HomeMy WebLinkAboutPermit Building 1984-1-12
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I INSPECTION LINE
726-3769
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Job Address
/1/1
S.. A.
O~ ~~ \4.\
CITY OF SPRINGfIELD
COllBIIIATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat
('Iater Heater
Legal Description \'\
()~
Owner n,,~~~'
Address /111 So II
~~/Nff/~'/
Phone72~'191J
Construction lender
Address
DES I GIl IEAI~ (name)
Primary /Ju 1""';! Ct!J~fI-Uc, .J/~AI
Structural
Phone
(address)
(--bJwt. ,.~..... '1-/
I 1
Electrical
Hechanical
CONTRACTORS (name) (address)
General !1uf'HtJ:j.UltJ.LU.//t)',.; I~~ .<;0,,,,,,,...
Plumbino
Electrical
~lechan;ca'
PLUIIBING
NO, I
F'FF r.HARr.E Nn
Each single fixture
Residence of
Range
INFORl1ATION L1Nt
726-3753
Sq, Ftg, 1.lain
~q. Ftg. Access.
Sq, Ftg, Other
flew Add Alter Rep,
--Fence Demo Change/Use
Other- -
~
~
N
VJ
Val u€ of Hark:
IS; {)()/J
Buildinq Permit Info: Describe Work(;.e.. Build Single
Fa~;lv nesidence With Attached Garaael
RLlAJ. R~Jh).l.r-11J~A' St;'~
(lies. no.)
(lic~. nn.
:~I) tJ IJ 2.
ELECTRICAL
F'F'F' rHdRr.F' NO,
SQ, FL
Relocated building
(new fix. additional)
Is.F. Residence
(1 bath)
10UPlex (I bath) each
IAdditiona1 bath
I ~Jater servi ce
Sewer
~ew circuits alts.
or extensions
~""""~r::
I SERVICES
I
ITempOrary Construction
IChange in existing
r~c::iny.nce
multifamily, comm. or
Tnnu<;t.rii'l.l
\
Storm Sewer
Of
COffi~,/INO, FEEOERS
I
I
I
I
I
\ ~~ . TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
\~cc \S.cC
I
amps.
Of
Install/alter/relocate
dic::trih. fppderc::
amps.
TOTAL CHP.RGES
WHERE STATE L~W REQUIRES
shall not be valij until the
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
(exoires)
{phone np,\
(exoi res)
(ohnne no. )
g~
6. gQ-t)9()O
MECHANICAL
HI=" rI-lAIU::1="
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Snace heater ann vent
App 1 i ance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent sys tern apa rt from I
heatina or A.C.
Mechanical exhaust
hood and duct
I
I
Wood stove/heater
ISSUANCE OF PFR!llT
I HAVE CARE FULL Y ExmlINED the camp 1 eted app 1 i cat; on for permit, and do hereby cert ify tha t a 11 i nformat i on hereon ; s 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 OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 7nl.05~il1 be use~~is project.
IW,IE(please print) JJ>A.... ])u:n 5 /)Y\ SIGIIATUWP ~UJ.IA~A ./..1'>"- OP.TE/~I,/_
FOr. OFF I CE USE OiIL Y
Zone '"' ~
Fire ZonE' -
Flood Plain -
Type/const.\.I-,") <:"W.Units
Bedrooms Occy Load ----
Stories \ Occy Group\~-I4.
\ BUILDING PERI.IIT
Charges an':
Surcharges
"O'5,UJ
----....-.
O~52.
. Plan Ck. COIl1ll/lnd
65%/Bldo PfI'r Fep
Plan Ck. Res
30%/BI dq Per Fee
Fence
PLU'~B ING PERMIT
Charges and
Surcha rges
Demo
I'Sidewalk
I A/C Paving
I Curb Cut
I
ELECTRICP,L PERlnT
Cha rges and
Surcharges
_n~~o:.>
(j)U
11ECHANICAL PERMIT
Charges and
Surcharges
Sq.
Sq,
Sq,
Ftg. JI~i!l_
Ftg, ~3.?Clr)
Ftg, OtherE.'t\c;...,
..~ --
. $I6".&:'
x Value
x '\ - Value? Q~
x Value~,rx:t')-
TOTAL VALUATlOII\~. Q("\C)
'Syste~s Development
Charqe (1,5%) .
6~ ?~lHS
I
I
I
I
I
Total Comb. Permit
TOTAL
1 efl. \2.
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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, ~xam~le- Lot 1, Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinqjor forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examp.le- if new project. check-new - if addition,
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family foom
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 TEM1 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
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. ---
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
signa ture.
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
,
I
Permit Cl erk
f1IlDfl)
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: '~.J~,\'F.-. ffiQ ~9Q.\\\\\(LE'Q "t-.~"""r.,",,, '\C'l~,
~~ThM\"r.:,~~ c;..W_\~""",~'\~ ~\nl;; \:'IF'''', \-Q\< ~~
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PLANS REVIEWED BY:
.
nam~)\D\'\\=t \~,'-S\
SignaturQ,^,,\~\~ V-
date\-7'5-B'A