HomeMy WebLinkAboutPermit Building 1984-12-3 (2)
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726-376g
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Ranqe
Valu( of l-jark:
INFORlIATION UN'
, 726-3753
Sq. Ftg. 1'1ain
~q. Ftg. Access.
Sq. Ftg. Other
r~ew Add A Iter Rep.
--Fence Demo Change/Use
Other- -
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Job Address 8C7 ~c'Rn./'A" 57 S~"n=:])
Legal DmriPtion\"l ()~ ~'S 1.\2-
Owner --:J, /l /1, ~,
kiruA;:<o L.... (7tlKI'Vl.""11V
Address ;::0'::- <" ~d /cc,-l..h'--:-J,
......, I.,J ,-.x-,~, n (cc,;. rla.(.F'
Phone 7?1._.:::tA"t
Builr;inq Permit Info: Describe WorK(Le" Build Single
Familv n~sid~nce IHth .a~.t.ac;h~d Gi'f~o~1
S?R,,.:;,,",ocIt=-L.7), t)~
Construction Lender
Address
DESIGfI TEAfl
(name)
Phone
(address)
(llcs. no.)
(exoiresl
(ohane no.
Primary
Structural
Electrical
Mechanical
CONT RACTORS
PlumbinQ
(namel
---r;+c: WI'''''' /Iil~U-IA";T
f1,< S TO(V/ -H,'-<rv? 13 II.) M
JK t2.0"K.e-';~c"'<"c.1?
(a(lrlrpc;c;)
(lice;;. no. \
(~xt);rpc;;l
(ahanf! nn.)
Genera 1
~l'07 ;J,';m-J A <),,, n--- /)
~I oD s..-
Electrical
~1echani ca 1
'NO.1
"~IEach single fixture
I Relocated building
(new fix. additional)
Is.F. Residence
(J bath)
IDuplex (1 bath) each
jAdditional bath
I Water service
I Sewer
I Storm Sewer
FEE CHAR(;E Nn
"CC
MECHANICAL \::J.~
rlJARlil NO mc__ Ll:IARG.E.
furnace/burner to
BTU's
PLUI1BI NG
ELECTRICAL
s.- \O~)
Residence of
SQ. FT.
\
New circuits alts.
or extensions
, \6' (")cr:;
Floor furnace
and vent
SERVICES
Recessed wall
So~rp hp~tpr ~nrl vpnt
Of
amps.
Appliance vent
spn~r~tp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and rlu(",t
Temporary Construction
Change in existing
rp'S-irlenl"'p
multifamily, comm. or
lnrluc;tr;~'
COffi1./IND. FEEDERS
Install/alter/relocate
rli<:;,trih_ fpprlpr<:;,
Wood stove/heater
Of
amps.
ISSUANC, OF PFRlln
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\14 REQUIRES that tile Electrical work be done by an. "Electrical Contractor. the electrical portion of this pernit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
I HAVE CAREFULLY EXAtllNED 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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 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.
IWIE(please print) JAMeS 1<. C...c<<c, J.,,- SI-G:I^TURE~"""'<J /?ceJ
D~,TE 12- J.l?4
Zone c..t::-
Fire ZonE' -
Flood Plain ----
Tvoe/const\)- ,,,\.\:)_ _Units
Bedrooms Occy Load
Stories ? Occy Group~?_
FOr. orFICE USE ~flLY
V
Sq. Ftg. riain
Sq. Ftg. Access
Sq, Ftg. Other
v
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERmT
Charges an~
Surcharges
\~ CO Plan Ck.
I I. 65%/Bl do
-i:..-\O---""Plan Ck.
. 30%/B1 do
\ r') .c:o
-~C'O- Demo
___\D.OO
L\O A/C Paving
Conm/Ind
Ppr Fpp
R"es
Per Fee
\\b..
Systems Development
Charae (1.5%)
\-..). ~
PLD'~BING PERMIT
Charges and
Surcharges
Fence
ELECTRIU,L PERI:IT
Cha rges and
Surcharges
Sidewalk
Total Comb. rermit
TOTAL
~w
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100. Lane County Map Reference
1I OJ 4j
2. example~ lot 1. Block 3, 2nd Addition to
~prlngrield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etC. -
1. examole- 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. examole - 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. OESIGN TEM1 ANO 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
full schedules
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
o. 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
wi11 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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II
PERMIT VALIDATION
fl. .::II- 6 3 9</ <(
(j d ta//iN
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Permit Clerk
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Permit appl icant exempt from registration with the Buil der I 5 Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
nam~~~~e)J~
Signat~~' ~da~e\7~~-~ u....
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