'JIr~ x Value ~~, t!> ~-:? -.
. TOTAL VALUATION~../9~. ,~
I&';:S-/,.)$O '~P<:>.r? ISystems Development I ~ 7'"'" ~ ~5
1A'c"PT#~/',.t ~ Cha rqe (-1. 51,) ~ V' c;... 4::::)
I . I
I ~~~~~~ - I?~ ~O
I I I
I I I
I
I
I
C:Ilr t/-, ~ Plan Ck. CommlInd
-r 7 ~. ' 65%/Blda Per Fee
------~--- Plan Ck. Res
,/ / . 6$ 30%/BldQ Per Fee
, f:?rt"" drO I Fence
-'----;9:-~-1 D6mo
____tSd:>. ue I Sidewalk
'7.. ~ I A/C Paving
5</ .'t/TO I Cur'b Cut
------;~/~-I
,
fiB. ...
Tota 1 Comb., Permi t
JB7r.CJr
,~ ~/8.31
,
I TOTAL
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- , -., -- -., '.- -~--.._.~_.....~.. " 'f:-<---"-'-'~
~ - # ,- - (\ -- - - -- ." - ~~-. - -. . ; ,f! ~-!'I~.-""~.~"'~" -. --------r~.....-~--~-,-r'"
~'-"" !tI!r~..~~~'\~.... .:. . ~~ t-:_'._~ .....,,-, ~~~:;r~~~~~~~T.'~~~"i":;.~'f~.'.:J;(~t.lc",,"~~:.~~/~~~""""'\t'fo~.~-:, ...~.-d-1"il~f."'.!F;~"">:n--!!" _~.,,:.-...~ .~;
Department of Public Works
OFFICIAL RECEIPT
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address . i
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates ,
C. Name, etc. of owner and construction lender
D. Energy Sources . I '.. ;
1. example- heat/electrical ceilinq/or forced air ~ ~
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garag
2. example- if new project, check new - if addition c-
check add, etc.
F. Building permit information:
1. example - construct single family house with .an
a ttached garage ' "". (
2. example - remodel existing garage into family ro
3. example - convert single family residence into
restaurant (change of use)
~. Value of work as defined in Section 303 (a) of the
..' ." -, ...., .Structura 1 Spec i a lty 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 adjacer
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 schedulE
have been abbreviated .
2. If the item{s) to be installed are not covered or
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
'~upervisor. 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
payab 1 e when .the permit is i ss.ued.
(
. ....-;.,.....,., .d,...._, '..~-.; No. B' '65236
Date ~ ~I 19$<:
( Rec'd FrO~C;~~~];~f:-:~' .~t:: ..
Address ~.~. ""'~I_ ~? f'~2
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Received For: J~~:!!!f ~
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( . \..... . '~THORIZED~I~ATURE/ '
Amount Received
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QIIC::INI=="" FORUe:: INr
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V. FOR OFFICE USE ONLY
Permit Clerk
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
... ' . .1" l
''''':. '.
'. i
.. Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
n~m~f.bR~~ ?Z~_.......
signature
~.
~.. '~C'.date
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