HomeMy WebLinkAboutPermit Building 1986-9-12 (2)
Address
UESIGN TEAr~
(name)
._~
. CITY Uf SPRINGflElU . 'INFORflATION LINt
COMBINATION APPlICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. r~a i n
Heat ~q. Ftg. Access. ~
Hater Heater Sq. Ftg. Other ~
~ew Add Alter Rep.
Ranqe --Fence Demo Change/Use
Value of Hork: Other-- -- ~
7 O~, o::>bo
BuildinQ Permit Info: Descr.be Work(i.e., Build Single
Familv ~esidence With Atta~h~d G~raae' ,_ ~
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'I/CA?::5 TP/9 7! ~/.-<(T ~~h'//,/a:Y
(lics. no.) (exoires) (ohone no..
Phone
(address)
.
. jINSPECT6ION lINE
.726=37 9
.
,
Job Address /~g/ ~o TA ;4' <S:r.
legal De5Cription / 7-0;;>" ~t::;-:1'2' . tJ6"ltX?
,
Owner. n/,/ L .;zo-R-6 = C..4?PC?-:>,l:>.R /,...,___
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Address~..., C ",h'JStif";-r- """ ..", Phone
.c- '1$'(.O,/(W
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Construction lender
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(l ice;,. no,)
(pxnirpc;)
(ohonp no.
Genera 1
Ow~E??' _
Plumbina
Electrical OJ,y#~
~1echanical
PlUr16ING
ElECTRICAl
MECHANICAl
NO.
FFF f.HARr,F Nn
1='1='1=' r~ARr.1=' NO
1='1='1=' rHo'Rr.I='.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
../
New circuits alts.
or extensions
-:2.~r-? /?z6RE
SERVICES
2"2..5'=.
Floor furnace
and vent
Recessed wall
Snnrp hPntpr nnd Vf>nt
Sewer
Temporary Construction
Change in existing
rpc; i qe.nce
multifamily, comm. or
Inrlustrinl
7
Appliance vent
c;,PD~rate
Stationary evap.
cooler
Vent fan with
sino1e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
:5
,Co<>
Additional bath
\olater service
Storm Sewer
Of
amps.
CO~~./INO. FEEDERS
Install/alter/relocate
r1i~trib. feeders
Wood stove/heater
Of
amps.
TOTAl CHARGES
WHERE STATE lAH REQUIRES
shall not be valiJ until the
. TOTAl CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
ISSUANCE OF PFRI1IT
~2 _:5l>. TOTAl CHARGES M/fi. t:;t;:--
Electrical Contractor. the electrical portion .of this permit
Supervisor and returned to the Building Division
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 Oregon pertaining to the work described herein, and that UO OCCUPAlKY 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 701.055 will be used on this project.
IW.IE(please print) - .1'1.4 H\....~.,,~ SIG~ATURE -r.t YYL~rd1...~ DATE "t /,"2.. /"8 t.
J .. '""Y
FOR OFFICE USE DillY
Zone Lc:. Type/Const. Units Sq. Ftg. t1ain x Value
Fi re Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group 7f-"2 Sq. Ftg. Other/.I\I'7: ;qE~~<: Value 7='- -e.
TOTAl VAlUATION
BUIlDING PERflIT I ~ ~ I Plan Ck. Conrn/lnd &:~ Ishstems Development I fikt
Charges and ____.I.. ~____ 65%/Bldo Ppr Fpe C arae (1.51) .
Surcharges ~2. Plan Ck. Res
- ~ 30%/Blda Per Fee
PlUt~B lNG PERMIT Fence
Charges and ------------
Surcharges DfII!Io
ElECTRICAl PERIIIT ~7_S0 I Sidewalk I
Charges and ------------
Surcharges . ,/0 A/C Paving Total Comb. Permit
MECHANICAl PERMIT .L 5 "-'=' Curb Cut 60,77 ,
Charges and ---- -_..:_--- I TOTAl
Surcharges .6 C>
.~-
.
.
.
.... I
)
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 oj 43
2. example- Lot I. Block 3. 2nd Addition to
Springfie)d Estates
C. Name, etc. of owner and construction lender
D." Energy Sources
1. examEle~ heat/electrical ceilinq/or .forced air qa5
2. exampJe- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if ne~ 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 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 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 OIVISION 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 Oivision Staff
will prepare a type written copy and return it to the
applicant at the time the actua1 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
Permit Clerk
.
PROJECT CONDI.TIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt. from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
1.-un$C ~E~Er-=<'" signature 0c::--?---:,/ .7 ~--:z
r
date c:;~/:::> -~~
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