HomeMy WebLinkAboutPermit Building 1987-4-1 (2)
I INSPECTIO~ LINE
726-3769 .
iNFORI1AT: :':i ll:'C.
726-3753
Sq. Ftq. t'lain
~q. !"tg. Access.
Sq. Ftq. Other
~ew Add Alter ReD.
--Fence Demo Change/Use
--:-Other -- --
CITY OF 5PRI~GFIELD
CO/IBHIATION APPLlCATIQN/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
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Legal Description j?-o3-2, ?"73. <::::1;S'Boc:>
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Owner l;,.c-/F/e:: ,r;~'5.T ~;~A'~
Address 97~ CA$ ~ Phone
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Construction Lender
ValuE of \-Jork:
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13uilc;inq' Permit Info: Describe ('Iork(i.e..
Family Residence With Attached Garaqe)
Build Single
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(1 ics. no,) (exnires) (ohone no.)
Address
DESIG~ TEArl
(name )'
Phone
(address)
Primary
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Structural
Electrical
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CONTRACTORS (name) (address) ,
Generalfr7~~T,~e .~L.r/<:~~~
Plumbinq
(ohone no. )
Electrical
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PLUflBING
ELECTRICAL
MECHANICAL
tW.
Each,single fixture
FEE CHARGE NO. I FFF rHAR(:;F NO.
Res i dence of furnace/burner to
SQ. FT. BTlI' s
FFF rHAR(:;F
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Relocated building
(new fix. additional)
F1 oor furnace
and vent
New circuits alts.
or extensions
S.F. Residence
(] bath)
I Duplex (1 bath)
IAdditiona1 bath
IHater service
I Sewer
!Storm Sewer
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I Recessed wa 11
. Soace heatPf and vpnt
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SERVICES
each
!TempOrary Construction
IChange in existing
residence
ImUltifamily, comm. or
Industrial
Apoliance vent
seoa ra te
Stationary evao.
cooler ~ ,
I Vent fan with
sino1e duct
I Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I \'Jood stove/heater
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Of
amps.
COMM./IND. FEEDERS
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amps.
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I ISSUANCE OF PFRmT
I TOTAL CHARGES
Electrical Contractor, 'the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~IINED the completed apn1ication 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 Oregan oertaining to the work described herein, and. that NO OCCUPANCY \~ill 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 exemntion is noted hereon, and that
only subcontractors and employees who are in comD1iance with OP.S 7nr.055()ll be used on this nroject.
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I FOr. OFFICE US[i/CmL Y v --.J I}
Zone
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So. Ftg. 11ain x Value
Sq. Ftc]. Access x Value
Sq. Ftg. Other x Value ~~
\ TOTAL VALUATION
~. YO ST;stems Development
C arqe (1.51,) .
Tyoe/Const.~--~
Bedrooms
Units
Occy Load
I Occy Group 3-L-.
V?G '~PE ~~~
'I - // ~ . Plan Ck. CommlInd
. L P' ~ 65%/131 do Per FeE'
?- --- ---';'2/---PTan Ck. Res .
~ t7, 30%/B1dq Per Fee
_ 'Fence
---------~- ~I D~mo
Fire Zone
Flood Plain
Stori es
BUILDING PER~1IT
Charges and
Surcharges
PLUl1BING PERMIT
Charges and
Surcharges
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TOTAL
27.<1>1-
..ELECTRICJ'.,L PERf~IT
Cha rges and
Surcharges
11ECHMlICAL PERMIT
Charges and
Surcharges
Sidewalk
AIC Paving
.", Cu~b 'C'ut
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Total Comb. Permit
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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
i. eiample- heat/elect~ical ceilinq/or forced air qa
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. examole - remodel existing garage into family rom
3. examole - convert single family residence into
restaurant (Change of use)
G. Value of work as defined in Section 303 (a) of the
,Structura I Speci a lty 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 jab 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
full schedules
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. -
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 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.
V. FOR OFFICE USE ONLY'
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B
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5:8 0 3 ;
Date "I?R/c. J _ 19~7
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Address ~~Ne-.-/ o-R _ q? ~~
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Amount Received
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
',Additional Project Information:
PLANS REVIEWED BY:
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date .Y"/-$7