HomeMy WebLinkAboutPermit Building 1988-1-11
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Job Address
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CITY Of SPRINGFIELD
COMBINATIDN APPLICATION/PERMIT
EnERGY SOURCES:
Heat
t~ater Heater
Range
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INF0R11ATION liNt
726-3753
Sq. Ftg. f.1ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
-Other- -
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I INSPECTION LINE
726-3769
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Legal Description
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Owner K..e.c T;3, O-.-.L
Address) I '15, :.-\ l,u.h \\ood
WD~!I:?l.<.--v'M
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o Phone 1.{.~L/-a5,~
VaIUE)l! Hork: b?l
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Buildirla Permit Info:
Familv Residence With
Describe Work(i.e.. Build Single
Attached Garaoe)
Construction Lender
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T-\~ I ^ ,..J,
(l CO~u..,().<...>,~
Address
Ut~ HiN TEAt.,
(nameJ
Phone
{address 1
(l ics. no.)
(exoires)
(ohone no. I
Primary
Electrical
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Structural
Mechanical
CDNTRACTORS
Genera 1
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f:G.4\ 'I ~~'..~
C ()
(address)
13.;1,:l- \....). ?;e)r:S-
(lies. no.' (pxoirps)
(ohonE> no.'
C\'1J. TI
&,OO.Y)D lh) 09
II
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Plumbina
Electrical
~lechanical
Ptlll!lBlIlG
ELECTRICAL
MECHANICAL
NO.
fTL- ..t.H1l.1?f;~ IIln
t:'t:'t:' rl-l~ Nn
t:'t:'t:' rl-l~
SQ. FT.
furnace/burner to
BTU's
Each slngle fi~ture
Residence of
Relocated bullding
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (I bath' each
Additional batll
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~~p hp~tpr ~"rl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoar~te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hoor! and r1Uc.t
Wood stove/heater
~Iater service
Temporary Construction
Change in existing
rpc;J qrnc.p,
multifamily. COIl11l. or
Industrial
Sewer
CDMM./IND. FEEDERS
Install/alter/relocate
r!; <;t.ri h. fppr!prs
'-J
\0..
Df
amps.
TOTAL CHAllIGES
WHERE STATE t~~ REQUIRES
sha 11 not be v,aH'1 ,l.mti 1 the
TOTAL CHARGES
that the Electrical work be done by an,
label has been signed by an Electrical
ISSUANCE OF PFR!IIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
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 1 further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfiield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAHCY 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 th -basis for exemption is noted hereon. and that
only subcontractors and employees who are in com~l~ance with ORS. 7nl.055 will e used on ~~,t~pr:j;ct.
IWIE(please print)Y "'::;;;)?1~.5 .p u./;,tJl'l1 l""K SICIIATVRE'X. 'ne{) ft!.2I~DATE V / /-.f'p
FOR OFFICE U!!t"DiIL Y I
S6. Ftn. 11Jin
S~. Ft~~cess
--
Sq. Ftg. Other
Zone
Fi re Zone
Tyoe/Const.
Bedrooms
Stories
Units
x
Value
Occy Load
Occy Group
x
Val ue
Flood Plain
~
\J
x
Value
q OQO ".::-
TOTAL VALUATIDN
BOILDING PERMIT _____7_{~__ ' Plan Ck. CommlInd
Charges anc /'" 6S%/Rldo PPr Fpp
Surcharges 6. 13 Plan Ck. Res
3D%/Bldo Per Fee
PLU!lBING PERMIT Fence
Charges and ------------
Surcharges D!1ffiO
ELECTRICAL PERIHT Sidewalk
Charges and ------------
Surcharges A/C Paving
11ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
'Systems Development
Charqe (1.5%)
ft1CXtJac.t.k~ .:J3 j;;;,-,OO
FU2-.-
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I
ITotal Comb. Permit
1
I TOTAL
93~
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COMBINATIDN APPLICATION/PERMIT (CAP)
I~ Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100. Lane County Map Reference
]7 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinqjor forced air qas
2. example- waterheaterjelectrical/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. 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. 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 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.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:
..
PERMIT VALIDATION
~~
Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date