HomeMy WebLinkAboutPermit Building 1984-10-24
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I INSPECTION LINE
726-3769
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CITY OC SPRINGfIE,D
COMBINATION APP,ICATION/PERMIT
EnERGY SOURCES:
Heat
Hater Heater
tt
INcOR/1ATION UNt
,726-3753
Sq, Ftq, 1,Iain
~q. Ftg. Access.
Sq. Ftg, Other
New Add Alter Rep,
--Fence Demo Change/Use
Other - -
Phone 74't- 8Jlf/
ValUE of [.jark: r' (Jo
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BuilGinQ Permit Info: Oeser,be Work(l~e., Build
FallUly neSiQ,enn H*'th ttached Garage) .
1.4M>IJiJ( 1 A~ i..'~~.
, /
Single
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Legal De,cription 17D"2,7';;-'32 -/')~L?{)O
.... ---
Job Address
RanQe
Owner SfHIAI"J!;tl 7Jti-A
Address 172'3 )1;;:J;f/4
01J--M::i.J.f) /)J,,~Q~
Construction ~erOJer 'n{f)l/!l '
6nM
Address
DESiGN rl:.Af4 (name)
Primary ~ ILiAA 1.t;tJf) 1 Lti-fL1
Structura 1 I II U I'
Phone
(address 1
f)/JOIHR
(1 ;C5. no.)
(expires)
(ohone no.1
If
Electrical
II
"
1/
f1echani ca 1
CONTRACTORS (name)
General all <;/4
Plumbino
') L .d (address)
lil'1 AYh1.~J'l~ t.OJ5~)(7?t;"'-
nics. no.'
(pxoi rp<;)
'1/R~
I
(ohnnp M. )
,'?O/JO 2-
& ~9-0rtlO
Electrical
~1echanical
NO,
~I=~ rI-lARr,~ NO
MECHANICAL' \.:) . ~
~n;, rI-lAQr,~
PLUflBING
\J.~
FFF CHARGE Nn
ELECTRICAL
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
() bath)
Duplex (1 bath) each
\
New circuits a1ts.
or extensions
\~ ~CC
Floor furnace
and vent
SERVICES
Recessed wall
SDnC.P hPntpr ~nn vpnt
Storm Sewer
Of
amps,
Appliance vent
SPDd ra tp
Stationary evap.
cooler
Vent fan wi th
sina1e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Additional bath
~Ia ter servi ce
Temporary Construction
Change in existing
rps i rlJ'.nce
multifamily, comm. or
Tnnllc;trinl
Sewer
C0I1H, (l NO, FEEDERS
Install/alter/relocate
nic;trib. fee-derc;
Wood stove/heater
Of
amps.
TOTAL CHARGES I TOTAL CHARGES
HHEnE STATE L,'I~ REQUIRES that tile Electrical wark be done by an
shall not be vali1 until the label has been signed by an Electrical
ISSUANCF OF PFmllT
\ ~.C1V . TOTAL CHARGES
Electrfca1 Contractor, the electrical portion of this permit
Supervi~or and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed 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 rm OCCUPAIlCY 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 ORS 701,0 W'll,~~ u~ed~:hi~/~r::~
NAI'lE(please print;])efJ. YI Pi) >1." (J/o1 YA.Un (_ lx}.J.AA OATEo,JJ/;limr.;
Zone CL Type/Canst,\,)- '\ ~~ Units Sq. riain
Fi re Zone Bedrooms Occy load_ Access
Flood Plain Stories Occy Grou~~_ Other.
x
x
Value
Value
x Value
TOTAL VALUATlOtl~ ~ T
BUILDING PERmT , ----~,~- I Plan Ck. CorrmlInd , '2.~.I..\O
Charges anc 65%/Bldo Ppr Fep
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLUl1BING PERMIT Fence
Cha rges and ------------
Surcha rges D~mo
ELECTRICAL PERI~IT ____~S. GO I Sidewalk
Charges and
Su!.:'~ha rges . cpO I A/C Paving
11ECHANICAL PERMIT I Curb Cut
Cha rges and ------------
Surcharges I
ISystems Development I
Cha roe tr. 5%) ,
\., .~
Total Comb. rermit
TOTAL
j 'lCo. 4l\ I
,
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
8. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 uj 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. examl?le- heat/electrical ceiling/or forced air qas
2. examole- 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. 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 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 SCHEOULES
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
signa ture.
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.
3' )_<6~
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V, FOR OFFICE USE ONLY
Cl"kr-ALfJ~
Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
~~r_>', ~~\\
Sig~turl\ ~~ ~
- '- " -
da te'f1-~-'h~
,', 'name\
.