HomeMy WebLinkAboutPermit Building 1985-9-5
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Job Address
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Nater Heater
Range
ValUE of Hark:
/1 ~. .an!:>.
BUi~lna Permit Info: Describe Work(i.e.. Build Single
Family nesidence With Attached Garaae)
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INFORlIATlON UNt
726-3753
Sq, Ftq. 1.lain
~q. Ftg. Access.
Sq, Ftq. Other
Ilew Add Alter Pep.
--Fence Demo Change/Use
Other - -
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1 INSPECTION LItlE
726-3769
Legal Oe<cription 17.p:r-"f'S'.32. a2"/~O
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Owner _<)"?A"/~~D ~c../ 7"" Zi:.-~';'"r' ')
Address '2,S"'C> A/s=4 /:/.' 57: ?'I~.b8"<./,,/
Construction lender
Address
DESIGN I tAil
(namel
Phone
{address}
Oies. no.)
(exoires)
(ohane no.
Primary
oJV/YG/r .
Structural
Electrical
Mechanical
CONTRACTORS (name)
Genera I %h }1 c::.v..-GF"
(addr~ssl
(1 ir:~. no.)
(p.)(oirp~ )
(nhonp no.)
Plumbina
Electrical ~,,,\ c=:~~
'lechanic'aJ 4~~""'T ~c:.O
PLUIIBING
ELECTRICAL
MECHANICAL
--.1!Q."
FFF CHAReF 'IV
~I="~ rl-lARGE ~
I=H" rYARliE.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
~~ew circu~ts a1ts.
<u:. extenSlons
-J.- ",,;01 J441J~ #G'
I SERVICES
I
/s-'
Fl oar fu rnace
and vent
S.F. Residence
11 bath)
Ouplex (1 bath) each
Additional bath
Recessed wall
~n~~p hpritpr rind vpnt
Storm Sewer
Of
amps.l
Appllance vent
seoaratp
Stationary evap.
cooler
Vent fan with
~incrle duct
Vent system apart from I
hea t i ncr or A. C.
Mechanical exhaust
hood and du~t
Wood stove/heater
~Iater service
Temporary Construction
Change in existing
rp~J drnce
multifamily, corrm. or
lnrlustrii:ll
Sewer
COMM./INO. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.!
I
........ ~~ ~r:w~ 6610-
ISSUANCE OF PFR!lIT
TOTAL CHARGES I TOTAL CHARGES j ~ - . rOTAL CHARGES A/At . /c:P.-....
WHERE STATE L'\\~ REQUIRES that the Electrical work be done by. an "Electrical Contractor, the electrical rortion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXmlINED the completed application 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 Ore~on pertaining to the work described herein. and that rw OCCUPAl~CY will be made
of any structure without the permission of the Ouilding Division. I further certify that my registration with the Builder's
Ooard 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 OP.S 701.055 will be used on this project.
IWIE(please print) SI€.0tl/IJ Tr\, Ri:A--D SIGIIATURE~ c::... 0
FO~ OFFICE USE DIlLY
Sq. Ftq.
Sq. Ft~.
.:;:>~ :< Sq. Ftg.
OATE 9-.5 -is
Zone
c::c
Type/Const,~hI~
Bedrooms
Stories
Units
Occy Load
Occy Group
f1ain x Value
Access x Value
Other ~~,~t!!FC-... Value
TOTAL VALUATION
~? .:>c=c>. ......
Fire Zone
Flood Plain
BUILOING PERNIT I ____2G:.- I Plan Ck. COlT1T1/Ind
Charges anC: 65%/Blda Ppr Fpp
Surcharges :?2Y Plan Ck. Res
30%lBlda Per Fee
PLUI~BltlG PERMIT Fence
Charges and ------------
Surcharges D~Rlo
ELECTRICAL PERIHT ____.1../): ---- Sidewalk
Cha rges and
Surcharges 6e:> A/e Paving
HECHANICAL PERMIT .1.0 a.- Curb Cut
Charges and ---- ---"'----
Surcharges _ ~t?
3& 0/0
Systems Development I
Charqe (1.5%)
#,4
Irotal Comb. rermit
I
I TOTAL
'i?ct =< y
/22:Ciy
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
1/ 03 43
2. example- lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
L. examQle- heat/electrical ceiling/or forced air qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition.
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examele - 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 TEM1 ANO 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.
11. Abbreviated Plumbing. Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the app1icant 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 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
GV
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:
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name.-b.BY'G ?L'~'~??
Signature~_.-(~--?
I
date 9-t::-~
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