HomeMy WebLinkAboutPermit Building 1983-10-12
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716.3769
CITY U~ SPRiNGFIELD
COI1B I;IATI ON APPLI CA TIONI PERMIT
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1NfORI1ATION Li,'jE
726-3753
E!lER1W S?URCES: / '.' Sq. Ftg. (.lain
Heat ' r-' 10 ~q. Ftg. Access.
Hater Heater IV J/...LI Sq. Ftg. Other
r~ew Add- Alter Pep.
Ranoe ___ _Fence_Demo_Change/Use
V~' .5H700.00 _Other .
BuilGinQ Permit Info: Describe Work\i.e.. Build Single
Familv Residence Hith /'l,ttached Garaqe)
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Job Address
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Legal Description lj? J- () +-
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Address
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Phone)y;. (~fJ'
Construction Lender
A.l>':/vt....
Address
Ut:,lGN rtAr-1 {name)
Primary --.....
Structural (
Electrical 1\',<:] f), liJ
Mechanical ,-,)
CONTRACTORS I name l
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Genera 1 A' .
Plumbinq ------
Electrical C ./.lrr Ii/t;"
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f,lechani ca 1
Phone
{address}
(lics. no.)
(exoires)
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{ohone no. i
(addrf>ssl
(1ics. no.)
(pxnirf>s)
(nhone no.'
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PLUI1BIrIG
ELECTRICAL
, MECHANICAL
110.1
FFF
CHARGF
NO_ I
I Residence of
SQ. FT.
New circu~ts alts. _.1
or extenSlons
FFF I fHARr:;F
I
NO.
FFE
rHA8f;F
Each single fixture
furnace/burner to
BTU's
Relocated building
(new fix. additional)
Floor furnace
an_d vent
S.F. -Residence
f1 bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snnr~ heater ann vent
~Iater service
Temporary Construction
Change in existing
rp<;idPnr:e .
multifamily, comm. or
lnrlu<;trial
Appl iance vent
seoaratp
Stationarv evao.
cooler ~ ,
I Vent fan with
sinole duct.
Vent systelTl apart from I
heatino or A.'C.
Mechanical exhaust
hood and dlU:t
Wood stove/heater
Sewer
Storm Sewer
Of amps.
ICOMM./IND, FEEOERS
Install/alter/relocate
rli<;trih. fpprlpr<;
Of
amps.
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ISSUANCE OF PFR!11T
TOTAL CHARGES
Contractor, the electrical portion of this permit
and returned to the Building Division.
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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of OreClon oertaining to _the work described herein. and that HO OCCUPAHCY will be made
. of any structure without the permission of the 13uilding Division. I further certify that my registration 'fIfth the Builder's
Goard 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 comoliance with ORS 7nl.055 will be used on this project.
HAlIE(please print) 'Q,'J/iUJ [;f}{rl//.;!tfJT)/ SI",;IATURE ~!tlc.(l ;:1[~.;/" om /dc/./j-j
FO~ OFFICE USE
Sq.
5q.
Sq.
Zone. CC'.
TYDe/Cons t. ~
Bedrooms
Star; es \
~\
Units \
Occy Load
Occy Group"?'- \
0i~1 Y
Ftg. t1ain x Value
Fta. Access x Value
Ftg. Other x Value
Fire Zone --
nood Plain _
BUILOItlG PERl,m
Charges an~
Surcharges
I)~ au I Plan ex. Comm/lnd
~ '\. 65<;:;/B1do Ppr Fee
---- ---':;(--1' Plan Ck,-ReS
. ""\'_ 0 30%/B1 do Per Fee
j Fence
TOT^L VALUATION
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i; ~Y'::>C'" Y"':::Zilsystems Development I f '0 "CI:)
I :->--,0 Charo. (1.5%) "I _ .
PLU'1BING PERMIT
Charges and
Surcharges
DI;l110
ELECTRIUL PER,~IT
Charges and
Surcharges
Sidewalk
Ale Paving
Total Comb. Permit
Co5,hIG ,
/lECHAlIlCAL PERMIT
Charges and
Sure ha rges
Curb Cut
ITOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
I
t. Applicant to furnish
A. Job Address
B. legal Description
1. examOle- Tax Lot 100. lane County Map Reference
11 OJ 43
2. examole- lot 1. Block 3. 2nd Addition to
~pr\n9tield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air QdS
2. examPle- waterheater/electrlcal/or solar
Eo 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. example - construct single family house with an
attached gar..,ge
2. examole - 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 TEM1 ANa 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 Pl~mbing, 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 fonm 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. BUILDIIIG DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
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.
..
11.
be delivered to the
by his electrical
is .~ authorized
Ill.
IV.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
PERMIT VALIDATION
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Permit appl icant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
llamep~~\\J "3,
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