HomeMy WebLinkAboutPermit Building 1988-5-11
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, 'I INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork: /8 f!J1J rJ
(lJ ,
Builc;inq Permit Info: Describe Hork(i..e., Build Single
Fami1v nesidence With Attached Garaoe)
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e- AiIdLz ~ iL,.I' #~
jL cJ~' S:;:6~
(lies. no,) (exoires) (ohone no. J
.
~.,.
or'
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5Y~ '. 0., ~ CV
(p ~ r:::lv clAp )
17.t!:'?-~7~34"- 5"B~
Owner Vf-V.~tl; _ r ~ ~o)' 7ed))A J
Address q 7 S O. a....../c.. Phone
c/o gul(('cr rlS u If (er 1001-1'-131
Mechanical
CONTRACTORS (name) (address)
'A-ll4/1 .m r?..J:n .~/}. P_ .<
Plumbin~ t2.hff ?PJn~/, .
E1ectric.a1 ~ _ ~~/. /I
~lechaniCa\ /~A.~iLA ,1/ ~ g;;'~ l' (f[i[j;jJ
, PLUr.1B I NG
Job Address
Legal Description
Construction Lender
Address
DES I GN TEAr~
Primary
Structural
Electrical
General
NO.
(name)
Phone
(address)
(lies. no.)
ELECTRICAL
FEE CHARGE
NO
...
rHARr,. NO.
Residence of
Each single fixture
SQ. FT.
s
~~ ~.?~"
Relocated building
(new fix. additional)
'22-S"
New circuits a1ts.
~ or ext~sions
7- '17 ~r.r ~
SERVICES
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
~Ia ter servi ce
Sewer
Storm Sewer
I
ITempOrary Construction I
'Change in existing "
residence
'multifamily, comm. or I 1'7
Industrial ""i
I 10f ~ ~~ amps.1 ln~
ICOMr'l./IND, FEEDERS I , I
I I Install/alter/relocate I I I
distrib. feeders
I 10f amp~1 I I
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I I , I I
I I I I
?;7. S-~ TOTAL CHARGES bP. ;e> TOTAL CHARGES /&'.-
that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
WHERE STATE LAH REQUIRES
shall not be valid until the
INFORllATION LlNt .1
726-3753
Sq. Ftg. f'1ain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter p.ep.
--Fence Demo Change/Use
--Other -- --
r:F;: ;
d
w
,~
''-0
(exoires)
(ohone no. )
~ ...--2g y/
MECHANICAL
~
furnace/burner to
?1J'b~. BTU's
Floor furnace
and vent
I.~ n.fARr,.
~ a
Recessed wall
So~~~ h~~tpr non vpot
I App 1 i ance vent
seoarate
Stationary evap. ' I I
cooler
Vent fan with f:z- 6 d4T> I
sinole duct ~.
I Vent system apart from I '-
heating or A.C. ,
I Meehan i ca 1 exhaust
hood and nlJCt
I Hood stov~iheater
I
,
I
ISSUANCE OF PFRrlIT
I HAVE CAREFULLY EXAllINED 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 Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO 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 OPOS 701.055 will be used on this project.
rW1E(p1ease print)D kIU vJ1 e...,T.v'1c.oe c::
Zone c::: c::::;
Fire Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLU'~B ING PERMIT
Charges and
Surcha rges
ELECTRICAL PERrHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Type/const.~ ~~
Bedrooms
Stories
SIGNATURE
FOR OFFICE USE ONLY
Sq. Ftg. r1ain~~PL~
Sq. Ftg. Access x
Sq. Ftg. Other x
DATE5 -((-~'
_t
Value /~....~.
Value
Value
(f~1S '1 TOTAL VALUATION
~ -'? ":l ~ u -2s _ ".J~ys terns Deve 1 opmen t' ..t' / "',
=>~. ~~I Qftharqe (1.5r,) -LLh
I
I
I
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ITotal Comb. Permit
/
Units
Occy Load---67
Occy ,Group t:3,. 2-
.... 70--
Plan Ck. Comm/Ind
65%/Bldo Per Fee
Plan Ck. Res
30%/B1dq Per Fee
I Fence
I Domo
IS1dewa1k
I AlC Pavi ng
I Curb Cut
I
---$~~~---
~O~
'3 ;7. :>G)
------------
j.BS
~.-
------------
~.~
---_/~:.~--
,76
'!
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
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 ceilinq/or forced air qas
2. example- 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
fu.ll schedul es
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. -
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.
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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IV.
V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exem~t from regi~tration with the Builder's Board because:
Additional Project Information:
. ,
PLANS REVIEWED BY:
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nameJ&>~Ht!E- .?l...:-~~
signature
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