HomeMy WebLinkAboutPermit Building 1983-11-10
I IrISPECTJON LItlE
726-3769
Job Address laM )_ VI ,-A ~,
Legal De<cription \'1 r--..'?-. ~':) ~\
.
CITY OF SPRINGfIELD
cOtmUIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
.
JNFORilATIDN UNt
726-3753
Sq. Ftg. f,la;n
~q. Ftg. Access.
SQ. Ftg. Other
r~e\oJ Add Alter fl.ep.
-Fence Demo Change/Use
Other - -
~1)
CJJ
Q)
:::J
l/)
.~'?(Y}
Owner ~f'UkLl') ~tf\.t'\t ~Ll00\Cl CLI
Addres, h4.W n .. ~ Phone
co~~~e~ J ~
Uater Heater
Range
(name)
Phone
(address)
ValUE of l'lork:
J ')ac>. eo 0
~uil(\inq Permit Info: Describe I~ork(i.e.. Build Single
Famillt r<esidence Hi th Attached Garaqe)
:t~~~~~+-DYYJ
. ') () I
\,... (lics. no.) (exPlresl (ohone no.)
Address
UES I tiN TEAr.l
.'
Primary
Structura 1
Electrical
f1echani ca 1
CONTRACTORS
General ~G
wDe ~ 0.-D
\
(addrf>s~J
2..b~~
(1 ics. no.)
~'--J~ )
o
(exoi res)
fl~
Q14'QS
(phonf> no.'
l\~-
Pti'?,
(name)
Plumbino
Electrici'll
~1echanical
PLUf1BIIIG
ELECTRICAL
MECHANICAL
sq _ FT.
furnace/burner to
BTU's
FH I rHAR(;F
I
NO.
FFF rH^R(;F Nn
FF~ rHAR(;F NO_
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Sn~rp heater ~nd vent
Storm Sewer
Of
amps.1
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
I ~lechanical exhaust
hood Clnd dud.
I ~'iood stove/heater
I
Additional bath
~Ja ter servi ce
Temporary Construction
Change in existing
re.<:_id~n('"p
multifamily, comm. or
Indll<;trial
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
di<;trih_ fppdpr<;
Df
amps.
ISSUANCE OF PFRtHT
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'\H REQUIRES that the Electrical work be done by an. Electrical
shall not be vali1 until the label has been signed by an Electrical Supervisor
I TOTAL CHARGES
Contractor. the electrical portion .of this permit
and returned to the Building Oiv;sion
,
I HAVE CAREFUllY EXAt1INED the completed apr1ication for permit, an do hereby certify thatjilil information hereon is true
and correct. and I further certify that any and all work performed s be done in accordance th the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the wo K described herein, ap that rlO OCCUPArKY will be made
of any structure without the permission of the Building Division. I fu r tify that m yrregistration with the Builder's
Board is in full force and effect as re~uired by ORS 701.055, that i exe th is for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701. 5 ~ e on his project.
Zone C r
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Grouit\- '2.
S IGiJATURE
FOr. OfFICE ~~E ~~
Sq. FtSl. Access
Sq. Ftg_ Other
Dfi/~~
IWIE(please print)
r-67~
,
x
x
Value
Value
x Value ~
TOTAL VALUATIOtl..J.~ 0.;...
BOILDlflG PERf.IIT I __~_h!~~__ P1 an Ck. Comm/Ind
Charges an': 65%/Blrla PPr' Fee
Surcharges \ ' 'i(p Plan Ck. Res
30%/Bldo Per Fee
PLU'1BltlG PERMIT Fence
Charges and ------------
Surcharges D~R1o
ELECTRICP.L PERi~IT .Sidewalk
Charges and ------------ I A/C Paving
Surcharges
flECHANICAL PERf1IT -- Curb Cut
Cha rges and --------~---
Surcharges
~ <r\ c;.D
Isyster..s Development I
Charoe (1.51) .
Total.Comb. rermit
TOTAL
~L\.~
r .. ....5
o
o
. ,
COflBINATlON APPLICATION/PERI'IIT (CAP)
I.
PERMIT VAtIQAJION
.-
Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot JOO. lane County Map Reference
11 03 43
2. example- lot 1. Block 3, 2nd Addition to
,Sprlngtield Estates
C~ Name, etc. of owner and construction lender
O. Em:!rgy Sourc.es ~)
1. example- heat/electrical ceiling/or'forced air qas
2. example- 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
a ttached garage
example - remodel existing garage into family room
example - convert single family residence into
restaurant (change of use) -
G. Value of work as defined in Section 303 (y) 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
electrical contractor for signature
supervisor. The general contractor
'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.
'4 COS"
~).I .'
tF Ld}U ct
2_
3.
. ,
"
,
I
II.
be delivered to the
by his electrical
is .not authorized
I I I.
IV.
v.
FOR OFFICE USE ONLY
Permi t
C1 erkt1tlD~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:
,.' t-'
lr'"
PLANS REVIEWED BY:
nameD~\n1. \==\\~\\
Signatur~.......c\.~'~ y- d~~e \\-\0-~~