HomeMy WebLinkAboutPermit Building 1984-3-27
Job Address '?IJ7 IU. I II I S,;f-. ~ ~ 'A.
Legal Oescnption ""{)~ (~~ o-J... ~~~
\~ 1()~Cf:;4:,9( Yf8'i) , ~:~:: of flork:
Owner ~ \Y\ . ~((u ~ 0'1 tL
C..T\C".LA ~ /-/ t1 Builciinq Permit Info: Describe I'Jork(Le., Build Single
Address 0) Do.......... ,JtlL~ if_C/o Phone74?-3s<;?J'amilv nesidence \'lith ,l\ttached Garaqe)
~. <ill 97Lf7K -5 ~ L~
Construction Lender ~ .(?Q [)"0' ~ LJ .
~ INSPECTION LINE
1726-3769
Address
UI:~HiN TEAr.1
Primary
Structural
Electrical
r1echan;cal
CONTRACTORS
, Genera 1
Pl umbi nq
.
'.
I NFORllATION liNt .1
726-3753
Sq. Ftg. I-lain
:q. ;=-tg. Access.
Sq. Ft9. Other
Hew Add Alter Rep.
-Fence Demo Change/Use
-Other - -
\>a
CITY Ur SPRINGFIELD
CmlBIllATION APPLICATION/PERMIT
I EJlERGY SOURCES:
Heat
\'!ater Heater
"'-
(name)
Phone
{address)
"\l
~
)-
II~
(lies. no.)
(exn;res)
(phone no.)
(name)
(address)
(l ics. no.)
(ohonP no.)
(pxnirf>s)
~
\1& ~ ~~ "~'J(,ra~~~ .
\J.~-{]4~~ ~
Electrical
~l~c;h;'\ni Cd 1
::rt If / <1 :2/0-0 V
~(^n2,{j() 12--IY-l5'/'
~
-?1/1/(r..(
9' Y2-30~J
PLUI1BIrlG
MECHANICAL
ELECTRICAL
NO
Residence of
SQ. FT.
\ New circuits alts.
or extensions
SERVICES
\
Temporary Construction
I Change ; n existing
rpc;;r!pnrp
Imultifamily, com. or
Tnnllc;t.rial
IOf amps.
from
Cj:"j:" 1 r!--lAQr,1="
NO.1
'S I Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath)
I FEF
.9",.
{.oD
I r.HARf.;F
[;;b tJ 0
NO
c>>
rf1AQr::1="
furnace/burner to
BTU's
Floor furnace
and vent
\6cJ?
L
I\S~
~ I
Recessed wall
Snac~ hpatpr anr! vpnt
each 1
I
I
I
I
3",,~~~
I ~~l.
I M UJd.u;-~
t\dditional bath
~Jater serv; ce
Sewer
Storm Sewer
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood nnd rllJr:t
Wood stove/heater
/
I
I
I
I
I
I
g)S .00
TOTAL CHARGES
Electrical Contractor, -the electrical portion of this per~it
Supervisor and returned to the Building Division
COMM./IND. FEEDERS
Install/alter/relocate
rl;~trih. fpprlpr,
Of
amps.
I
I
I
I I
c[)~1
ISSUANCE OF PFR!HT
II
TOTAL CHARGES
WHERE STATE L~W REQU1RES
shall not be val;j until the
I HAVE CAREFULLY EXNlINED the completed aprl;cation for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed 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 OCCUPAf~CY 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 OP,S 701.055 will be used on this project.
I~A V~Loc...k SIGII.~TURE 2 d:l-~~Dm
FO~ OFFICE USE OijL Y
Sq. Ftg. f1ain
Sq. FtC'. Access
Sq. Ftg. Other
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
IWIE(please print) I} AI N
J~;;/jy'.
(
Zone
Fi re Zone
Flood Plain
BUILDING PER~I!T
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and /
Surcharges
tlECHANICAL PERMIT
Charges and
Surcharges
Type/Canst.
Bedrooms
Un; ts
x
Value
Occy load
Occy Group
x
Val ue
Stories
x
Value
TOTAL VALUATION
\( ).rx.)
.4[)
-Dl9-f:D(--1- _) Fence
, D~mo
,.~ .r--f". Sidewalk
\ P1) I A/C Paving
I Curb Cut
I
Plan Ck.
65%/Blrla
Plan CIe.
30%/Bldq
Comm!1 nd
Ppr' Fee
Res
Per Fee
Systems Development
Charqe (1. 51,) ..
Total Comb. Permit
1 TOTAL
loll. LoO
..-
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100. lane County Map Reference
17 03 43
2. example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air oas
2. exa~Je- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
chee k add. etc.
F. Building permit information:
1. example ~ construct single family house with an
a ttached garl~ge
2. exam~le - 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 TEAM AND 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.
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
,}. 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
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
will 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.
II.
be delivered to the
by his electrical
is.not authorized
I I I.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
~~
~~ry
\JJ'>>
~
Permit
Cl"k1J\~_
'V
Permit applicant exempt from registration with the Builder's Board because.:
Additional Project Information:
,
,
PLANS R6VIEWED BY:
i
.
name
signature
date
I