HomeMy WebLinkAboutPermit Building 1983-5-27
I INSPECTION LIII~ ~ - L !::~3GFIE~D
726-3769 . COMB illATION APPLICATION/PERMIT
Job Address '" l L- ^ "\ ( A I r I EIIERGY SOURCES:
, I O~ IV ~. H~t
/-7, 67J '?5- Lfj ^ (A.(..,OO Mer Heater
" . . '-/ ~ Ranqe
.
INFORlIATION UNo
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ft9. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
Owner
I, Value of Hark:
IJJilll) I'M'" O'CUA 0 P/ude...... I ~D0600
dd ^ I - t . BuilGina Pennit Info: Oescribe Work(Le..
A ress V)t,,<<;- r....J '1-\' <;::-t-' Phone 7.!lidJdllFamilv.Residence lHth Attached'Garaqel
-~r+! rJ f'lt', <=1,011 7/ ,,', ""'-1l, ~+""r.-f-:, ~
Constructi on ~elilier -r- p J ~ I".i . i l)m A:J
Bulld Single
ex)
()J
j-
-.1
['V
uJ
legal Description
Address
DESIGN TEAM (name)
Primary n( 1 ..l f-o f) / SrI /1/ IT ( )
f
Structural
Phone
(address)
fl;r:<;, no,)
(exoires)
(ohane no.l
Electrical
t-1echanical
CONTRACTORS Iname)
ffi'. C-J
Plumbino :::-r h "'.....0 P Ii
o -
Genera 1
(address 1
(I D nsOLido.1j d, I fn~ .
'l- r3u j.u, Uu i:x l',.'- ,
(l ir:s.. 'lo.'
(pxoirpc;\
(onnflP no )
Electrical
~1echan;cal
PLUllBIIIG
ELECTRICAL
MECHANICAL
NO.
FFF fHARr;F Nn
~~~ r~AQr.~ NO
~~~ rI-lIl.IU~~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
i
Relocated building
(new fix. additional)
New circuits alts.
or extensions c:l or-ffioiL
I SERVICES
I<;~D
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
I Additional bath
I ~Iater servi ce
1 Sewer
IStorm Sewer
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Temporary Construction
IChange in existing
rp,; i (tf'nr,p
Imultifamily, COnln. or
JnrllJ"t.r;~l
I Of amps.1
COMI.1. IINO. FEEDERS
Install/alter/relocate
r1htrih fpprlprc;
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinole rluct
I Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hoorl and duct
Wood stove/heater
Of
amps.
I
I ISSUANCE OF PERllIT
TOTAL CHARGES TOTAL CHARGES 1':5 <?D TOTAL CHARGES
WHERE STATE L.\I1 REQUIRES that the Electrical work be done by an' Electrical Contractor. the electrical portion of this permit
shall not be valii until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EX~lINED the completed aprlication 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 OCCUPAHCY \'1111 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 7n1.055 will be used on this project.
.
.,
f?Et2~y' Li\')J /,( I~/' SIGilATUREy
FOP. OFF I CE USE OilL Y
Tvoe/Const. Units Sq. Ft9,
Bedrooms Occy load Sq. Ft9.
Stories Gccy Group Sq. Ftg.
K?-d~"-,
DATE,./"
HAI.IE(please print) tJ
Zone
Fire Zone
Flood Plain
r1ain
Access
Other
x
x
x
Value
Val ue
Value
TOTAL VALUATION
BUILDING PERfllT
Charges anc
Surcharges
J
Plan Ck.
___'JJs1,_00__ ...ill/Rldo
(IJiO PlanCk,
,'{ ,l 30%lBl dn
I Fence
I D~mo
.J is Ou I Sidewalk
-------~~J)o--I AIC Paving
Co"",/I nd
Ppr Fee
ROes
Per Fee
syste.ms Development
Charoe (1.5%)
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRfCAL PERI~IT
Cha rges and
Surcharges
Total Comb. rermit
MECHANICAL PERMfT
Charges and
Surcharges
TOTAL
JJ/.32 ,08
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- lax lot 100. lane County Map Reference
. 11 oj 4j
2. examole- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examDle- 1250 sq. foot house. 500 sq. foot garage
2. examjple- if new project. check-nfw - if addition,
cneck add, etc.
F. Building pennit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examjle - 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. 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
Permit Cl erk
PERMIT VALIDATION
GO {{1q
-~
oJJ
(L
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date