HomeMy WebLinkAboutPermit Building 1984-2-8
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726-3769
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Job Address (;; 3 ;2,
ega1 De5cription \ 1
wner VV1 V+~OYL J)I[F O~
Address Cj ""33 ') () /-1--( q 7 00
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Cons truct i on Lender S /:J-;}:7 ~
Address
DESIGN TEAf1
(name)
(~(,.0Jck
Cr~~
Primary ~ I~
Structura 1 W 0D d
NcJA//'f
Electrical
Mechanical
CONTRACTORS (name)
General ~_-/~
. I
P1umbino
Electrical
~'echani ca 1
PLUflB I NG
NO. '
, FEE 'CHARGE NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
~/ater servi ce
Sewer
Storm Sewer
c..(5J
PI t'"_ \_A"\\ \\ '\\ \ U~ \~.-- \ .J.
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CO~lBlilAT 10:1 APPUCATION/PER~1IT
"':fcqr'rrT-,..,q ~ T .,.= ---"t
126-3/:13
Sq. Ftg. r.la in
~q. Ftg. Access.
. Sq. Ftg. Other
Ne\~ Add Alter Rep.
--Fence Demo Change/Use
Other-- --
- - =--'f V\) ~
~
~
~
~
'{)
o ~ '5(11)
ErlERGY SOURCES:
Heat
\~ater Heater
~\ 7i7-//l0
PhonW.rc?rb' )
Range _
Va1l!6J Horkl/? /,C)<.--"
;'If::QCe: 1f:;?7~ ,
Buildinq Pern,it Info: Describe Work{i.e"
Family nesidence With Attached Garaqe)
Bui] d Si ng1 e
c~\)C?'{ \\:'J'e>\,\ \.(')\. ") ~
r-:'(\~\\\\r." ~k'\\\. ~\\. '\l
Phone
(address) (lics, no.)
\Z.. y..J ) ~ ..-v L C. {' ; ^'" \ -
(exoires)
\
(phone no. I
(address)
(lics, no.)
(exoires)
lohone no. )
ELECTRICAL ~~.
MECHANICAL ,,\ ~.
, FFF . f:HAR(;F NO,'
FFF I f:HAR(;F
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
. Recessed wa 11
Soace heater and 'vent
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sina1e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Of
amps.
COMM./IND. FEEDERS
Install/alter/relocate
di5trib, feeder5
Of
amps.
I SSUANCE OF PFR1lIT
TOTAL CHARGES \5. CD TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED 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 OCCUPAllCY 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 OP.S 701.055 will be used on this project. '
. LNo/'1/f # 7~ 7- / J 2- 0 " /)
NAr'IE{p1ease print) 11!ksoyt 'Dc.FO'i.. SIGrU\TU~M/i::--t~~~
. FO~ OFFICE USE OilL Y I V
Zone ~ M Tyoe/Const.\)-"l~'MIlInits \ Sq. Ftg. r1ain~\?_~rd' x
Fi re Zone - Bedrooms - OcCy Load Sq. Ft9. ~~s ;\ \ ~d x \ .'2.5
Flood Plain Stories \ Occy GrouPn-'2. Sq. Ftg. Other~\~C) x
, ClC <..::><.:-J . Plan Ck. COIlUll/Ind
__.:J.~'______ 65%/B1da Per Fee
'::) 8<..) Plan Ck, Res
\). 30%/B1dq Per Fee
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____-..!...l.!______
. CO
BUILDING PER~lIT
Charges and
Surcha rges
PLUt~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERf~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'{
DATE 2/;f /J?y.~
Value
Value
Value
~.q~'1
\(0. (0<:\-5
TOTAL VALUATION '2D, ~ ~
~.co
"~..,-.:." A.k
-'_<,:,-_c-4'~:>/""3{OD Systems Development
~ o-~ VW_ OQ Charge (1.51,) ,
Fence
D~mo
Sidewalk
A/C Paving
ITotal Comb. Permit
,- .
I IOTAL _
4 2. I.{ ~L( .
~,
Curb Cut
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
.
.
I. Applicant to furnish
A. Job Address
B. Legal Description
1, example- Tax Lot 100, Lane County Map Reference
17 03 43
2. examp1e- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examp1e- heat/electrical cei1inqjor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examp1e- 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 ~f 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
fu 11 schedu 1 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., -
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
payable when the permit is issued.
\
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl icant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name.~\1\L/-:.\ \ (\a') \
Signatu~.r" ~ ~ ~'~~e '2.- Q_1-~L.\
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