HomeMy WebLinkAboutPermit Building 1986-4-28
.*~. ~~.~_. .
,-
~~
jlNSPECTION LINE ~~ CITY UF SPRINGFIELD tilt
726-3769 COMBINATION APPLICATION/PERMIT
Job Address 2.-,:~ J (\ tu7+ A- J I ~~~~GY SOURCES:
Legal DescriPtio~ ~ (') 7J~~~ ?{2. ()'"'\ ~ I~ater Heater
Range
INfORJtATlON UNt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.'I':'/';)
Sq. Ftq. Other
New Add Alter ~ep.
--Fence Demo Change/Use
Other- -
Owner 1..u7Lll e. Jw~[Jr:;A-Il..:1 \.1lt.-.
Mdress ~ ;l.q S:. A voS;- Phone
~ FR-4.s (" HEre! 0fU 7tf1. ~ 70 b "
Val u€ of ~jork: ....
~;;too. -
Builriinq Permit Info:
Family nesidence With
Describe Work(i.e., Build Single
Mtached Garaqe)
~~c
rw I L--{) Lh G
Construction Lender
Address
UI:.SHiN II:.Af1
(name)
Phone
(address)
(lies. no.)
(exoires)
I
(ohone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS lname I
IT ,,( 8. HI? LL ICy
(address)
fl;r:~,. nn.'
(pxnirp~' (o~nnp nn. \
~ If :! - 2C)(p L.
General
Plumbina
Electrical
~1echanical
PLur.lBI NG
"-)\ \
FFF~ CHARGE
ELECTRICAL
~:J ~ARU[ ~
MECHANICAL
\- )~ ~
NO.
NO
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(J bath 1
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Snare heatpl" and vpnt
Storm Sewer
Of
amps.
Appliance vent
"E"Daratp
Stationary evap.
r:ooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
r...o:,irlpnrp
muitifamily. comm. or
Tnnuc;trial
Water service
COffij./IND. FEEDERS
Install/alter/relocate
r1it;.trih. fppners
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valij until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCf OF PFRlllT
TOTAL CHARGES
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 NO OCCUPAHCY 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.
IlAt-IE(please printl:!CWN PIf1ItUt-Ot,A)6 Ir/'-- SIGIIAT~ R~ hATE Yo' 2f'--<t,:
FOR OFFICEnSI7' om v , /,
L?o: Ft~. 11ain ( !,-
Sq. Ft9. Access'I.'l.~~ x
Sq. Ftg. Other x
Zone -(' r
Fi re Zone -
. TVDe/Const.\1 - \.)
Units -
Value
Value
Flood Plain ---
Bedrooms
Stories \
Occy Load
Occy Group?-.~ '? .
BUILDING PERHIT
Charges and
Surcharges
~5U ~U . Plan Ck.
U . 65%/Bldo
-----I--SLJ--- Plan Ck,
,'~ 30%IBldo
Fence
COIl111/1 nd
Ppr Ff'lP
Res
Per Fee
-*t'> !?~;-qD
. '~5. O~
Value
TOTAL VALUATION fL. '2J:'J(,)
PLU'IBING PERMIT
Charges and
Surcharges
D~Rlo
.Sidewalk
AlC Paving
Isystems Development
CharQe tL5~) .
I
I
I
I
Irotal Comb. Permit
'3~--
ELECTRICAL PERlnT
Cha rges and
SurCharges
IIECHANICAl' PERMIT
Charges and
Surcharges
TOTAL
I 7'3.0!1.
.
Curb Cut
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
1/ UJ 43
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinglor forced air qas
2. examole- waterheater/electrical/or 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. examele - remodel existing garage into family room
3. examyle - 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 DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is"~ 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 actua1 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.
{
1~ .'
~/
;'.
V. FOR OFFICE USE ONLY
Permit Cl erk
w
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
~ ~ 1'\\--\ \\" ~()'\'
\\.. '\C \ \. IC'\. 9 r\.. \ 1 ) \
8
~~ \ r'\
(=:c-:\'Q\(~\ (\'1('),\'1:
~f>^ \J\""\
\. 'ICl ~
PLANS REVIEWED BY:
.~ -
namel ~'''' \ \. \E.\ ')\
Signatur~k d.0=> V--da~ew..-rc~-P0
.