HomeMy WebLinkAboutPermit Building 1984-10-3
I INSPECTION L1IIE
726- 37 69
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INFORrlATION liNt
726-3753
Sq. Ftg. I.lain
:q. Ftg. Access.
Sq. Ftg. Other
r~ew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
.,.,,-
Phone
Ran~e
ValuE of flor.: of!!)
Arm.
BUildinQ-ftler.mit-, Info: Descr.be Work{Le..
Familv Residence Witr Attached Garaae)
Build Single
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Job Address ;Y~S~lm _ '..A/ ",J.it:;
Legal Descripti~n\'7 O~ ~7\ ~2 ~ ~'I(-() )
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114 In- 'lfjdo
CITY UF SPRINGFIELD
CDMBIIIATION APPLICATION/PERMIT
EnERGY SOURCES:
Heat
t.Jater Heater
(namel
Phone
(address)
.~rv n 9-...
o
flies.
t l"'n~Qj)fll J)o
Constru ti n
Address
UESIGN TEAr..,
no. ,
(eXD; res)
(ohone nO.l
Primary
Structural
Electrical
Mechanical
CONTRACTO,S, [name V ,
General_ r~ ~t )~ ~{\ t(lt t-l")
Plumbino
(address)
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45f\
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(lic<:. no. \ (exnirps,- Jl:!.hnnf'l nn.'
<[~n . ID-3-84-
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Electrical
"'echan; ca 1
PLUllBING
ELECTRICAL
MECHANICAL
NO.
FEF r.HARr.F ~n
~~~ r411.Rr.I='Nn
1='1='1= r4ARr.r:
SQ. FT.
furnace/burner to
BTU's
,.
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~~~ h~~tpr ~nd vent
COMM./IND. FEEDERS
\ Install/alter/relocate
_l.oi c:;trib. fe€>dPrC:;
/' I
-I.
Appl iance vent
seoarate
Stationaryevap.
cooler
Vent fan with
sinale dllct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and oud
Wood stove/heater
~!ater service
Temporary Construction
Change in existing
rps i d.p'n~p
multifamily, COJlll1. or
tnrllJ<:.tri~l
Sewer
Storm Sewer
Of
amps.
~,
Of
amps.
ISSUANCE OF PERmT
TOTAL CHARGES ~ TOTAL CHARGES I TOTAL CHARGES
WHERE STATE LA\/ REQUIRES tbat the Electrical work be done by an, Electrical 'Contractor. the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical.Surervisor 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 OP.S 701.055 will be used on this project.
Zone r r
Fire Zone
Flood Plain
Tyoe/Const. ~ \.)
Bedrooms
Stories
Units
Occy load
Occ'y Group~-4
SIGNATURE
FOP. OFFICE USE DIlLY /
Sq. Ftg. f1ain
Sq. Ftg. Access,\" rz_~
Sq, Ftg. Other
(j)d
rR~
OATE
IlAI.IE(please print)
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERHIT l\ W. 00 Plan C.. Comm/Ind
Charges anc 65%/Blda Per Fpp
Surcharges -----\~~~- Plan Ck. Res
30%/Bldo Per Fee
PLUMBING PERMIT - Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERI:IT Sidewalk
Cha rges and ---=-=--------
Surcharges A/C Paving
MECHANICAL PERMIT Curb Cut
Cha rges and ------------
Surcharges
---
'(J~ 1_I'\~Yste.ms Development
,~ ). harQe (1.5%) .
11- 'V,,- - -
l-.1d2fYY)
\ 70- 0=
Total Comb. Permit
TOTAL
! \ W~:~
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I.
,
Applicant to furnish
.A. Job Address
B. legal Description
1. example- Tax Lot lOa, Lane County Map Reference
1I 03 43
2. example- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example-lheat/electr;cal ceiling/or forced air oas
2. exa~le- 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 pennit 'information:
1. example - construct single family house with an
attached garllge
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. 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
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 .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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Lo'd-OJ7
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II.
I I I.
IV.
V.
FOR OFFICE USE ONLY
Pennit Clerk
ctf~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY;
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Ccr~'\~'-k~\ ~
C'~~\:€'r\.. ~~~
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Permit appl icant exempt, from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
nam~\\\'~-<~M\6-"" Signatus;::J.-ljA~-A Y
(j'a ~e \\--\ ~<t:\
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