HomeMy WebLinkAboutPermit Building 1984-6-14
1 INSPECTION LINE.
726-3769
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CITY OF SPRINGF'IELD
CDr1BlilATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
t.Jater Heater
e
INFORI1ATION li"t
726-3753
Sq. Ftg. 1.lain
:q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A 1ter P.ep.
-Fence Demo Change/Use
Other- -
I
OJ
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-C..
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Job Address (~c:,'; ~\" 'A J
Legal Description \,C)~ ',~S:5\ f)4Q{))
Owner
() C l.&W-a. e1dg..
Address r/)~c- A) _ 'Ail' .<..}-
construct~ d OX..J
Phone
Range
vall of flork: CO
I?_nO.
Buildintl Pennit Info:
Family nes;dence With
Describe Work(;.e.. Build Single
Attached Garaae'
(' .nf'l\.\llliJU' io.-D
Q(lNilJj
Qo.lY\OCU QJ
11}f1 fJ fJ
...-
Address
DESIGf~ TEN1
(name)
Phone
(address\
(l ;C5. no.)
{exnires1
{ohane no. I
Primary
Structura 1
Electrical
f1echan;cal
CONTRACTORS (namel
General ?Y.f e j {\ nil.. "\& .
(address'
roO(IJID W.S'f/")-f
(lies. no.) (exo;rps)
,~'74v;3 .Jul'J Rtf
JOhone nn.
Plumbina
Electrical
~1~c;han; ca 1
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FEF . CHARGE Nn
F~F rHAR(;F Nn_
FFF rHARr,F
SQ. FT.
furnace/burner to
BTU' 5
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(j bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Snacp heater ann vent
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
rps i (tf-nre
multifamily, camm. or
Tndustr;;:>.l
Additional bath
~Ia ter serv; ce
CDMH./IND. FEEDERS
Install/alter/relocate
distrih_ fpeders
Wood stove/heater
Of
amps.
move.. <..f.DMf
lSdJ
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
ISSUANCE OF PFRt1IT
TOTAL CHARGES I~.{)() TOTAL CHARGES
that tile 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 EXMllNED 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;wi1l 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 em~]oYees who are in comoliance wlth ORS 7nl.055 will be used on this pro;;r~
IWIE(please printt! E )! L~ L Lo,dSb/';/ wk.4IGIIATURE~ ~DATEX 6/;tIi.-
FOR OFFICE USE 0111. y
Zone Tyoe/Const. Units
Fire Zone Bedrooms Occy Load
Flood Plain Stories Occy Group
<"D~ LPo " 071. I3/.
BUILDING PERflIT () ~ _'Yl 00 Plan Ck.
Charges anc _____~_g-. 65't/Blrlo
Surcharges 0 Plan Ck.
. 30%/Bl do
PLUMBING PERMIT Fence
Charges and ------------
Surcharges
Sq. Ftg. f1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
Value
Value
Value
x
x
TOTAL VALUATION
Conm/l nd
Ppr Fpp
Res
Per Fee
Systems Development
Charoe (1.57,)
Demo
EI.ECTRIC~.L PERI:IT
Charges and
Surcharges
11ECHAN I CAL PERMIT
Charges and
Surcharges
_____./_5.fPO Sidewalk
1-0 A/C Paving
. LO
Total Comb. Permit
TOTAL
! 3(,.L/O
Curb Cut
e
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examFle- Tax Lot lOa. Lane County Map Reference
II 03 43
2. examele- lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner 'and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. examole- 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-nfw - if addition.
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examjle - 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 CONTRACTDRS
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, & E1ectrical 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 DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON TME 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. ---
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:
e
PERMIT VALIDATION
(o3U-I1
h-/Lfff
~
ry
Permit C1 erk
~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
--
.
date
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