HomeMy WebLinkAboutPermit Building 1984-8-21
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INFORltATlON liNt
. 726-3753
Sq. Ftq. 1.lain
:q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
./7/$(?/; .P
II
Job Address
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CITY UF SPRINGFIElD
COMBIIIATlON APPlICATlON/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranne
ValuE of Hark:
~/ q q? C?5?
BuildinQ p'ermit Info: Describe \1ork(Le.. Build Single
Familv nesidence With Attached GaraQe)
10" - A M~ ..- -<-'~C:H"J ..a.M. H
i1i/t/"lT I/Yi.;- r:ttb.J; KZ.GI'5W.7)A-wr
AI /1-17> 1/2 / ~ L '\ /I
. (lies. no.) (exo;res)
C)
o
10
IZ)
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I INSPECTION lINE
726-3769
Legal Description
n ~
Owner .(/JjlM~'
Address
Phone
Construction lender
Address
DES I GN rEAI~
(name)
Phone
(address)
(ohone no.l
Primary
Structura 1
Electrical
f1echanical
CONTR.AL: rUI{~ l name I
General ~~.J
R~-d
(address) t'
IfX ~I /J =3</ c$
(l ;c<:;. no.
(pxn; rp<;. \
(ohonp no.)
~rJ
Y$r-
74/(, - t, 7 c.?.
Plumbino
Electrical
f..lechan; ca 1
PlUIIB I NG
ElECTRICAl
MECHANICAl
NO.
FFF rHARr.F NO
~~r . rHAR(.;1=' ~Jn
1='1='t' rHAIU~1='
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
SeOo'lriltp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd ~nd rlurt
Additional bath
Sewer
Temporary Construction
Change in existing
res; rlence
multifamily, comm. or
I nduc;triil 1
~Jater service
COI~I'1. II NO. FEEDERS
Install/alter/relocate
o;<;trih. fppoprc;
Wood stove/heater
Of
amps.
ISSUANCF OF PFR!lIT
TOTAl CHARGES I TOTAl CHARGES , TOTAl CHARGES
WHERE STATE l.\\~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical rortion of this permit
shall not be vali1 until the label has been signed by an Electrical 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 I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed here in, and tha t HO 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 701.055 will be used on this p~ct.
HAIIE(please rri~ iL- f) ~,4f~IG!IATURE~ jA.~~~ AJATEI'~c?l-1l/
FO~ OFF I CE USE DillY
Sq. Ftg. Hain
Sq. Ftg. Access
Sq. Ftg. Other
Zone
Fi re Zone
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAl VAlUATION
BUllOING PERfIIT
Charges and
Surcharges
. Plan Ck. C0ll1l111nd
65%1Rl do Ppr Fee
------------ Plan Ck. R"es
30%lBl do Per Fee
Fence
'Systems Development
Charoe (1.5~) .
j()g -~
Lid. U
::s ,;7. en.
/.;J, J'
PlUMBING PERMIT
Charges and
Surcha rges
OIJRlO
Sidewalk
A/C Pav; ng
Total Comb. Permit
ElECTRICAl PERI~IT
Charges and
Su.rcharges
11ECHANICAl PERMIT
Charges and
Surcharges
TOTAl
33- ~ 2'1
Curb Cut
.
.
;
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. ~pp1icant to furnish
A. Job Address
8: legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 oj 4J .
2. example- Lot f. Block 3, 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electnca(/or solar
E. Square footage or valuation, etc. -
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check ~ew - 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 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.
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V. FOR OFFICE USE ONLY
Permit Clerk (~_ LL~d'~ /
~
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
5 i gna ture
date