HomeMy WebLinkAboutPermit Building 1987-7-10 (2)
Construction lender ~~)(
INFORllATION UNt
726-3753
Sq. Ftq, Main ------
~q. Hg. Access.
Sq, Ftg, Other
New Add Alter Rep,
Ranqe --Fence Demo Change/Use
~_ r:~ ValuE o;(t(j9,'j, 000 Other--
/J / -J... -, Ph^' BuildinQ penriit Info: Describe Work(i-.e.. Build Single
/-( <; ~I one 7~?zi..97' Familv nesidence IHth ,Q_ttached llaraael
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
. I Heat
l~ater Heater
.
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I INS~CTlON LINE
726/'3769
Job Address //1'1 S' ,4-s/w;pf
Legal Oescription / 7~C>Y-3'>"'/I,
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Owner .n ~ '
Address //17 S
Address
UI:.SlliN II:.Af.,
[name I
Phone
{addres,; 1
fli~s., no.l
(exoires1
i
(ohone no. I
Primary
Structural .-;;;M~ (., /ltO,~.A~..
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;J..jj 01.,;) I), _ Q'77111(
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Mechanical
CONTRACTORS (name)
General JJl4rasf fJ4}J 4.
Plumbino
faddrf'!oss1
(l ic!':_ no.1
(plIn;r""c:.)
(ohnn"" nn \
Po. 6tIY qIl '7~.G" ;::;;,e..u 'i'lIIm ~d'2n~
19
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Electrical
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3,'7'7<:1
1;;"'1/-,.,
~1echanical
~UllBING
<- - NO.
I ~ ELECTRICAL
rHARr,F -- Nn
~
MECHANICAL
FFF
FFF
r~A~r.:1=" ~IO.
11="1="1="
r~AI)r.:1="
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BrU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
,
SERVICES
Recessed wall
~o~~P hp~tpr ~nn vpnt
Sewer
I!emporary Construction
Change in existing
rps.i npnce
multifamily. corrm. or
Inr1u!>tri~l
Of amps.
ICOMM,/INO, FEEDERS
I Install/alter/relocate
nidrih. fppnprs
Appliance vent
SeD<lr~tp
Stationarv evao.
cooler ~ ,
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hnod and duct
Wood stove/heater
Additional bath
~!ater servi ce
)
Storm Sewer
Of
amps.
I SSUANC[ OF PFRtflT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
- WHERE STATE L'\\~ REQUIRES that tile Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN11NED 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 Spri ngfi e 1 d and the laws of the State of Oreqon pertai n i ng to the work descri bed herei n, and that NO OCCUPAfKY wil 1 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 . 1 be used on 1S roject.
ZoneJ I
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
SIf.iJAT IRE
FOr. OFF I CE USE miL Y
Sq. Ftg. t1ain
Sq, Ft~, Access
~bF~~~~O::,r,T_/'3''':1J? ~/- Value /0'9.,,=....
/; Illpuo I:: f.~ -I TOTAL VALUATION
. ( JU V '-1,0 'Syste. ms Development
c..,-l n, -- CharQe (L5~)
..I /,.,-,
OATE#
UA/.IE(please print) ]Jp 0 n
-77 fJ AI ,;; t') ,,)
~
x
Value
Val ue
x
BUILDING PERMIT
Charges and f"'\
Surcharges r
. t.lL:'"~ .C-. Plan Ck,
__J-2..L~?'?__ 65%1Bldo
Plan Ck,
-::? :;;:.td:;;. 30%/Bl do
COIJJJl!l nd
Ppr Fpe
R.es
Per FeE>
&4
PLUt1BING PERMIT
Char.ges and
Surcharges
Fence
Dt)mo
ELECTRICAL PERI:IT
Cha rges and
Surcharges
Sidewalk
A/C Paving
Total Comb. rermit
L/ 7~ ?/
L/7S'. ~/
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
.
.
t
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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
II UJ 43
2. exam~le~ lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrlcal/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. exam~le - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code ',,:-.
H, DESIGN TEAM ANO 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
fun schedules
C, BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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.
8Cof05~
tJ - J-J ;..g 1
V, FOR OFFICE USE ONLY
Permit Clerk
co
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project. Information:
'..
PLANS REVIEWED BY:
name ~#a;:/2~signature ~~____~~ date 7"7<:::>-R-;>
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