HomeMy WebLinkAboutPermit Building 1986-4-2
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I IrISPECTlON LINE
726-3769
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CI TV Uf SPRiNGfiELD.. INfORltATION LINt
COMBINATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. F tg. 1.1a i n
Heat Sq. Ftg. Access. V YG-'
Water Heater Sq. Ftg. Other
_ , tlew){Add Alter Pep.
Banq~-,. --;-. _ ~-=-- -Fence Demo Change/Use
f -ValuE of Work' ~I -Other- -
, . t:1'O ""-.-
..... '"2~ 7/7. .
Phone ('\41 Bunci-;n~nnit Info: Describe .Jork.( i-.e., Build Single
. 1 K' \~:nW-Att::Ga\j~
~t\.~ ( 110 b;.U '.'1
'- J
0'7200
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Job Address "'5= r---- -' \ - ~
~ ~ >,o.1m n
Legal Description \ 7 03 ~C; 3d-"
Owner I ps:, .YJ.( JLlC;;:P..a ;;11
Address271()leJ1n~ /)iIJuJ
~ c r",.JL O.c::. '2$1.J.f)"
Construction Le'~der O"JlZ 7t1;'~g.
Address
Ut.~ll.i" H.Al1
tname)
Phone
(address}
(lies. no.)
(exoires)
(ohone no..
Primary
Structural
Electrical
Mechanical
CONTRACTOp5 (name)
General \ Zd 0 ~L i~. ,-
(\
(address)
erA J '1AI1J) ~
11 ks. no. l
tfG gg I
(pmi rp,.c;)
/ '2 - 2.t: - ffi
(ohone nn.l
Plumbina
E1 ectri ca 1
Mechanical
PLUtlB I NG
ELECTRICAL
MECHANICAL
NO. '
, F~~ 'rIjIlQr.F Ill"
. ~~t" . ru~ NO
'FF~ '..t!IAB!i.E.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
~ New circuits alts.
~ ~~s~~~
SERVICES
'Z2,~)
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
il.mps.
I
Appliance vent
s~parat~
Stationary evap.
cooler
Vent fan wi th
~inole duct
Vent system apart from
heatino or A,C-
Mechanical exhaust
hond i'lnd durt
Sewer
Temporary Construction
Change in existing
res j ~.nce
multifamily, comm. or
Tnrltlc:trial
Water service
COffi1./IND. FEEDERS
Install/alter/relocate
rlic:trih. fpprlprc:
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
ISSUANC, OF PFRI1IT
TOTAL CHARGES ~<-5Z> TOTAL CHARGES ~N. /-r)':-o
that the Electrical work. be done by an 'Electrical Contractor. the electrical portion of this pelT.lit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 Oregon pertaining to the work. described herein. and that UO OCCUPAUCY 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
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FOP. OfFICE 'f5~' VI
Zone c:: C Tyoe/Const.5" -AI Units S<(. Ftg. llain x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access.i::Y'09" x/O. - Value ~'I~.'-
Flood Plain Stories I Occy Group.-l/'Z Sq. Ftg. Other~'N x value.R3'17.-
TOTAL VALUATIOrd27L?-
BUILDING PERHlT , ___"7~:2~_ PI an Ck. Conm/Ind
Charges anC: 65%/Blda Ppr F'pe
Surcharges ,?p ~€/ Plan Ck. R-es
30%/Blda Per Fee
PLUP1BING PERMIT Fence
Charges and ------------
Surcharges 0_
ELECTRICAL PERrm ----~~:..~~- 'Sldewalk
Charges and
Surcharges .'9~ A/C Paving
MECHANICAL PERMIT /5._~_ Curb Cut
Charges and
Surcharges .(;0
~</.~3
Systems Development
CharQe tl.5%l .
/~o. 7b
TOTAL
It//. ~q'
~6. ::z '"3
Total Comb. Permit
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II 03 43
2. examyle- Lot I. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exa~ple. heat/electrical ceilinqjor forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
1. example- 1250 sq. foot house. 500 sq. foot garage
2. examRle- 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
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. & Electrica1 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 itern(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 itern(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 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
payab~e when the permit is issued.
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V. FOR OFFICE USE ONLY
P'noit Cl"k ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
n~me Lt71<';~ ?t~~signature 4-..';~ ........., date t./-I-~b
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