HomeMy WebLinkAboutPermit Building 1988-1-8 (2)
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CITY OF SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
~l~ o~ \'lo:~..Jj;OtTO
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Builriinq Permit Info: Describe \~ork(i-,e., Build Single
Famil y nes i dence Hith .A.ttached r.a faCIe'
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INfDRlIATlDN UNt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other - -
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'lINSPECTION LINE
726-3769
l~ 000
Owner~. W~~
Address .-~oS-~. /J- 4Y 'P}~-rifld
c~!der CL-L--. 9 ") c{7 7
Address
Ut~Jl,jN ItM'
(name)
Phone
(address 1
(lies. no.)
(exoires)
(ohane no.
,Primary Sc..l.a.. rl!J"S/Y"'C.i,~
Structural
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'Ie~-4977
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Electrical
"1U~
.tl
Mechanical
CONTRACTORS
(name)
(address)
(1 ics. no.
(exo;res)
(ohane no.)
Plumbino
<::;"L"..... ~,,1V'~ci.~
J...~l<Il.s P/""HJ,";:'S .
Ihod~...... J;:J,;;r"..LC
t &e"
~N...R,1
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7-,z'6-S'i('
HIS, '1'7'7
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Genera 1
Electrical
~1echan;cal
---
PLU1.1B I NG
ELECTRICAL
l
... CH'IRIiE.llQ
MECHANICAL
NO.
~ Each si n91 e fixture
Relocated building
(new fix. additional)
FFF (HARr:F ~I'p
1fY /5~
'O.EL.. J:JJABJl.E.
SQ. FT.
furnace/burner to
STU's
NA
Residence of
,.., . New circuits alts,
~t 'or extensions
~
Floor furnace
and vent
S.F, Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Soace heatp~ ~nrl ~pnt
Storm Sewer
Of
amps,
Appliance vent
seoarat@
Stationary evao,
cooler ~ ,
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
reo; i ('IF'nre
multifamily, CQIllll. or
I nrlu<;tri<l 1
~Jater servi ce
COMM./INO. FEEDERS
Install/alter/relocate
di,trih. fppdpr<;
Wood stove/heater
Of
amps.
')//.A!i!~c-
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be val;1 until the
,75
'SI/A/!tf.~c
. 13
/-
ISSUANCE OF PFR!1lT
TOTAL CHARGES
that the Electrical work be done by an,
label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor~ the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXMlINED 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that rw OCCUPArlCY 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 compliance with ORS 7~1.055 will be used on this project.
llA!.IE(please print) ,16 S D>'\ .1> SC/t-,G. V' SIGNATURE Q~.~ li"" j
FO~ OFFICE USE O!JCY
r
Sq. Ftg. t1ain
DATE /-:? "~g'
Zone C ~
Fire Zone
Type/Canst.
Bedrooms
V'-N
Units
,
x
Value
Value
Value
Flood Plain
Stories
Sq. Ftg. Access
Sq. Ftg. Other
(i)
/2-:2-,~O ~~~~B~~~ ~~:.'"~~~d, ~~ ~20 ~
------------ P"'i'an Ck, Res
tJu/3 30%/BldQ Per Fee
__-L{i~!?"___ Fence
Occy Load
Occy Group
x
x
TOTAL VALUATION
BUILDiNG PERMiT
Charges an~ ).
Surcharges
Systems Development
CharQe (1.5~)
PLur1BING PERMIT /
Charges and S
Surcharges
175
'-<9
___2~~____
I.I'~
___If/A_____
Demo
ELECTRICAL PER!~IT
Cha rges and \J
Surcharges '\
'Sidewalk
A/C Paving
Total Comb. rermit
TOTAL
.,5
/P~,O( .
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
J ._1,:,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J, Applicant to furnish
A. Job Address
B. Legal Description
1, example- Tax lot 100. Lane County Map Reference
II oj 43
2. exam~]e- Lot I. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electricar/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq, foot garage
2. examp'\e- if new project. check-new - if addition,
check. add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examF'e - remodel existing garage into family room
3. examp'le - convert single famlly residence into
restaurant {change of use}
G. Value of work as defined in Section 303 (a) of the
Structural SpeCialty Code
H, DESIGN TEAfl 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.! Exce~t where blank sp~ces occur in t~e description
. port10n of the Mechanlcal and Electrlcal Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item{s) to be installed
8. 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 ANO
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 ba 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.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name~~) /f;~
signature
/p/ Mr~
date
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