HomeMy WebLinkAboutPermit Building 1981-1-12
INSPECTION LiNE
726-3769
CITY OF SPRINGFielD
COMBINATION APPlICAT!QN/PERMl
INFORMATION LINE
726-3753
...--
ENERGY SOURCES:
I Sq, Ftg, Main
Sq, Ftg, Access,
Sq. Ftg, Other
_New_Add_Alter _Rep.
_Fence_Dema_Change/ Use
_Other _
oQ
-
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cp
Job Address
lS$"
(e/I tr n f/li)( 0
Heat
Water Heater
Range
Value of Work: dD
1500
legal Description
Owner
GerLa ch ~~ I. )12JJ...E,
6,&:) Cent-Plln ia l ~hone
Buildina Permit Info: Describe Work (i,e" Build Single
Family ~R~~i~~n~~ Vv'ith Attoched Ga~)
Address
Address
Phone
-~~
Construction lender
DESIGN TEAM
(name)
(address)
(lies, no,)
(expires)
(phone no,)
Primary
Structural
EJedr!caj
Mechunical
CONTRACTORS
(name)
AD COIY
S I h A)S
,
(address) (Iics, no,)
l1JJ1J 13~ Nill ed
(expires)
(phone no,)
(or 3 .3151
General
Plumbing
Electrical
PLUMBING
ELECTRICAL
MECHAN ICAl
l
CHARGE. i
Mechanical
NO,
FEE
CHARGE NO,
FEE CHARGE NO,
FEE
Residence of
furnace / burner to
I'\TU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A,C.
Mechanical exhaust
hood and duct
Each single fixture
Relocated building
(new fix, additional)
S,F, Residence
(1 bath)
sq: ft,
New circuits, alterations
or extensions
SERVICES
Duplex (1 both) eoch
Temparary Construction
Additional both
Amps,
Water service
Sewer
o Wood stove/ heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Amps,
ISSUANCE OF PERMIT
TOTAL CHARGES
TOT Al CHARGES
TOT Al CHARGES
WHERE STATE LAW REQUIRES thaI the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shail not be valid until, a
label has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information herean is true and carrect, and I further
certify that any and all work perfarmed 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 herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division. I further
certify that my registration witl> 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
heron, and that only subcontractors and employees who are in compliance with ORS 701,055 will be used on this project.
Basis for Builder's Board exemption:
NAME (please print1 A. 'R. \J I{ ETS, 1 " "I [
"IGNATURE ~~
DATE J 12.1'& (
FOR OFFICE USE ONLY
Zono
Fire Zone
Flood Plain
Type/ Const.
Bedrooms
'Inits
()ccy load
()ccy Group
"-q, Ftg, Main
"q. FIg, Access
Sq, Ftg, Other
'(
Value
lIalup
Value
x
<::: to riP' "'
'(
TOTAL VALUATION
BUilDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck, Res
30%/ Bldq Per Fee
Systems Development
Charqe (1.5%)
PLUMBING PERMIT
Charges and
Surcharges
Fence
~
Total Comb, Permit
I~'O()
Demo
ElECTRICAL PERMIT-
Charges and
Surcharges
Sidewalk
AI C Pavina
MECHANICAL PERMIT
Chorges and
Surcharges
r---
I TOTAL
I 5 .rJD
Curb Cut
COMBINATION APPLICATION/PERMIT {CA'I
I. Applicant tQ furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example-water heater/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 (o) 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 ar 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 schedL,les
have been abbreviated
2. If the item{s) to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
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 typewritten 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 applicationl
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:
AdditionQI Project Information:
PLANS REVIEWED BY:
namp
'iignatur'"
PER.V\IT V ALIDA liON
.-t1-~1
.....
Permit Clerk-
~atE'