HomeMy WebLinkAboutPermit Signage 1980-12-31
llllSPECTION LINE
726- 37 69
Job Address,~;<)
Legal De5cription
.
J4 <-f:> C1t/L
CITY UF SPRINGfIELD
COIIBIIIATJON APPLIc~nDN/p~RMIT
ErlERGY SOURCES:
Heat
\~ater Heater
Range
.
INFORllATION liNt
726-3753
Sq, Ftg, l'lain 'IJO'Q
.:q. Ftg. Access.
SQ, Ftg. Other
'rlel< . AdlN Alter Rep,
--Fence Demo Change/Use
~Other -- --
~
~
Owner_ -f-JJ7 OM.-/~OrYJ/1
Addres~1S7_GS HQlU~~'
~!:r~t~e~ () 0 C\ f ~l
Phone
Valu€-9f Work: ~
1'J 00, LA-'
Buildino Permit Info: Describe Workl;~e.. Build Single
Far.1i1v P..esidence Hith JI..ttached Garaqe)
& f m(l)(J .J1 r1. ./ J ffO 0 0
-P U. ) ()()n
Address
UESIGN TENI
(name)
Phone
(address)
(lies. no.)
(exoi res)
(ohane no.')
Primary
Structural
Electrical
11echan; Cd 1
CONTRACTORS
(name)
(address)
(1 ir:s. no.)
(pxnirpc;)
(ohonf> nn.)
General r<n~lJy7_0 V'"
Plumbino
Electrical
H~chanical
PlUI'1BIflG
ELECTRICAL
MECHANICAL
':0,
FFF rHARr,F Nn_
SQ, FL
FFF rHAR(:;F NO. I FFF rHARr,F
furnace/burner to ; I
BTU's .
Floor furnace :,,1
and vent _
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(l hath)
Duplex (1 bath) each
SERVICES
Recessed I'Jall
Sna~e h~ater ann vent
Sewer
Temporary Construction
Change in existing
rf>sirlflnr:p
Imultifamily, comm. or
Industrial
IOf amps.
ICOMM,/INO, FEEDERS
Install/alter/relocate
distrih_ fperlprs
Appliance vent
seoar<l.te
Stationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart
heatina or A.C.
I Mechanical exhaust
hood and dud
Wood stove/heater
from
Additional bath
~Jater service
Storm Sewer
Of
amps.
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\\'l 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 EXAmNED the completed apf'llication 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 riC OCCUPAIKY 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 comnliance with OP.S 7nl.055 \.Jill be used on this project.
IJAI.IE{please print) J?~/P/?./,dl AAIJ.ed SIOIIATURE OL_~.t/ ~rC
FOR OFFICE USE OITLY
Sq. Ftg. t1ain
Sq. FtQ. Access
5q, Ftg, Other
om 1:78/lxe?
- - - I
I
Zone
Fire Zon€'
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
Stories .
x
BUILDING PERMIT
Charges and
Surcharges
~J-~()D I
_ .:.J.._______
TOTAL VALUATION
PLUI~BING PERMIT
Charges and
Surcharges
Plan Ck.
65%1BI do
Plan Ck,
30%/81da
Fence
COJllll!lnd
Per Fee
Res
Per Fee
ISystems Development
Cha rqe (I. 5%)
Demo
ELECTRICAL PERliIT
Charges and
Surcharges
Sidewalk
A/C Pavi n9
Total Comb. rermit
11ECHAN I CAL PERMIT
Charges and
Surcharges
TOTAL
I
J5,cD
Curb Cut
.
i
"\
COMBINATION APPLICATION/PERMIT (CAP)
I
II
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-' Tax Lot 100. Lane County Map Reference
II 03 43
2. example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilingjor forced air QdS
2. examp]e- waterheater/electrlcal/or solar
E. Square rootage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-new - if addition,
check add, etc.
F. Building permit inform.tion:
1. examole - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3.- examole - 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 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 Mecha~ical 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. BUILDIriG DIVISION STAFF HILL 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 \.,.111 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
,,,' ~..' . _ .1, ;....
,,,..1 I.
PROJECT CONDITIONS TO, BE SATISFIED BEFORE OCCUPANCY:
, '
.
.
PERMIT VALIDATION
Permi t Cl erk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
1'-.;.
,_I
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