HomeMy WebLinkAboutPermit Building 1983-1-10
, ';;....."'.
Owner'
/l'
~U1'1r' .
I ~ ~() (j/1A'1;t;AMJ.I.Il YJ.{Jfr
.
Phone7<1C-76{}j
I NFORt1ATION \.1 NI:
726-3753 ~
Sq. Ftg. Main '~
~q. Ftg. Access. ,('
Sq. Ftg. Other -l.......
New Add Alter Rep. 3
Ran,ge -F~ Demo Change/Use I
1JJr (!tr): ~~:)\\~ UJ.-\~"
Buil61nq Permit Info: Describe Work(i.e., Build Single, ' '\.
~::2p:::e kA:Ga;2nt ~
/' . r1' -,/ C .
V
1 INSPECTION LINE CITY OF SPRINGFIELD
, 726-3769 /"'\ 11 , CO~1BIJFIO~1 APPLICATION/PERMIT
Job Address ! G.~U LM7f;;;;,4/lI1Lab f~r-rl-, ~~~~GY SOURCES: ~)t ~
Legal Description 11- 03 -1.~""3 (..( ().3 ~ 00 l'later Heater
Address
Construction Lender,
~rL1fWv
Address
DESIGN T~EAf1 (name) _ n
, /0 f)
Primary ~~~
Phone
. 1~1 haddress)
(,AY~ ~--
;p~.
(E~xoi res)
fJ;~
J
(.phone no. )
Structural
30 'J1-p /~
:A2.~-OG~l.
,
: f1echani ca 1_
! CONTRACTORS, (?J.me) /) ft . " (afflss ~\.. -', -
. General A~J1j /~uvlJ,/~)L;/;LfMJ-IJDY-
.' ' J _ '.
: Pl umbi nq
(lics. no.) ,(e~pjfes:
~~ge.{t1. p~
(ohone no. )
I
, Electrical
7t.f6-7b a I
. Electrical
~1echan i ca 1
PLUt1B ING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF rHARGE NO.
FFF rHARGF'
Each single fixture
Residence of
SQ. FT.
furnace/burne~ to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
Sewer
I
each I
I
I
I
SERVICES
I
I
I
I
Recessed wall
Soace heater and vpnt
S.F. Residence
(.1 bath)
I Dup.lex (1 bath)
IAdditional bath
~laterservi ce
Storm Sewer
ITempOrary Construction
IChange in existing
res idence '
Imultifamily, comm. or
Industrial
10f
:\
'\
I
\~cJ; \~ ~
I ~cX> ~ ~f.)
I
I
I
I
?' to
TOTAL CHARGES ,0. TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Elect'rical wark be done by an,:Electrical Contractor; the, electrical portion of this permit
shall not be val iJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
&::i...o~ ~~ \.\.l
t=-\OO~ ~\U
I
I
I
I
COMM./IND. FEEDERS
amps.1
I
I
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent 'system apart from
heating or A.C.
I Mechanical exhaust
hood and duct
II~OOd stove/heater
I
!
j
I
!
'j
Install/alter/relocate
distrib. feeders
10f
I
I
I
amps.!
I
I
I
ISSUANCE OF PFRMIT
I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordi nances of the Ci ty
of Springfield and the Laws of the State af Oregon pertaining to the work described herein, and that NO OCCUPAr~cY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder"~
8aard is in full force and effect as required by ORS 701.055, that H exempt the basis for exemption is noted hereon, and that
ooly "booo'"o'o','o' ,mploy", WhO'~ '0 o,mpl"oo, wi'h a's, 701.0SS ;i11 b~'" 00 'h" .p,oj,e'.
NAt-1E(pleaseprint) Dlc.-k W E~ ( SIGNATURE_IJJ:.dd DATE ;/;ok ~
FOR OFFICE USE DNLY
Zone ?H I2 Tyoe/Const.
Fire Zone - Bedrooms
Flood Plain -Stories
Units
Occy Load
Occy Group
So. Ftg; Main x. Value
Sq. Ftg. Access x Value
Sq. Ftg. Otherf..C...'N)\\ ~ ~value 4. Cr::J:JL.)
TOTAL VALUATION
BUILDING PER~1IT '
Charges and
Surcharges
~2... -~
-----\~2~--
2. 0 t:o
--- --'-BO--- D~mo
___k)\~
I A/C Paving.
__~~!h____1 Curb Cut
, ,I.
I Plan Ck.
65%/Blda
Plan Ck.
30%/BldG
Comm/Ind 'j',A' _~ 'f"\_. C..JT'\~' 'Systems Development
Per Fee ~yl J .t'\l J. .Chgrge (1.5%) "
Res
Per Fee
01 ~\-
PLW~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERMIT
Charges and
Surcharges
I Sidewalk
Total Comb. Permit
MECHANICAL PERMIT
Charges arid
Surcharges
I
I
I TOTAl
6L\.O~
Il
'.
D
....:
COMBINATION APPLICATION/PERMIT (CAP~;
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
j B. ~eQal Descrjption'
1. examp l'e~ 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. ~nergy Sources
1. example- heat/electrical ceiling/or forced air qas
2. example- waterheater/electricalfor solar
E. Square footage ar valuation, etc.
1. example- 1250 sq. foot hause, 500 sq. faot 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 raom
3. example - convert single family residence into
res taurant (chan-ge of use) "
G. Value af work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design ar canstruction 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 anly 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 an
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 nated on the CAP, the label must be delivered to the
electrical contractor fof signature by his electrital
supervisor. The general cantractor isnat authorized
to sign the electrical label. -
Ill. Applicant to sign and date , ,
, Whenever possible, the initial applicatian 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
applicatian, 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.
,..
Gl
?JL- ~ 11$5
r~{fo -(34
;'
y",
:~
. I;~
.
or-
/,/ .
'" " ~
V. FOR OFFICE USE ONLY
Permit
Cler(~(JYL/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
," .
Permit applicant exempt from registration with the Builder'sBoard because:
Additi ona 1 Project.-Info.rmati on:,
PLANS REVIEWED BY:
. I. .
name
signature
"'. "
d~'te
, .
.