HomeMy WebLinkAboutPermit Building 1985-3-18
CITY UF SPRINGFIELD
COMBItlATION APPLICATION/PERMIT
EilERGY.-50URl;ES-,<-
Job Address ...),,,0:- ~,7/ If _ __~ Heat t;LE;C,
Legal DescriPtion:~ 5'"" J;./l.(-?\S\J~~f'lr'l l~ater Heater-
- - - , Range --
t? - '( lA/ u/ "'" Lo. '? = Vafli~".E1(:)-
Owner 5;0\,,-J-I.. 'H/ PM' cf Ir e. p, ~('Jtr---
Address C~'1 JUI'- I ~ ~ Ph Z c Bullciinq Permit Info: Describe Work(i.e.,
01,..1 U L..<..../ (..'" 0'..,0., one 20 - Family rl:esidence \~ith Jl..ttached Garaae)
(1I'M+I..-1) fl/'G Cf7:liJ<j ,;-/'51
/
Construction lender A/t'j)~,c;
IItlSPECTIOtl LItlE
726-3769
Address
Ut:.::dliN TI::Ar1
-
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lNFORf1ATION UNt
726-3753
Sq, Ftq, t,lain'/l' TI
~q. Ftg. Access. ----
Sq"Ftg, Other -----
~ew Add Alter Rep.
-Fence Demo Change/Use
Other - -
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Do
Build Single
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no.l
(name)
Phone
{addressl
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flies. no.l {exn;r~
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Structural
Primary J 4-4 t!J//
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General iJ fA/ /}1" Tf/~'=
, Plumbina
Electrical P.-u 1-'- - C C!-L6r7Ji1!f,r /S<::: 1L.,Lrr-c;.4 >~,! ,~"?,~"".'11} <.{-::J. v .:>0'6
Electrical
f1echanical
CONTRACTORS
/clechani ca 1
NO,
J'f-r'1- <./ n, ,_
(name)
faddrF!ss1
%~ r<?() PUf/i!Ch/tdilC--
(l ir:e:.. no.
(exnirp<; )
(ohnne nn. \
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5-"'''1)
bPi -7.P4 /
PLUlIBItlG
k'l.~
FEE 'CHARGE
(j,~
ELECTRICAL
MECHANICAL
Residence of
rHAR(;F NO. I
furnace/burner to
BTU's
FFF rHAR(;F.
NO
FFF
Each single fixture
SQ, FT,
Relocated building
(new fix. additional)
S.F. Residence
(1 bath\
Duplex (1 bath) each
Additional bath
~Jater service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~r:p hp~tp~ ~no vpnt
Temporary Construction
Change in existing
~I;><;J rte.nce
multifamily, comm. or
Tnou,trial
I App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnne! ~nd rllJct
Of
amps.
COMM,/IND, FEEOERS
Install/alter/relocate
riidrih" fp.p.rlp~<:,
\ Oft ~ \()() amps. \(1 \O.tX.
Wood stove/heater
I SSUANCE OF PFR!IIT
TOTAL CHARGES . TOTAL CHARGES
WHERE STATE LA\~ REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
I HAVE CAREFUllY EXMlINED 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 oertaining to the work described herein, and that rw OCCUPAltCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only sUbcontractor~;P1pe~;~~.-;.;~omDliance with ORS 701.05 "ill be us ~Z' ~ ~r!F/(f '\'_
HAt,IE(please print) l.J{;-A./ /VI <",v J V/?eF SIGIIATU 7/~' f OATE/t7-3()-f''Cj'
- ,
FOP. OFFICE USE QiILY ;-
Units \ So, Ftg, tla;n rlcr)
Occy Loa~ Sq. Ftg. Access
Occy Groupl?-,-'; Sq, Ftg, Other
...
IJ4f 1% S/~ z..
C0111I1/lnd I.V
Pj!r Fee If' /3, 00
Res
Per Fee
Zone roc
Fire Zone -
Flood Plain _
BUILOING PER~IIT
Charges anG
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRIC~,L PERtHT
Charges and
SUEc:harges
11ECHAN I CAL PERMIT
Charges and
Surcharges
, TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
TYDe/Const~ "- )
x~n
Value (" aJ:J.-
Bedrooms
Stories
x
Value
Value
\
x
TOTAL V ALUA TI Otl
I '":2....1" _ I Plan Ck.
---..!~lf[r-- m~:~~:
___~~~____ Fence
ID-~D-~ <j
D /J Systems Development '
Lr<' Charqe (1,5%) ,
0.0.00
t...'t"\\~""\t-.l ,~:y
,2,:',"0_ \O,CX:>
to.YO
A""'~
\0."""'-
---..-~~O--
~~-~'-~.._---,
De:R10
Sidewalk
A/C Pavi n9
Total Comb. Permit
Jl QC6.1&.
,
Curb Cut
TOTAL
.
-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
Mil &Lj 3 9~
IJ 'J,); ;/S/'
I. App 1 i cant to furn 1 sh
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 03 43
2. examele- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examf.?le- heat/electrical ceilinqjor forced air QdS
2. example- waterheater/electrlcal/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
a ttached garage
2. examele - 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 Specia~ty Code
H, OESIGN TEAM AND CO~TRACTORS
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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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.DQ1 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
payable when the permit is issued.
V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
(:::'i\~\\\..J(b. ~\"'-\.J~QE (""()~\Le \'\\....'\"'\ \c:-.\ \?e ~o\..'pa
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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