HomeMy WebLinkAboutPermit Building 1980-9-22
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PlINSPECTION LI"E
726-3769 "
Job Address tjO C; 7 ((-; /'yi ~ clr~_
Lega 1 De~cri pt ion 17 -i'1 .2 -' 3/, t./V
O~mer
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Address
46';7
Construction Lender
Address
DESIGN TEN1
Pri ma ry
I Structural
,
l Electrica'l
I
! 11echanica1
I CONTRAUORS
,
I G',nera 1
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I Plumbinq
j Electrical
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Lllerhanica1__ __ __ ,_
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Each single fixture
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
Hater Heater
INFORI1ATION UN!: I
726-3753
Sq. Ftg. r.1ain
~q. F'tg. Access. SJ":L
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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Ranfje
ValUE ofl';O{b <::I::?./ I 06
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Bui1~inq Permit Info: Describe Work(i_e.,
Family P-esidence With Attached Garaqe)
S ;-10 f
Build Single
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7'1(,,-''157
Phone
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(name)
Phone
(address)
(ohone no.)
(1 ics. no.)
(exnires)
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· . . ,X~, }~ECT~~ICAL_.h_ ._.___.... ~~:~~~~.ICA~, j . _ _ .._~
1...fEE I'CHARGC,j~cL:-=-=u~--,.---==~ ".FE.E~.J:iWiiJNO-'=--- .. - .---.-..~-~.[5T_~lcf-IAAc~.~!
Residence of ' ~. furnace/buriler to 1
SQ. FT. BTlI' s
(name)
MrCi U (!.. do
(address) (lics. no.)
'3 7/ 73 UJ t~ ,€c!4;y- J.f r1 J j l..n ()
(exoires)
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ciru <;; T ---L/I C
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Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
IDuP1ex (1 bath)
IAdditiona1 bath
IHater service
. I Sewer
Istorm Sewer
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New circuits a1ts.
o or extens ions
C7\.
Floor furnace
and vent
1'$ (.4)
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ISERVICES
each
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Temporary Construction I
IChange in existing I
residence '
Imultifamily, -comm. or
Industrial
IOf
ICOMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeder~
IOf
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SDace heater and
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I App 1 i ance vent
seoa ra te
I Stationary evap.
cooler
I Vent fan with
sina1e duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and duct
I Hood stovejhea ter
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ISSUANCE OF PFRf1IT
TOTAL CHARGES TOTAL CHARGES /~ GO, TOTAL CHARGES
~JHERE STATE LAl-J REQUIRES that the Electrical Vlork be done by an Electrical Contractor, the electrical portion of. this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Divisio~-
I HAVE CAREFULLY EXN1INED the completed apfJl ication 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 OCCUPAr~CY will be made
.of any structure without the permission of the Building Division. I further certify that my registration ~Iith 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 camoliance with ORS 701.055 will be used -on ~his project.
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NAf'1E(please print) --:J3j//: DC)'-j;)
p/J l?S'"cle..t-iIGiJ.l\TURE /~:er ,&~ A~&t:foATE 9'-'-//?ftJ
FOr OFFICE USE ONLY
Zone P-II TYDe/Const. ~-~''''''{ J
Units I
Fire Zone -- Bedrooms - Occy Lbad
Flood Plain /..//7 Stories I Occy Group /v\-
BUILDING PERf'1!T
Charges and
Surcharges
PLUt1BING PER1~IT
Cha rges and
Surcharges
ELECTRICAL PER~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
So. Ftc). r1ain x Value
Sq. FtC'. Access S /::1. x Value ,,;( 3';j"-sI. ~'
Sq. Ftg. Other x Value
TOTAL VALUATION .-1. f(t t.{.. ~
.
,
,--
~ I Plan Ck.
__.:-___...;;t?.f'Q 65%/Blda
c; - Plan Ck.
J I (;;> , 30%/Bl dq
II '1" , Fence
-..-Lf'.---------
Ii) 1'1 I Dt:mo
/.5.:::..701 Sidewalk
------- ~~;I A/C Paving
,,'! I Curb Cut
iVlfL ----~---,
Comm/lnd
Per Fee
Res
Per Fee
:1.~o
/Systems. Deve.10pment I
Charqe (1.5~) , _
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Comb. pocm+
Z::~7~
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COMBINATION APPLICATION/PERMIT (CAP)
LApp ii cant to furni sh
A. Job Address .
B. Legal oescrip~ion
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- heat/electrical cel1inq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examDle- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, checkriew - if addition,
check ~dd. etc. '
F. -Building permit iilformation: l
1. example - constrbct sinqle'family house ~ith an
ai:i;achcd gan'_g(' '
2. examDle -. remodel exisUng 9aragr. -in1,0 fC~~l~ room
3: _ ~~~ - conV2,-'t si';lglc film"ily reS'IGC/'el? 111CO
restaurant (change of use)
_G. Value of work as-defined in Section 3(1J (il) air tllf!
Structural Specialty Code 1
H OF-SIGN "lEAl'" AND CoNTRACTORSi
To- avoid design or const.y'uctiuil delays, Eiuihi[ing
D.ivisiol1 Staff must be able- to' contact <:ppr'op.riaV
persons, regarcJ-ing des-ign irri'oi'maCion Gi" job s;ite
-correct1ons, etc. "
)), AhbreviatedPlumbing, ~lechanici\l, & Electrical SdledL!les
A. Except where blank spaces occur in'the descript.ion
portion of the ~lechanical and Eleci-.rical SchceDules,
the applicant need -F-ill..in ollly the ~!o; Buxd~ adjdcf;;;t
to the -appr0~riate item(s~ to be installed ,
B. Full PlLlmbing., ~lechani(;al, aild-Electy-ical Sch,.edulrs
are availi\ble at the Bui-Iding Divi_sion ';
,1. To conserVe space on the' permit form thc_~ch2rlules
have been il_bbreviaU,rl "
2. I f the item (5) _ to he ins ta n_ed (! i-C! not co{'ered 011
.the ilbbreviated scl1todule:; YOIJ should c()i"10i!lt l:/le
full schedules ,
C. BUILDING DIVISION STAFFWIl.L FILL OUT ALL m::s AND
CHARGES ON-THE SCHEDULES , -
D~ As noted on the CAP; the 'label 'must be deliv~~ed to the
-electri~al contractor for signature by his eT~ctr1(al
supervisor. --The general contr.actor'is not authori,>:ed
to sign the electrical label. -,
III: Applicant to sign and date
~Jhenever possible,-the i,nitial appl ication 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, 4nd _no plans will be processed until:these
fees are pa i dO. An, other fees and cha rges are due and
payable when the permit is issued.- ,!
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V.' FOR OFFICE USE ONLY
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,PROJECT CONDITIONS TO_BE SATrSFIE~ BEFORE OCCUPANCY:
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Permit applicant exempt from registration _with the Builderls,~oard becallse:
Additional: Project Information:
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PLANS REVIEWED BY:
. ...... .!~,..,...' ':;';";";;l'.il, '~'_ ~~.":''';14.~\''. :"fJ..\-.J1', 74.J1'~"....'.::l..'~ .:.J!:~'~.1jl';.--' .'&I_f. l. .i.: .'~.........:.L;.,.,~l"'" ~~l .:. iulllli. ..~.a.~",......~"",li-.
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signature/I\ /-C~A .fZLA:.r"':-# ~
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name
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