HomeMy WebLinkAboutPermit Miscellaneous 1981-2-6
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INSPECTION LINE
726-3769
Job Addreu
legal Description
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Conl.ruclion lender
Address
DESIGN TEAM
Primary
_Structural
t:ledricol
Me-cho:-:1tnl
.s9!.nRACYQn~
GenoroL
Pl....mbin~
Electrica.
M~ch(]ni":<:I1
NQI-"-~'''-
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Each $in~le fixture
Rcl(lcotod building
(now fix. additional)
S.F. Ruidence
(l bath)
, I Duplex (1 both) each
Additional both
Water Jorviee
Sewer
Storm Sewer
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..s~~....~ed~1t. ot-
CITY OF SPRINGFIELD . INFORMATION LINE
COMBINATION APPLICATION/PERMIT 'Q\ cl~ jUo::::' 726-.3753
ENERGY SOURCES: i Sq. fIg. Main 10'12
Hoc" ~- \ P C Sq. Fig. Acc.on.
Woter Heoter ~ I G ~ Sq. Fig. Other
, ,oC)+-" ,~" Ronqe ~ I ~_c.... _New_Add_AlhH_Rep.
Value of Work: _pnce_Demo_Change/UslJ
~~ 2 00;:) ~O'h" t'>".ohlio" f<>.t.
"'~.I'.'" ,_,) \.o....ov~
Building P~r;i't-Inf~;. Describe W-;;~k. (i.e., Build Single
Phone Li8S-1 ~ <..Z Fomily Residence With Attach"d Gara'!!)
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.(f:.. p,p., At J.IJ(yJ:tL ;;:O/YU I
11- O:S" 2 7 - Lj 2 .2'-/00
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Phone
(name)
(oddreu)
(lin, no.)
(phone no.)
(expires)
o ~ 'i"SL("" / P IJJ" c...- h.<>. ,........
(.lam!))
(addrlln)
(phort& no,)
(Iin. nc.)
(expires)
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Il S '-.J '2. 7rr'\-.
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3~",p
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-'-Fu'TCHARGE INO: ,--
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ElECTRICAL
MECHANICAL
'TFeE
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CHARGE NO.
FEl
r';-ARG,
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furnoce/burnl'lr to
ItTU's
Applionc3 vent
separate
Stationory ovop.
coolor
V..nt fan with
singlo duct
Vent sy5f6m aport from
hoatinQ or A.C.
Mechanical exhaust
hood ond duct
Rosidence d
_s9:ft.
New circuits, alterQtiora
or extensions
SERVICES
Temporary Construction
Amps.
'Wood stove/heater
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-0-
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10,000 CFM
P lMA.lI;:\ (\ .Mill orfuix I
t2&aco.'6.d PMQ
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I TOTAL CHARGES
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/5,02 I
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Amos.
r: hr k.la~ it>arvxd ~
Rdcrffihd &~
/5,O!:!
ISSUANCE OF PERMIT
15.o.~
WHERE STATE LAW REQUIRES that the Electrical work b. done by the Electrical Contractor, the C1lectrical portion of this permit..shall not be valid until.a
laboi has b_n signod by on Electrical Contractor and attached -to the electrical panel.
15. Oft
TOTAL CHARGES
TOTAL CHARGES
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is trup. and currect~ and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of thtJ City 'of .Springfield and the laws of the State of Orogon
pertaining to lhe work. described herin, and that NO OCCUPANCY will be mode of any structure without tho permission of the Building Divilian. I further
certify that my r&gistTation with.the Builder's Board is in full force and effect ns required by ORS 701.0S5, rhat if exempt the bcuis for.,xemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will bo used on this project.
NAME (please print)
Basis for Builder's Board exemption'
'P1 W"; c.. ""
DATE
t<A
Zone
Fire Zone
Flood Plain
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SUILDING PERMIT
Charges and
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
ELEORICAl PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
,."
Fr-.L..i W
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zIt, J E'>I
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SIGNA TURC:
FOR OFFICE USE ONLY
Typel ConH.
Bedrooms
C;torieil-
\J/J
x
Volue
Value
Valul
_Units
""ccy Load . -
Occy Group_.R '3>
Sq. Ftg. Moin
Sq. Ftg. Access
Sq. Ftg. Orher_
x
x
TOTAL VALUATION. .!l,aQO.~
Q.o,op
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15,05-
,(pC
__--15.0,9 ___
,"'.9
Plan Ck. Camm/lnd
65%/Slda Per Fee
Plan Ck. Res
30%/ Bldq Per Fee
I,:::>" al1ouu. ,;
Systems Development
Charae O.5%)
0,00 PD2-'h-'lJ
~ 6 r=;)//"~
36C),0,9
Fence
Demo
Total Comb. Pormit
J~.
''d-iD
Sidewalk.
lAIC Povino
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Curb Cut
052..;;).2
TOTAL
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Addilional Projecl Inlormotion, L0;,.., ~nA1>> D1 j:J.(p()
/J /,. .."p.
fJ-P, f'Jf'.I~ri r::U/}/Y trZkr/ rLUIVl A:/)
/..M /)fJpf' .1/ rm.J .
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~ addA1//7VJ/J} /-/)f'Y(jp,(/;,' ~..r:b./L/1'O.
t - pt-.. -~ I '::-- ~,-'
ppJ.J.JrY1 (~) ~DL/lifJMJ,N" ~ / g:!I &..DJjJl1'g ~.1 H .Pfl ./11> g..llll D~
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COMBINATION APPlICATlON/AIT (CAP)
I. Applicant 19 furnish
A, Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Relerence 17 03 43
2. example-Lot 1. Black 3, 2nd Addition to Springfield Estales
C. Nome, etc. of owner ond construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air g05
2. exomple-woter heater/electrical/or solar
E. Square footage or valuotion, etc.
1. example.1250 sq. loot house, 500 sq. loot garage
2. example-if new project, check new.if addition, check
odd, etc.
F. Building permit information:
1. example-construct single family ho',se with an attached
garage
2. example.remodel existing 90r0ge into family room
3. example-convert single family residence into
restauront (~hange of use)
G. Value of work as defined in Section 303 (a) 01 the
Structural Spedalty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Division
Stoff must be aple to contoct appropriate persons regarding
design information or job site corrections, etc.
II. Abbrevialed 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, Me<:hanical, and Electrical Schedules
are available ot the Building Division
1. To conserve 5pace on the permit form the schedules
have been abbreviated
2. If the item(s} to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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 typewritten copy ond return it to the applicant at
the time the actual permit is issued for his signoture.
IV, Fees and Charges
Plan check lees are due and payable at the time of the application,
and no plans will be processed until these fees ore paid. All
other fees and chorges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
PLANS REVIEWED BY,
~^-" Pl:1lMIT VALIDATION
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Permit Cler~
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name -r- ()'")I.L 5kC1.llr m IA
signature
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date
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