HomeMy WebLinkAboutPermit Building 1986-11-12
Job Address
725
Nt
A
L) \;)"I) c"rWO
CITY 0, SPRINGfIE~D
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Range.
ValuE of Hork:
l I :s.f-S. ot)
BuilcilnQ Pennit Info: Descr.be Workli-.e.~
Familv nesidence With Attached Garaoe)
~~4
"/
''1
I
I INSPECTION LINE
726-3769
.
INFORt1ATION LWt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
Owner' t---h.-iJAb
Address '72 S IU
I~g~t
A-
Phone
Build Single
~
J:;;
-
~
legal Description
(name)
Phone
{address}
~f'
Construction Lender
Address
DESIGN TEAI~
(lies. no.)
(exoires)
(ohone no. I
Primary
Structural
Electrical
Mechani ca 1
CONTRACTORS (name)
Genera 1 fA.) lU/t.%n -oifF
Plumbina
( addn'55l
~~
/ c,-
(l ice;. no.'
(pxnirpc;)
(ohone no.)
Electrical
r\."IC1
~1echani ca 1
PLUI.IBI NG
ELECTRICAL
MECHANICAL
NO.
HF rHARGF NI"l
~~~ r~ARr.~ Nn
~r~ r~ARr.~
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
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snnrp hPntpr nnrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
5 i na 1 educt
Vent system apart fram
heatina or A.C.
Mechanical exhaust
hood and dlJ(:t
Wood stove/heater
~Iater service
Temporary Construction
Change in existing
re<;..i (Lence
multifamily, comm. or
Tnrludrinl
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
di<;.trih_ fpprlprc;
Of
amps.
ISSOANCE OF PFR'lIT
TOTAL CHARGES I TOTAL CHARGES , TOTAL CHARGES
WHERE STATE L'\W REQUIRES that tile Electrical work be done by an- Electrical Contractor, the electrical portion of this perTilit""--
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~1INED 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 Oregon pertaining to the work described herein, and that rw 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 the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project.
IWIE(please print) D uo..wC\..LArBl tL.{'+ SIGNATURE ~~~ DATE \\-\L-~
FOr. OFFICE USE GIlLY
Sq. Ftg. liain
Sq. Ftl]. Access
Sq. Ftg. Dther
Zone
F1 re Zone
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
Stories
x
TOTAL VALUATION
BUILDING PER~IIT
Charges and
Surcharges
, ,., -0' Plan Ck.
_____<2'_3_o..:?__ 65%/Rldo
qd Plan Ck.
., 3D%/Bldo
Fence
ConrnlI nd
Ppr Fpf=!
Res
Per F~e
'Systems Development '
Charqe (1. 5~)
PLOt~B ING PERMIT
Charges and
Surcharges
D~mo
'Sidewa 1 k
ELECTRICAL PERlilT
Charges and
Surcharges
A/C Paving
Total Comb. Permit
I TOTAL
,~111
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
~
.
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ 03 43
2. examr.le- lot 1. Block 3. 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction 1ender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air Qas
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
attached garage
2. example - 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 apprapriate
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. BOILDING 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.
6~ 1) 1{
( 0_rffo
{(r ~
V. FOR OFFICE USE ONLY
Permit Clerk
Y;---
..
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
..
PLANS REVIEWED BY:
name
signature
date
..
..
725 North "A" Street
'f-:r:'
_;'!;;:.:'~;.1l,,~:~l,i:J~~iT-;-;(i ':(J .;'"
t;.
h.
J"i?,i:f:!'-,'
>.( .,
.. ,., ~
:,':1{'.
"i~
"1
':.,\
,.:gii,fi,";"M'; - ' '~!f:!:<#'i~l~
, ,,:":~".. 'I '.