HomeMy WebLinkAboutPermit Building 1987-12-4
CITY OF SPRIN~~ELD
COMBINATIpN APPLICA(1pN/PERMIT
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Legal Description 17..","~.2.7-c...j'3 ~~8~
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Address tI-7 t) f)o~c
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I INSPECiION LINE
726-3769
Job Address
Owner
Construction lender
Address
DESIGN TEM
Primary
Structural
Electrical
:~
~_1
\4ater Heater
Range
INFORtlATION UNt \
726-3753
Sq. Ftg. r'lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other -- ;--
09
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Phone~15
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ValuE Of:r~~1 !!Jf}.'
Buildinq ~ermit Info: Describe Work(i.e., Build Single
FamilyJ(esidence \4ith I).ttached Ciaraqe). .
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---Rf'Tcs. no.)' (exoires) (ohone no.)
(Ila~)
Phone
(address)
- . - - - -
. Mechanical
CONTRACTORS (n~~e)
General ~
Plumbinq
(address)
(1 ics. no.)
(exoires)
(ohone no. )
IYJc1f'? itA rf?. 8~8 '3077N<:-~~~Y.?..-?b.
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3 ;5"'S;b
6g7-<8'~/
Electrical
~1echani c'a l.:8'~"'::;';'-.d~H
NO. '
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Pt!l:l1ll1HN.15
ELECTRICAL
MECHANICAL
fEE 'CHARGE NO,
, FFF 'rHA!l(.;F NO.'
'FFF 'rHA!l(.;F
Residence of
furnace/burner to
BTlI's
Each sUrllgle fixture
7.5"0
SQ. FT.
I
Relocated bu]l~in~
(new fix. a~iticnal)
-<~>
Floor furnace
and vent
S.F. Res;de:lce
(1 bath)
I Dup 1 ex (1 lbatltli~ each '
IAdditional bath
I ~Iater senr-ijce
Sewer
,j..
....r."'"
~ New circuits alts.
or extensions
~ 6rq ~ffC=
SERVICES
Recessed wall
Soace heater and vent
V- *re::? lJC/C.7Wt??/X 6.
Appliance vent
seoarate
Stationarv evao.
cooler - ,
/ Vent fan with
sinole duct
.vent system apart from I
heatinq or A.C.
I Mechanica 1 exhaust I
hood and duct
I I'lood stove/heater I
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ITempOrary Construction
/Change in existing
,residence
multifamily, comm, or
Industrial
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amps.1
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Of
ICOMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeders
10f amp~1
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I HAVE CAREfUllY EXArlINED 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 Springfi~ld and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAfJCY will be made
of any strw:tu1"'e ....itoout the permission of the Building Division. I further certify that my registration ~/ith the Builder's
Board is in full f,orce 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 project.
NAt'lE(please print) 1!;/;IJLi# t:.,$~4/.,.,
Zone C; C.
Fire Zone
Flood Plain
BUILDING PfRHIT
Charges and
Surcharges
PLUI~B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERtm
Charges and
Surcharges
t1ECHANICAL PERMIT
Charges and
Surcharges
SIGNIITURE ~ddJf>' e~'
. . .
DATE/.2~~?
Tyoe/Const.
Bedrooms
Stories
5"""/Y
FOR OFFICE USE ONLY
Sq. Ftg. f1ain x
Occy Load Sq. Ftn. Access . . x
Occy Group 13.;....2.... Sq. Ft;. Other ;z?~"7?~C
..
I 0 0~ t./ TOTAL VALUATION
19f1 g 1/-/21_gi~~~~~~s(~~~~~opment L;Y::~~.
,-
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Units
Value
Value
Value :4~/~
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,
'_J5.~~~_' ~~~~B~~~
~../'-:;:;:;;;oo. Plan Ck.
./ ~....- 30%/Bl dq
_ _ _ J ,,5"". e:>e> Fence
, :/ S-I D(:mo
<.:<..-5C> I S i dewa 1 k
-----~;~/3J,A/C Paving
____./~~_~J Curb Cut
.. . ,73-1 .
Comm/Ind
Per Fee
Res --
Per Fee
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I ' Irotal Comb. Permit
I I 2/5". ~6 I
I I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
. PERMIT. VALIDATION
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... .......
'1--:.
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/electricalior solar
E. Square {ootage or valuation, etc.
1. example- 1250 sq. foot house, 5DO sq. foot garage
2. example- if new project, check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct singl~ family house with an
a ttached 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. DES I GN TEAr1 AND CONTRACTORS '. '- ( .. ~l .~... .....1
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. Apqr,eviated 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 theCAP, the label must be delivered to the
, . e"ectricalconfractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
Ill. Applicant to sign and date
Whenever possible, the initial application w{ll 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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Permit Clerk
V. FOR OFFICE USE ONLY
_ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'I. .') .::t. .. _.
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Permit applicant. exempt from registration with the Builder's Board because:
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..Additi ona 1 Project, Informati on:
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PLANS REVIEWED BY:
~/f;6 a~d??) Signature.~__..,(~
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date //~/t!?-g;:.>
name
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