HomeMy WebLinkAboutPermit Building 1982-5-24
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INSPECTION LINE'
726-3769
Job Address
n19~C~ntennail RL~d
17 -01-n -41.--.I...J 111QO
CITY OF SPRINGFIELD
COMBINATION APPLICATION/ PERMIT
ENERGY SOURCES:
Heat
Water 'Heater
Range
Value of Work:
INFORMATION LINE
726-3753
Add;ess
Spi-1 ilgf+c 1 j ,OR
Phone
$1.000.00
Building Permit ,Info: Describe Work (i,e" 'Build Single
Family Residence With Attached Garage)
Sq. Ftg. Main
Sq. Ftg. Acce ss.
Sq, Ftg. Other
_New~Add_Alter _Rep.
_Fence_Demo_Change/ Use
_Other
00
N
o
(J"J
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, legal, Description
--
Ow-rier .'
H5 i'l t t 'B..r.o..:t /1 p rc::
Address
,Phone
R,uilrl 1D' nUl waLl Li'lr into bat~ plumb-
I ing for new sink. Place 6 elec pluq out-
Ilets.
Construction lender
DESIGN TEAM
(name),
(address)
(Iics. no.)
(expires)
(phone no,)
Primary
Structural
'Electrical
Mechonical
CONTRACTORS
(name)
(address)
(Iics, no.)
(expires)
(phone no.)
General
Plumbing
Electrical
Mechanical
PLUMBING ElECTRICAL MECHANICAL
NO. FEE I CHARGE NO. FEE I CHARGE I NO. I I 'FEE I CHARGE
~ '.,;d.o'.o' I I furnace/ burner to , I
2 Each single fixture sq. ft. BTU',
I Relocated building , ,-,- New circ~its, alterations ) r~-l) I Appliance vent I I
(new fix, additional)' X or extenSlons2 n r mn r ' nn separate
I S,F, Residence I I I I I Stationary evap. I I
(1 bath) SERVICES cooler
I I I I I I I Vent fan with I I
Duplex (1 bath) each Temporary Construction single duct
I I I I I I I Vent system apart from I I
Additional bath Amps, heating or A,C.
I I I I I I I Mechanical exhaust I I
Water service hood and duct
I Sewer I I I , I I Wood stove/heater I I
I Storm Sewer , I I I FEEDERS I I Heat Pump I
.;/ I r I I / I Air handler to I
Amps. 10,000 CFM
I I I I I Air handler over, ,
10,000 CFM
I I I I I I
I I I I I I
I I I I I I
I I I I I ISSUANCE OF PERMIT
TOT Al CHARGES <<l;lO_n~ TOTAL CHARGES $15.00 TOTAL CHARGES
WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical ,portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFUllY EXAMINED the completed application far permit, and do hereby certify that all information hereon is true and correct, and I further
certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oreg~n
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division, I further
cerHfy that my registration with, the Builder', Board is in full force and effect a, required by ORS 701.055, that if exempt the basis far exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used an this project.
Basis far Builder's Board exemption:
NAME (please print)f!a-YfJ Jd if/. g/};C l'
SIGNATUR~~df>l~/ld-
DATEI ~-~tj-:?2...
FOR OFFICE USE ONLY,
Zone --C=?
Fire Zone
Flood Plain
Type/Canst. V-N ,Spr
Bedro,ams
1
Units
nccy load
0ccy' Group ---B 2
"q. Ftg. M"in
C;q"Ftg, Access
Sq. Ftg. Other le.a.s P
'( Value
x Value
'pi'lr.P RE'lllo,deJ Value
TOTAL VALUATION
13$ S'f 0 g 'f I Syste,ms Development
6.50 Pd 5-20~oo.rge (1.5%)
I
I
!Lggg~ gg
<:'torie"
BUILDING PERMIT
Charges and
Surcharges
___~JlD~O
.40
_~__JlO.JJO
_40
____-.$15.JJ0
.nO
Plan Ck, Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
Demo
II Total Comb. Permit
I
I
I
I
~1r;,4n
PLUMBING PERMIT
Charges and
Surcharges
Fence
ElECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL rERMIT
Ch':Hges and
Surcharges
Curb Cut
I
I
I
,r TOTAL
Sidewalk
I A/ C Pavinq
$36.40
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to 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 (0) 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 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 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
nam'"
Lorne Pleger
PERMIT VALIDATION
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5-24-82