HomeMy WebLinkAboutPermit Building 1985-9-6
INSPECTION LINE
1726-3769
~
CITY UF SPRINGfIELD
CO/tBINATION APPLICATION/PERMIT
."
I NFORlIATION UNt
726-3753
Sq. Ftq. '.Iain
5q. Ftg. Access.
Sq. Ftg, Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
Owner.<)?A'/~~Z:;> ~c.../ TY Z?e...+;"-;-_ ~
Addres-;- 2S'O Alt:il fi' 57: ?,,~j,R'~"/
Build Single
I
~
\1
00
W
'.
Job Address
:2 5'0' PlS1: A' $r.
E/IERGY SOURCES:
Heat
Hater Heater
Ranqe__
ValuE of l'lark:
/1 04:>. -0.
BU1~;inQ Penmit Info: Describe Work(i.e..
Family nes;dence With Attached GaraQel
Legal Oesc'ription 17.~.=J'S'.32. <!:)Z'/e>O
r
Construction lender
h" ~A'/6/f ;?6'-..,.-v t!!!'C:. ~
G-6.~" r:-n.....e:.~ ,l/f!n/bAN _ O/">~/C ~~ .
... . ..
Address
DESIGN IE:.Ar~
(name)
Phone
(address)
(lies. no.)
(expires)
(phone no.
Primary
OJVHGX
Structural
Electrical
t1echan; ca 1
CONTRACTORS Inamel
General ~h 7? g::;;z><;:
(addrpss)
{l ir'c;. no. J
(exoirpc; )
(ohnnp no.)
Plumbina
Electrical b',-",c..~"') E~.7:
Ilechanical -~/?;~""T rcc::>
PLU/IBI NG
ELECTRICAL
MECHANICAL
NO.
FFF CHARGE NO
FH" rl-lAflr.F NO_
FFF r,",AIH::~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
,.".--'New circuits alts.
oJ: extensions ~
-J- a;tl,.~-=-
SERVICES
IS-
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Recessed wall
So~r.P hp~tpr ~nd vpnt
Of
amps.
I
I
I
I
I I
........ ~n::?'f ~A 6>....,
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hond ~nd duct
from
Additional bath
~Ja ter servi ce
Temporary Construction
Change in existing
res.i d_ence
multifamily, COtml. or
Tndustriill
Sewer
Storm Sewer
Of
amps.
COMM./INO. FEEDERS
Install/alter/relocate
di..trih. fppders
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an.
shall not be valiJ until the label has been signed by an Electrical
ISSUANCE OF PFR!lIT
IS: - rOTAL CHARGES A/At , /cP.-'"
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXMlINED the comp 1 eted app 1 i cat; on for permit, and do hereby cert ify tha t a 11 in format i on 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 rw OCCUPAIKY will be made
of any structure without the permission of the Ouilding 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 compliance with OP.S 7nl.055 will be used on this project.
IlAI.IE(please print) ..5T€.mtv 1'Y\, Ri:A--D SIGNATURE ~7L /:. 0
FOR OFFICE USE DIlLY
Sq. Ftg.
Sq. Fta.
??~ :2 Sq. Ftg.
DATE 9-.5 - 1.5
Zone
c:c.
TYDe/Const.~hI~
Bedrooms
Stories
Units
Occy load
Occy Group
riain x Value
Access x Value
Other 11't!!S1-^-"-'-"''-- Value..../.?~. .....
TOTAL VALUATION
Fire Zone
Flood Plain
BUILDING PERIlIT
Charges and
Surcharges
5l . Plan Ck.
______~,_~_ 65%/Rlda
<.J Plan Ck.
:<. '2 / 30%/B1dQ
COllll1!1nd
Ppr Fp~
R"es
Per Fee
3&:. '70
.Systems Development
. Charqe (1.5%)
#4
PLUt~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICP.L PER/lIT
Charges and
Surcharges
D~l!1o
____.15 --- Sidewalk
~ A/C Paving
'0 &- Curb Cut
____JJ.__.____
_ ~t:>
Total Comb. Permit
ItECHANICAL PERMIT
Charges and
Surcharges
TOTAL
~~<Y
/225:'6- Y
J
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examp.'e- Tax lot 100, lane County Map Reference
17 03 43
2. exarnple- Lot 1. Block 3. 2nd Addition to
spr1ngtleld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. . exam~le- heat/electrical ceilinq/or forced air qas
2. examyle- waterheater/electricalfor solar
E. Square footage or valuation, etc. -
1. example~ 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 residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays. Building
Oivision 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 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 penmit is issued.
.~ 105 ;)-Sif
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ffD
V. FOR OFFICE USE ONLY
Permit Cl erk
cfY
4
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLA~S REVIEWED BY:
..
name
Lo8./G 1".( ~ E.??
.
Signature~,~~
date_9~,,"-~