HomeMy WebLinkAboutPermit Building 1987-11-4
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I INSPECTION LINE
726-3769
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CITY UF SPRINGFIE~D U INFDR11ATION LINt
COMBINATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. 11ai n
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
New Add Alter Rep.
Range --Fence Demo Change/Use
/ _ ;alUE of l'lork: 1$1$ ~ ~ ~ Other- -
Phon~ 3.."-\1...- BU'ilciinQ Pennit Info: Deser.be Work.(Leq Build Single
I f-.=tq.l F.amilv Ilesidence ~~ith Attached Garaae'
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(l ics. no.)
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Job Address
LP'Y~
N. "Au sr-.
Legal Description
Address
k.\ k.E \<'!\Jt')G,LL-
\3L 1;-. ~'R.Of-\JOWA'i
ts\.)C:,-'G: \01:::;- )
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Owner'
Construction Lender
Address
UlSIG" rEAI1
(name)
Phone
(address 1
(exoires)
(ohane no. J
Primary
Structural
~r()
ii r
9;;, 6'0
.(';'q, L.//
\:J IP ~
Electrical
Mechanical
CONTRACTORS (name)
~General ') Y:;>,--t.~ Ql"""f"'P., C'\.\(_
(addr~ss)
(lir.c;. no.) (plmires)
..a..\C\Cl~ 111'-1/'6/
(nhone nn_)
Plumbina
t '><.014 ('~W RJO_
E:DC...,;t;:, uo:; ,
'" f "\ () L
3H4-()'l..loQ
Electrical
"lechanical
PLUllB I NG
ELECTRICAL
MECHANICAL
Each Single fixture
FFF ~HARr,F Nn~1 '-EELIJ:IJAJlGL NO,
I Residence of furnace/burner to
SQ. FT. BTU's
New circuits alts. Floor furnace
or extensions and vent
i="H. fl-lM.G.E.
~
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (l bath) each
SERVICES
Recessed wall
SD~CP hpatpr and vpnt
q
'1
ITempOrary Construction
IChange in existing
res.; d{mce
Imultifamily. conm. or
Tndustri~l
IOf amps.
!COMM./IND. FEEDERS
I Install/alter/relocate
dic:.trih. fppdprc;
IOf amps.
I
I
I
Appliance vent
c:;poa r~ tp
Stationary evap.
cooler
Vent fan wi th
~inale duct
I Vent system apart from
heatina or A.C.
I Mechanical exhaust.
hood and dud.
I \-load stove/heater
I
I
I
Additional bath
~Iater service
Sewer
Storm Sewer
ISSUANCF OF PFRrllT
TOTAL CHARGES I TOTAL CHARGES , TOTAL CHARGES
WHERE STATEl:'U~ REQUIRES that tile Electrical work be done by an, 'Electrical Contractor. the ,electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 OCCUPAIKY 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 subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
NAt.IE(please print) ':3"'\ t--\" R.xJ::-,s-, SIGIIATURE ~ _ ~ ~
FO~ OFFICE USE OIII.YI~\
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
DATEi:ll-\4-0l.lo"\
Zone
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
Fire ZonE"
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERNIT
Charges and ,
Surcharges 01-
, . , I Pl an Ck.
____~:1.~b_~9__ 65%/Rldo
Plan Ck.
,3. 73 30%/Blda
Call1l1llnd
Pf!r Ff!e
Res
Per Fee
ISystems Development '
Charoe tl.5~) ,
PLUllBING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICAL PERIHI
Cha rges and
Surcharges
Sidewalk
A/C Paving
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
Total Comb. rermit
I
I TOTAL
1 ~ ;1.3
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 03 43
2. examp.le- Lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical cei1inqjor forced air qas
2. example- 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. exa~le - 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.
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 SCHEOUI.ES
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. ~
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
'\2"C 0 . 'r'\" :#'
I
Permit Clerk
ID07'-f
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.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY;
name
signature
.
.
date