HomeMy WebLinkAboutPermit Building 1987-4-1
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I. INSPECTION LINE
726- 37 69 '
Job Address53"'? W CEHTEH~//9-C _U/7'~
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Legal Description / 7~3-2.?~ 7'3 c::::1$"",.g>0c>
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
l'later Heater,
Ran'1e
lNFORllATIOII lll'it. .
726-3753
Sq. FtC). 1'1a i n
~q. ~tg. Access.
Sq. Ftc). Other
New Add Alter Reo.
--Fence Demo Change/Use
--Other -- --
Owner ~/F/~',!=;~5.r ~~~A~
Address 97..;..<} PA~ ~ Phone
~ 4-/?J4C~ I L&>_
Construction Lender
ValuE of l'lork:
B' 'l,,~tOOI."""'f-D 'b 'J k('
Ul C:lnq Pernllt n 0: eSCrl e I'or Le.,
Family Residence With Attached Garaqe)
Build Single
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Address
DES I GN TEAr1
(name)
Phone
(address)
(lics. no.)
(exoires)
(ohone no.)
Primary
Structural
Electrical
t1echani ca 1
CONTRACTORS (name) (address)
General MLhr7;7?tF .~Ls/C.~-<'C~
Plumbinq
Electrical ~hC"~C;- L9~-z::.?:-
, .. - -
(lics. no.) (exoir~s)
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(ohone no, ) i
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PLUr1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF rHARr,F NO.
FFF rHARr,F .
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Res idence
(l bath)
Duplex (1 bath) each
IAdditional bath
Hater service
ISERVICES
I
Recessed wall
Soace heater and vent
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ITempOrary Construction
IChange in existing
residence
ImultifamilY, comm. or
Industrial
10f amps.1
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
10f
I
I
I I
I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
label has been signed by an Electrical Surervisor and returned to the Building Division
amps.
I APDl iance vent
seDarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and duct
I \,Jood stove/heater
I
I
I
from
Sewer
Storm Sewer
I
ISSUANCE OF PFRrHT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valij until, the
TOTAL CHARGES
Zone /... ,.......
Fire Zone
I HAVE CAREFULLY EXAnINED the comrleted aprlication 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 SDringfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPANCY 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 ons 701.055, that if exempt the basis for exemotion is noted hereon, and that
ooly '"b"o""",,-:::.:m:;'0Y::: :h' .ra." i:/,om,,:::O" wi'h D'S 701.055 .ill b'~v"."d O~i' "jO.iect.
IW'1E(please p'rint) \ .Jln"n I/J I It,~ SIGrJI\TUR. _ Df\,TELj--j-P7
FOR OFFICE US ONLY l
So. Ftg. ~1ain x Value
Sq. Ftg. Access x Value
;t?--~ Sq. Ftg. Other x Value
Tyoe/Const.~--~
Units
Occy Load
Occy Group
~ c!:rb
Bedrooms
BUILDING PERI'1JT
Charges anc
Surcharges
I
V6G '~PE ~~~
- // ~ Plan Ck. CommlInd
_'__Lf?.'_~___ 65%/Blda Per Fe~
/~ Plan Ck, Res
. ~~ 30%/Bldq Per Fee
____________, Fence
I Demo
I S i dewa 1 k
- --- -- --- --,~I.A/c'.Paving
''I' Curb Cut
------------,
TOT^L VALUATION
Flood Plain
Stori es
I
~:y~
ISystems Development
Charqe (1. 5%)
I
I
I
I
. ITot.a,l
i T~TAL
Comb. Permit
1~~-jL
2?(!)f-
MECHA~lCAL'PEkMIi'
Charges. and
Surcharges
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,
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PLW1BING PERMIT
Charges and
Surcharges
.,ELECTRIC.n,L PERr~IT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
-.. PERMIT VALIQATION
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 constructlon lender'
,',' D~ En~rgy Source~ ", _. ,
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, checknew - if addition,
check add, etc.
F. Buil~ing 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
,Structu~~l Specialty Code,'
" H. DES I GN' TEAt,1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons 'regarding design i'nformatiori ..or job site
corrections, etc.
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 I
. 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 n6t covered on
the abbreviated schedules you should consult the
full 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
electrical contractor for signature
supervisor. The general contractor
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
wi.ll 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.
73 {;$O'3g
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II.
be delivered to the
by his electrical
is .not authorized
III.
IV.
V. FOR OFFICE USE ONLY
Permit Clerk 4~ '
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
Permit applicant exempt from registration with the Builder's Board because:
'"Additi ona 1 Project Informati on:
"
.-.. .,,:, "'-."
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PLANS REVIEWED BY:
'nameLcs~~ (~~::;;~
signatur~~~~
, /' ...,.,. /'
date
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