HomeMy WebLinkAboutPermit Building 1987-3-12
CITY OF SPRINGFIELD
Cm1BINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
Hater Heater
I INSPECTION LINE
723-37 69-~
Job Address
~n...-L dJ lid: t.
:2 7 L/ /2., to l 58'00
A / F/}
;-- cd..et d/
Phone ~ c( 5
533
Legal Description liJ 0 3
Owner /~ ?J
Address qT5 Dale i'-f
co""'"~ L,17L~ J- /'0 .
d
3D I 2..
Address
DES I GN TEAt~
Phone
(address)
(name)
Primary
Structural
. E1 ectri ca 1
Mechanical
CONTRACTORS (name) ;J . (address)
General ff)t: 011~/lV s:v~)
P1umbinq O~. /~~
Electrical WA../J1.J2.1tLo ~(J'~~'/'.
/'J tf. A .... ,.,.11 _ A-A /. / /? . -
~'echanica1 /~/<..-<::. ~~J/'-- ~
(J
PLUr.1B I NG
(\
NO.
FEE CHARGE. NO.
/
Each single fixture
Residence of
7~tJ
Relocated building
(new fix. additional)
ValuE of ~7i~MO
Bui1ciinq Permit 'Info: Describe Work(i.e.,
Family ~esidence With Attached Garaoe)
~hz()M t ~~
Range
(lies. no.)
~\
INFORl1ATION UNt
726-3753
Sq. Ftg. r,la in
Sq. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
Build Single
0~
/
(exoires)
(ohone no .>)
" .~l"I
lA V\"'I v-
~)J \ ,,/
. ~ ~ ~....., b
(lies. no.) (exoires)
:;---f/f1
~
~
~
--
~
0<::{
(o.hone no. )
/4g1- 2f(j/
,
S531J
/-:j
d/)-/5S(/_ .1!7/}
'19'019 /2-2~/-F'7
ELECTRICAL
FFF f.HARGF NO.
SQ. FT.
v
New circuits alts.
or extensions
"2 .62 /Y7L>R~
SERVICES
,';?ZS2
I
!TempOrary Construction I.
IChange in existing I
residence
I 'multifamily, comm. or ,
Industrial
, / IOf :;z ~ amps.1 ]g7S2:
, '75& I COt~r'1.IIND. FEEDERS I
, 'Install/alter/relocate I
distrib. feeders
I IOf amps.1 I
'I I I
I I , I
" I I
TOTAL CHARGES /5: 00 TOTAL CHARGES 60. 00 . TOTAL CHARGES M//v. ;: ):' ere>
WHERE STATE L!l.H REQUI RES that the El ectri ca 1 work be done by an. El ech-i ca 1 Contractor, thee 1 ectri ca'l porti on 'of thi s permi t
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAt1INED 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 pertaining to the work described herein, and that NO OCCUPAriCY 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 ORS 701.055 will be used on this project.
"AI" Ip ,,," pc' 0') DA ~ l E1 JY1 LIVt tl- IC'-- 510""URE 1.1....:.!) 5>;A1 'I~
FOP. OFFICE USE oiil Y , I;
Sq. Ftg. Main x Value
Sq. Ftg. Access x ~a1ue
Sq. Ftg. Othe~o.o~"" x ~$I5~Value jg../':""/'''...e
--. "
TOTAL VALUATION
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
I ~later servi ce
I Sewer
Istorm Sewer
j
.s"1//A' ~R ~ Toy:?.F
,
,
I
I
I
Zone a:
Fire Zone
Type/Const.~)\I
Bedrooms
Stori es
Units
Occy Load
Occy Group
j
V~G C6P~ #$2~
8-2
\
Comm/Ind
Per Fee
Res
Per Fee
Flood Plain
BUILDING PER~1IT
Charges and ""\
Surcharges J-J
Plan Ck.
65%/B1da
Plan Ck.
30%/B1dq
ELECTRICAL PERtm
Charges and \1\
Surcharges
___j2&,-~~_
5./ 'I
____is: ~
.(;0
'6'b,'~~ I Sidewalk
------~~y;;-::-Iyc P~ving,
____jZ_~~_1 Curb C~t'
~ be:> I
PLUI1BING PERMIT
Charges and .~
Surcha rges
Fence
D6mo.
MECHANICAL PERMIT
Charges and
Surcharges
v
2-f3-R1
I~ Bfngrt!
I
I
I
I
,
I
I
MECHANICAL
f.~U naceflturner to
I 1[~7/~.<"?BTlI's
" ~~ />~J?
F(~or furnace
and vent
Recessed wall
Soace heater and vent
v--. /lhr~J? p/ .:::rN~ f'<".
Appliance vent I
seoarate
Stationary evap. I
cooler
I Vent fan wi th ,
sina1e duct
I Vent system apa rt from'
heating or A.C.
, Mechan i ca 1 exhaust I'
hood and duct
I l'lood stove/heater I
I I
I I
I I
ISSUANCE OF PFRMIT
FFF f.HARGF
6. d<e>
IG.~"
I
I
I
I
,
I
I
I
I
DATEY-Iz -77
t
Systems Development
Charge [1.5%) ..
/LA
I
I
i.
ITotal
I
I TOTAL
~omb. Permit
227.2c;
I
I'
I
I
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. 'to/> ~,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
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 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, ~uilding
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 .schedul es
have' been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated scheduiescyou should consu.lt t.b~,.
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 coritractor 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 anp return it to the .
applicant at the time the actual 'perm"it is issued for his- -,
signature. ;
Fees and Charges
Plan check fee~ 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.
B 0 '/13> 11:
9/ /1-/rt
\ .; ,
III.
.
..
V. FOR OFFICE USE ONLY
Permit Clerk
~
PROJECT CONDITIONS TO BE SAT..ISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
., ..Adgit.iona 1 P,r.o~'ect In.formati on:,
,
.i
PLANS REVIEWED BY:
name ! ~/Y~ n~~
signature
..:- .-.
~~~~
//.1. /~.
date '3-/1-8'"')
. 1. ."