HomeMy WebLinkAboutPermit Building 1985-8-26 (2)
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'f' . I SPECTION "ILE CITY OF SPRINGFIELD
I : 1'1 ell COMBINATION APPLICATION/PERMIT
...., ,1726-3769
(.I "'Att....,~e"...,.. ) ErlERGY SOURCES:
Job Address \ 501 ~ 1f>~A~tJZ ~T. \~'?""~~' Heat
Legal Description t1-o-s.-"7b '1Jrt.. wt "700 t~ater Heater
Range
Owner R>N CGtNlNC::t ~T1t/N
Address \[01 Czr;,l~ %
~~Flap I ~ '11t.t11
Construction Lender ,C>>Ml4t5\2- ra>tJP. ij.~,
Address h\1?U:S)4/0. M\Ck\tc~
OESIGN TEAM [name)'
. Primary\Yl~7 ~ 4t }..0"Jf.-"
~rra:r7) ~Jr! ~ULIW:
Structural ~b~ w.h<?A.9l'J~
Electrical HO~[ iX~ ~_:nzu:.., Co;
f1echanical ~"t~b1~ t~&
CONTRACTORSN'(~'~~'~
: General MR.)l~.c; _~~ 7504 A4~~~.
Plumbinq ~.JY/R
, Electrical .~~cO!!::V~ E rC:.:;7"7"
~lechanical EM../<"
INFORllATlON UNl:.
726-3753
Sq.. Ftg. r,la in
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other - -
~
~
tv
00
ValuE of Work: '
*58'0.. ;I9..0 ,cx>"6-,~.
Buildinq Permit Info: Describe Work(i,e., Build Single
Phone'}""'~lb14 Famil y f(es i dence With JI.ttached Garaqe)
~~L&- ~aJ(b(, \l-}4 /,' ~HIlt~.
I i
(~~")' ~~~G) >?\'~bh
(lics. no.) (exoires) (ohone no.i
~F~
\4,Cf
Phone
(address)
J.t?i D (CFJZ6. tlt?
~Z-&311
~~'?'~'
~o~
(lics. no.) (exoires)
Ev.r;es;,E
'~lqb PtlJ41lU4 6tV)?
~ )-1C~H4lb(
(address)
7Zh":'7ht!f1
b l)b-;!) tn 7?
(ohone no.)
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PLUfm I NG ELECTRICAL MECHANICAL
NO. FEE CHARGE NO. FFF fHARCiF NO. I I FFF I fHARCiF
Each single fixture Residence of ~ furnace/burner to
'5" S-.j ~2 S' SQ. FT. BTU's 6:"0 ~.
Relocated building New circuits alts. Floor furnace
(new fix. additional) or extensions and vent
IS.F. Residence
(] bath)
IDuPlex (1 bath)
IAdditional bath
/Ad'IHater service
, ~S'I Sewer
J~lstorm Sewer
I
I
I I !SERVICES I I I Recessed wall
Soace heater and vent
each I I I I l:z I~ (/#.IT5
I I ITempOrary Construction I I I ~~~~~:~~e vent
I I #f.I.A I Change in existing I I 1 Stationary evap.
~v residence cooler
'I I 'L"" I multifamily , comm. or I _ I ., IV~nt fan with 13 I'"
I Iv ,/ .1'Jn1'O~dU:;~~_~ amps.1 I~ I ~I ~~~~~~y~~~~ apart from IU~ :
1/15 ,., heatlng or A.C. ,.- I ,7
I I IC0t1r'1./IND. FEEDERS I " I Mechanical exhaust Ida:P 4
'.. hood and duct Jr~~-I 1'.
I I I Install/alter/relocate I I I Hood stove/heater ,. I
distrib. feeders
I '1lof p:se> amps.V~ YO I~ IA'~1/.A-~AI,IY:lf2 1/.2,
I I II ~S- I I ~ s I ~ /,) ..; -? I I
I (I -.zstP I 12rl I I I
I I I I I I SSUANCf OF PFRrm
TOTAL CHARGES r'7S:-<lIlO1 TOTAL CHARGES I~~ 011oO I TOTAL CHARGES 1:''/. 4~
WHERE STATE LAH 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 I
cl6 --1/2 .
I I
I I
I HAVE CAREFULLY EXA/1INED the completed aprlication 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 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 comoliance with ORS 701.055 will be used on this project.
fW1E(please print)
Zone ~H-
Fire Zone
Flood Plain
BUILDING PER~lIT
Charges and
Surcharges
PLW1BING PERMIT
Charges and
Surcha rges
ELECTR I C,ll,L PERrm
Cha rges and
Surcharges
MECH~NICAl'PERMIT
Charges and
Surcharges
SIGNATURE
FO~ OFFICE USE ONLY
Sa. Ftg. t1ain x
Sq. Ftg. Access x Value
Sq~tg. Other--i!itYI'H-~ x Value 24;,. () ~~.
rGri:~) , ' TOTAL VALUATION~~/~, ,.
'-. &.~I..._1FO ,rp~rr? ISystems Development Ie> 7.A ~ e5'
1Ic.PT#~P~~ Charge 0.51,) , ~ L-'c;... t:)
", 1- I~ ~
I rt;t/CI5~~':r( -' If. $"0 ,)
I I I ---- . .---
I I I '~/C).54
I fiB. ...._ ITotal Comb..rermit I Jg.,.r.CJr
I --ITOTAL ,~t'18.31
Dft,TE
valueJ"'~'I/,g. p.1
Tyoe/Const.31- H
Bedrooms
Stori es
Units
Occy Load
Occy Group
~ 1./.., ..-e. Plan Ck. Comm/Ind
~r 7..... ' 65%/Bldo Per Fee
------3i.~$ j6~~B~~; ~~~ Fee
____~.7~_~-' Fence
, 19~ ~ I Dtlmo
-___t6!2:...~_ Sidewalk
-7 ~,~ A/C Paving
. 5't.. .'~ I ~~;'bC~t
!------2./~-1
11
COMBINATION APPLICATION/PERMIT (CAP)
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
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources "
1. example- he,at/electrical ceil ing/orforced air qas
2. example- 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 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)
~. Value of work as defined in Section 303 (a)' of the. .
. ~-:... 'Structural Specia 1 ty 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 Bujlding 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 irijtial application will be used as
a worksheet only. Where' possible, Building Divislon 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 o~her Jees <!nd charges are due and
payab 1 e whel1.the per~it is i s~ued. ' ,_ ~
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III.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
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. Addi,ti ana 1 Project 'Infcirmati on:
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PLANS REVIEWED BY:
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signature
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