HomeMy WebLinkAboutPermit Building 1984-2-24
1 INSPECTION LINE
726-3769
.
CITY Uf SPRINGfIELD
COHBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ha ter Hea ter
Address
lJt~IGtl TEAr.,
(name)
Phone
(address 1
INfORlIATION liNe
726-3753
Sq. ftg. 1.lain
~q. Ftg. Access.
Sq. ftg. Other
New Add Alter Rep.
Ranqe --Fence Demo Change/Use
ValuE of wo~~.lJC) Other----
Buildinq Permit Info: Describe Work(i.e.. Build Single
Familv nesidence With Attached Garaae}
~ ~ :... wd/ ~rYI- ~ ~qA~
l.<Jl-Ad~.,I ~". /L.,'.. -6, (\0
a>fl4 c...7b V
(lies. no.l (exoires)
.
Job Address I ~
Legal Description
~ ~ ~S'f... ~
\\ . &sA\ f)~~
Owner /J....kv....,,_ ~lIJ"fw-f.e..r )l/M<-(o$J-,.g",-<r.
Address J:2 /7 _ <:, /hI;tL A' <:;'1 .) 't Pl"::''''-''' ~
11'1
J
-
Construction Lender
(ohaM no.
Primary
Structura 1
Electrical
-,.
, .. . r
t1echanical
CONTRACTORS
(name)
(address)
2~".5 Rc....~... """ L...
f1 ice;. no.'
(exo; res)
(nhone no.)
Genera 1
<::, ~4-o{' t:-v...<.-h .
:; 'II. ~ ~
't- 28 - 8 it
.;< ,,-,-So9)7
Plumbina
Electrical "/1,..,.,;::t" "'- PI-ed., \...
(,., M' ;::: 31-t{
"R"1. ./t.:l. P
~'echani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
Each single fixture
FFF I f.HAR(;E NO
I
\
I H~ rHAR~~ Nn_
I Residence of furnace/burner to
SQ. fT. BTU's
New circuits alts. Floor furnace
or extensions \()-:- \0.- - and vent
S::~~ rHARr.~
Relocated building
(new'fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
Iwater service
I Sewer
\storm Sewer
SERVICES
Recessed wall
$OnCP hPntpr nnrl vpnt
Of
amps.
I' Appl iance vent
Sf'!Dnrntp
I S'tationary evap.
cooler
I Vent fan with
sinole duct
Vent system apart
heatino or A.L
Mechanical exhaust
hood nnd duet
I ~/ood stove/heater
I
I
I
from
!remporary Construction
Change in existing
rf'S j (tenet".
multifamily. COIl1!l. or
Industrinl
COMM./IND. fEEDERS
Install/alter/relocate
distrih. fpedF!rs
Of
I
I
I
I
\ (') .-, TOTAL CHARGES
'Electrical Contractor. the electrical portion -of this permit
Supervisor and returned to the Building Division
amps.1
I
I
I
I SSUANCE OF PERil IT
TOTAL CHARGES I TOTAL CHARGES
WHEnE STATE L\H REQUlnES that tile Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore!]on pertaining to the work described herein, and that NO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force_and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only SUbcontractors!;:. employees who are ~~omPliance with ons 701.055 '("\1 be used on this projec .
NA/IE(please print)~}d S (">.A 1!5 .....~{a.~SIGrIATURE \)~ . OATE.:2 -~ v"ll'-}
Fori OFfICE USE DilLY/
Sa. 4<1. rIain.
Zone
Fire Zone
/Type/Const.
Bedrooms
Stories
Units
Occy LoaL-
Occy Grou~~~_
x
Value
Val ue
Value
X1J 0:)
flood Plain
Sq. Fta. Access
Sq. ftg. Other
x
x
TOTAL VALUATION
BUILDING PERflIT ' \r, --- . Plan Ck. Comm/Ind
Charges an': _____~_--__~/Bldo Pj:!.\" I=p~
SUrCharges.,,\~ :::mA-- LID Plan Ck. Res
"I II \ ::1<r11 \ l'" 30%lBldq Per Fee
PLUMBING PERMIT fence
Charges and ------------
Surcharges D~mo
~~;~;:;C;~ PERI:IT L__D<--=-=-__J Sidewalk
SUrCharges~\.\J~ ,L\O I AlC Paving
IIECHANICAL PERMIT I Curb Cut
Charges and ____________
Surcharges I
'Systems Development '
Charqe (1.5~) .
I I
I I
Irotal Comb. rermit I
I Of-'-..
I TOTAL ?~O. O-J
.
COMBINATION APPLICATION/PERMIT (CAP)
l.
Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
II uj 43
2. example- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. exampJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 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 res.idence 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.
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 7thorized
to sign the electrical label.
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.
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.
II.
III.
IV.
V.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
,;g"'t",$;~)Lr\ ~\ d~;' 'G -?CJ J:~ '-1
name ~