HomeMy WebLinkAboutPermit Building 1984-4-12
I INSPECTION LItlE
726-3769
e
CITY OF SPRINGFIELD
COHBlrlATlON APPLICATION/PERMIT
EnERGY SOURCES:
Heat
Hater Heater
.
INFORt1ATION UNt.
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
--Fence Demo Change/Use
-Other - -
I~
--to
~
~
G'
I~
Job Address q,I]' ;/}/. A.
Legal oescriP;ion iiJffi~l.
oLrLrtJ
ghJy~/Jff
Address f{ z...':l' u/;"jj;C.lJL? '" C' J Ph~57_?"'34
cons~JE~~- \ ~ J QM \\ \\
~ Address
Ut::>ltiN HN1
7%#fi
~1d
Range
ValuE of Work: I'
.;4l/ 6'tJ 0Z.- .
BuildinQ Pennit Info: Describe Work.{i..e., Build Single
Familv ~esidence With Attached Garaoe)
.st:.Y~ T#' "~U5
tJ?/',c r;f- ;?E/fZJ~r k////-I
C21l4'?~
~fi% R 5/".Il4/#/.&.5>
Owner ~..f'<? .
(name)
Phone
(address)
(lies. no.)
fexoires)
(ohone no. ')
Primary
Structural
Electrical
Hechanical
CONTRACTORS (name!
General 7J?.Jf'ftt/ 5#.e.-l l?4#
r
(address)
.;<.$
21./"'7 1I,1lV R'i/t3:?
nics. no.
(pxnirpc;.)
(ohonf> nn.)
~2.5'5'6
J/)-IZ-- B'tJ
"/{{l-/- 'Z'-"37"-7
Plumbina
Electrical
~1echanical
PLUlIBIIIG
ELECTRICAL
MECHANICAL
NO.
FFF . r.HARr.F NO
~~~ r~AQ~~ NO_
~~~ r~ADr.r:
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valij until the
I
I
I
I ISSUANCF OF PERIHT
I TOTAL CHARGES I TOTAL CHARGES
tha t the El ectrica 1 work be done by an, 'El ectri ca 1 Contractor, the e 1 ectri ca 1 port i on of thi s permit
label has been signed by an Electrical Supervisor and returned to the Building Division
ITemporary Construction
IChange in existing
rp$.i dJ'nrp
Imultifamily, COnln. or
Inrlllc;t.ri~l
10f
ICOMM./INO. FEEDERS
I Install/alter/relocate
. didrih_ fppdprc;
10f amp~1
I
amps.1
App 1 i ance vent
saoar<i.tp
Stationary evap.
cooler
Vent fan with
sinole duct.
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood i1nd dur.t
Wood stove/heater
\oIater service
Sewer
Storm Sewer
I HAVE CAREFULLY EXM1INED 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 performed 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 OCCUPAr~CY 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 7Ql.055 will be used on this pr~~~ ~
HAI.IE(please print)-r;:;A/fy 5'//,e"'i?#/?- SI"IIATURE~ ____~ATE;-I2--%<,I
FOr. OfFICE USE DIlLY ./_____ //
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fire Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
,.,~I 'Plan Ck. Comm/lnd
-/-rt..~__ 65%/Bld(l Ppr Fpp
- ,., 7- Plan Ck. Res
. -, ~ 30%/Bldo Per Fee
Fence
'Systems Development '
Charge (I.5~)
PLU'~BING PERMIT
Charges and
Surcharges
D~o
ELECTRICP.L PERr:rT
Charges and
Surcharges
Sidewalk
11ECHAN I CAL PERM IT
Charges and
Surcharges
AIC Paving
____________1 Curb Cut
I
Total Comb. Permit
TOTAL;( q. 0/ f.R
.
COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II 03 43
2. exam~le- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ce;l;n~/or forced air Qas
2. example- waterheater/electrical/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 permit information:
1. examole - construct single family house with an
attached garlJge
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. OESIGN 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
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING 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.~ 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.
,
II.
I I I.
IV.
V.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
e
PERMIT VALIDATION
13 &,;;;. -? 3- b
2/-,)~f
Permit Cler~
t7
.
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date