HomeMy WebLinkAboutPermit Building 1983-7-23
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Job Address J YO <; r-..<;(,....(/ j j, 'Ii' A~ ,uJ
Legal Description /7-tP'3-U-Yz. . ()~7t::>t::>
CITY OF SPRlIIGFIELD
CmlBlilATION APPLICATION/PERMIT
EtlERGY SOURCES:
Heat
Hater Heater
Ranqe__
INFORl1ATIDN liNt
726-3753
Sq. Ftq. 1.lain ~2,"-.p
~q. Ftg. Access.
Sq. Ftg. Other
-1lewXAdd_Al ter -,~ep.
Fence Demo Change/Use
Other - -
~
0-
'l""
-
rf)
00
11IISPECTIml LIlIE
726-3769
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Address
a J va}tt of Work:
Y)II/1M.n,{~.J k.1t ,(~LU: ) X \ (;H) ()
)/'0./:"7, (J (j),,:,,~'(J}Ch.Jl phone')'//,..".. Builciino Permit Info: Describe Work(i.e.. BU.ild Single
L) '+~ un 'So.. ,y ..,~ ?.Farnilv flesidence I~ith JI..ttrl.r:hpn GitrilQp.)
(>>vL~ r2dd~~ ~ ~'~
Owner
~tJ"~,
Construc~n lender
Address
UI:.;'Jli1{ ItAft
(name)
Phone
(addressl
(lies. no.)
(exnires)
;
(ohane no. 1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
QQQJ.. ~
Jaddress)
Arr~ rO
(1 ;r:<::. no.)
(exoirp<;.) (ohane no.)
Genera 1
933- ;;;;7;>7
Plumbino
Electrical
~'echani ca 1
PLUIIBIIIG
ELECTRICAL
MECHANICAL
-1lQ...1
lEach single fixture
IRelocated building
(new fix. additional)
I S.F. Residence
(I bath)
10uPlex (1 bath) each
IAdditional bath
Iwater service
lsewer
Storm Sewer
1 FFt I l"H^Rr.r
NO ,
Residence of
, CEL'-'liA&liI: "0 ,
_1_1=1='1='
Irl-l~
SQ. FT.
furnace/burner to
BTU's
/
y
New circuits alts.
or extensions
"2 OR;y,C~~
SERVICES
6:.(>>
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
ITempOrary Construction
Change in existing
rp'l i (tencp .
multifamily, comm. or
lnrluc;trial
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
I
I
I
/,!;:c>e>
Appl iance vent
seoarate
Stationary evap.
cooler
Vent fan with
s;nole duct
I Vent system apart from I
hea t i no or A. C.
I'Mechanical exhaust
hnnd and rlurt
I \iood stove/heater
I
I
I
Of
ICO~1./INO. FEEDERS
I Install/alter/relocate
rlidrib. feerlerc;
10f amp~l
I
I
i
amps.l
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
ISSUANC, OF PFRtHT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED 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 Springfielti and the Laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPArKY 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 comoliance with OP.S 701.055 will be used on this project.
IlAIlE(please print) 4114-.A/60/0 ((I)" f7i?..,(A,(~";lATURE~ D~ /~I
FO~ OrF I CE USE OIIL Y .b'
So. Ftg, 11ain" ~ 2S' fP. x Value /~~6<!l. tlO
Sq. Ft~. Access x Value
Sq. Ftg. Other x Value
~ ~OTAL VALUATIOll
& tl rJ.J'l5br~
r) . '/.,t-Jj J~/ SYStems Development
.~ I.,. _<:"</..,n Charqe (1.51,) '.
DATE
~ ,
7~ l.)/d;
- .
Zone C. C
Fire Zone
Flood Plain
Ty!>e/Const..:,
Bedrooms
S'"N
Units
Occy Load '7/6"0-
Occy Group"'. :i'
Stories
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BUILDIIlG PERIIlT
Charges an~
Surcharges
~u..... Plan Ck. COIlVll/lnd
~ 7 . 65%/Rldo Per Fee
------------""""i5'Tan Ck. Res
:;>.::r~ 30%/Bldo Per Fee
-;Z7~. ...co
PLUI1BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERI:IT
eha rges and
Surcharges
I Demo
IS.."'" 1 Sidewalk
-------.-60--1 A/C Paving
I Curb Cut
I
Total Comb. rermit
jC'<. %
-1
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
'3 ?:?%
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COMBINATION APPLICATION/PERMIT (CAP) PERMIT VAll DATION
I. Applicant to furnish
A. Job P.ddress
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 OJ 43
2. example- Lot I. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. examele- heat/~lectrical ceilin~/or forced air aas
2. examole- waterheater/electr1cal/or:solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. checknew - :if addition,
enee'" add. etc.
F. Building permit information:
1. example ~ construct single family house with an
attached garage
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 TEAM AND CON1RAC10RS
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 S1AFF WILL FILL OU1 ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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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Co \4'65
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V. FOR OFFICE USE ONLY
I
Cler~UJ()J
Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: !,?U/<'7.?/~ ~A'-Rn a~ ~~~LS
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PLANS REVIEWED BY:
name.L~~ R.~~
~ c-_
5ignatura-/'/ ~......~~.........
,. or 't.- p.
date 7-/~-g3
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