HomeMy WebLinkAboutPermit Building 1980-3-5 (2)
ValUE of ['lark:
15"'/ ,JOe),
Phonp/'ldn /. ,,,,Buildina P!!nnit Info; Describe l~orkt i,e..
-/"T/~'t2;j ")Familv P-esidence I-lith ,ll,ttached Garaqe)
V Llr}/illtIM_ Ito
,Ahr~
I
... IrISPECTlON ;erNE
1 726-3769
.
.
':i
CITY Uf SPRINGFIELD
C0I1BIIIATION APPLICATION/PERMIT
Legal
J 41-/ f) S"",.... tP
Description ~l)LV
EjJERGY SOURCES:
vtfea t
I.I.rater Hea ter
~e
Job Address
1/'
Owner
t7(J;;z, 30 3z
rR/Jfi/k c;r 0/ ;:A~ c
=;;./1-/<
Address
Construction lender
N{)NiF
Address
DES I GN TEArI
Phone
(address l
(name) *,;;:J H> //
,;
(1ies.no.)
Primary
, Structura 1
: Electrical
i f1echanical
1 CONTRACTORS
Genera 1
7''/ 111'11 13 II- ?C-l~
t?~,g;vT: dL
(address)
(l ics. no.)
(name)
c:;?.BLP
- fJ1JJ't?1A}
Plumbina
~ Electrical
_~. i...I~echani ca 1
PLUI1BIrlG ,
ELECTRICAL.
rHA'R'G"E "N~~- ~.- =-=----
FFF
CHMliE, NO,
NOJ
----:-1 Each single fixture:
I Relocated bui lding .
(new fix. additional.)
S.F. Residence
11 bath)
Duplex (1 bath) each
IAdditional bath
~!ater serv; ce
FEE
Residence of
SQ. F1.
New circuits alts,
or extensions
TWo oe. MOI'F
SERVICES
v-
/ S'.oo
Temporary Construction
Change 1n existing
rpc;idpnrp
multifamily, comm, or
Tndllc;trii'll
:: ,~~
Of
amps.
I
I
I
I
I
I
I
/5.00
COI~I'L II NO, FEEDERS
Install/alter/relocate
dic;trih. fppdprc; o'
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an
shall not be va1ij until the label has been signed by an Electrical
I NFORt1ATION U Nt -I
726-3753
......5q. Ftg. I.iain
~q. Ftg. Access',7ILJD
Sq. Ftg. Other
..Jlew .\2'Add _A 1 ter --,o,ep.
Fence Demo Change/Use
~Other - -
Build Single
cP
B
..--
())
\~
/Y'/l oJo.A CI/t!JJ )
(exoires)
"
(ohone no .-j
.~
;
(pxoi res)
- 1 ~
(ohone no.)
MECHANICALj
,
i
I
i
,I
~
JI
.., I ~
-- q
I.
i!
'<'<--;:-1
eEL .QJAJlliE"I
ii
f,
,i
Ii
~
;~
furnace/burner to
BTU's;
Floor furnace
and vent
Recessed wall
~Oi'lrp ~p~tpr ~nrl vpnt
Appliance vent
seoarate ~
Station~r ~ p.
coo 1 er II'
I Vent fa ,i1j!1'
slnale . t
I Vent sygtem apart from
heatino or A.C. ;
I Mechanical exhaust'
hood i'lnd durt -'
I I'iood stove/heater
I
I
I
ISSUANCE OF PFnt1lT
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
TOTAL CHARGES
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 Oregon pertaining to' the work described herein, and that rw OCCUPArKY 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 and employees who are in comO.1iance. with ORS 7Ql.055 dus~.nn. '7 th's .". roject, ':
~Please print).f=~jc ~k/i!/~ -: ~1^TURr--. ~U ~~ .~ ~--r.-:1f.')
FO~ OFFICE USE OIIL Y :0'
Zone <!-I.j Tyoe/Const. III.- 1'1Ie. Uni,ts I Sq, Ftg, 11ain toO x..1.9. 7'1' Value /5.ntX)~
Fire Zone~ Bedroo1ns Occy load Sq. Ft~, Acce s x Value'
Flood Plain r/O Stories I Occy Group H-Lj Sq, Ftg. Other x Value; i
'L~Z.Cf-<bO T~~1WI~~:L-~f/f'Q.- ,
Y'I.. ( 0..0 Isystems Development ., ,
n n ,r ) Charqe (1.5%) ,.J:J5".~ :
I I
I I
I I
I I
I
BU1LDIIIG PERt'lIT
Charges and
Surcharges
I I Plan Ck.
_______'J~,OO 65%/Blda
."./ Plan Ck.
d.II''6 30%/Bl do
Co"",lInd
Ppr Fpp
Res
Per Fee
PLU'1BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECrRIC~,L PERI~IT
Ctlarges and
.?urcharges
/ S.OOSidewalk
--------~ &0 IA/C Paving
I Curb Cut
I
11ECHAN I CAL PERMIT
Charges and
Surcharges
ITotal
I
I TOTAL
Comb. rermit
I qO.l/fI
1..f3IS.l{~
~
.
COMBINATION APPLICATION/PERMIT (CAP)
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
~pringtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examp.le- 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. examole - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structur'al Specialty Code
~H. DESIGN TEAI'I ArID 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 it.em(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 SCHEOULES
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
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
.
.
PERMIT VALIDATION
Permit Cl erk
.
Permit appl i cant' exempt from registration with the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date
.1