HomeMy WebLinkAboutPermit Building 1986-4-1
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Job Address . Q 55
Legal Description \ 'J7
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C I TV OF SPRIIIGfTI'ID
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
0'72.00 l/ater Heater
Ranqe_
INFORllATlO~ L,Nt I
726-3753
Sq. Ftq. Main I
~q. Ftg. Access. yrO
Sq. Ftq. Other
.-tlewgAdd _A 1 ter .....:~ep. I \'ill
Fence Demo, Change/Use '-"'\
Other - - I f)'.
a
I
I HlSPEC 10rl LINE
726-376, .'
Address
DESIGN IEAI1
(name)
Pl,one
(a~ddress )
ValUE of Work: ~
./"2" ?/7.
BuiltiinQ. Pennit Info: Describe Work(i~e.. Build Single
Familv nesidence With Attachpd Garaae\
\~o rL 0 ~ \ ..\~,~~
~/'\~ l/lQ\Q/;,.li\ J
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CXJ
0\J
Owner I Cc::. .~.f III C C ull T
Address ,-~7f!') -TP; ~~& i )/n" ')
CC.oc O.v-.lL Of---.. nL-P.=;
Construction Le'~der ~fZ 7t11-~~
Phone ,\y b
(lies. no.)
(exo;res)
(ohone no.
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name)
General \ Zd 0 <::::'t. t ~. ___
()
(address)
9:1/ f! All]) ,
b
(lirs nn,1 (~y~irps\
(l1hn"", I'l:n, 1
~Gg~1 /~-gt,-R,0
Plumbino
I El ectri ca 1
Hechanical
PlUIIBlIlG
ELECTRICAL
MECHANICAL
rIO.
HF (HARl;F Nn.-
<:EL J:liARIiE. ..l!Q....
n. ~ r~>1IDiL
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
~ New circu~ts alts.
or extgos10nS ,2D
"2~)c" ~~,.,.~
SERVICES
"22. f!j )
Floor furnace
and vent
S.F. Residence
(J bath 1
Duplex (1 bath) each
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
/
Appliance vent
~p1)ari'ltp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
hp~tino or Ar_
Mechanical exhaust
hood ~nd durt
Additional bath
Water service
Temporary Construction
Change in existing
rps i rlJ>n~p
multifamily. comm. or
T",(ipo:.tri"l
Sewer
CO~1./IND. FEEOERS
Install/alter/relocate
rHct..ih fpp(ip..o:.
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
ISSUANcr OF PFRllIT
TOTAL CHARGES 2-;?~:X:> TOTAL CHARGES ~#. k'/): e>O
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed aprlicat;on 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 exemDtion is noted hereon, and that
only subcontractors and employees who are in com?liance with OPOS 7nl.055 will ~ used on this project.
IIAI.IE(please print)
SIGNATURE
FOr. OFFICE USE om y
DATE
Zone C C
Fire Zone
Flood Plain
Tyoe/Const.~-/\I
Bedrooms
Stories /
Units
Occy load
Occy Group~'<2:
Sq. Ftg. t1ain
Sq. Ftg. Access "'/0"
Sq. Ftg. Other~2"~
x Value
x./t:/.06 Value ~'ICJO.'-'
x Value$8J7,-
TOTAL VAlUATIOll/27(?-'>-6
BUILDING PERfHT
Charges ant::
Surcharges
. a.o~..... Plan Ck.
___LJ!2~L':::_ 65%1Bldo
"'7 ~L / Plan Ck.
.;1 ~ r '7 30%lB1 do
I Fence
Conm/lnd
Ppr Fpp
Res
Per Fee
~Y,03
Systems Development
Charoe tL5~)
/~o. 7tb
PLUI1BING PERMIT
Charges and
Surcharges
DfjRlO
___33.'_~c:?.._S1d.walk
. "7(!) A/C Paving
___../..s;_~_J Curb Cut
-be; I
Total Comb. Perm; t / t.j /. qq-
I TOTAL I ~6. :z. 3'_
ELECTRICAL PERIHT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
I
.
.
:.. ..
~.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
II.
t. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2. examole- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examp\e- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new.- if addition.
check add, etc.
F. Building pennit information: .
1. example - construct single family house with an
attached gaT'age
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.
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
Z. 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 .
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. ---
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.
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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III.
IV.
V. FOR OFFICE USE ONLY
Permi t
Clerk ~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REVIEWED BY:
name
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L.t>7<'H~ rC~~signature ~~-C_ _.~
,~ ,r
date
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