HomeMy WebLinkAboutPermit Building 1982-5-2
'I INSPECTION LINE.
, 726-3769
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Legal
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Description 17.()3. 2S. '3 'I . ~ ~q~
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
!'Ja ter Hea ter
Job Address
Ran(je
INFORtlATION UNt.
726-3753
Sq. Ftg.. r,la in
~q. Ftg. Access.
Sq. Ftg. Other
r~e\. Add Alter Pep.
--Fence Demo Change/Use
--Other -- --
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wner i /c....:-....\ J-/Li.-""--::/I'h-'''-7 CA
Address ..... ...;. . " / ~ L- 4/ I / ~ 77:. J/' Phone ,;p'/ J,.""
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Constructian Lendel /
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ValUE of l'lork:,
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Buil(;inQ Permit Info: Describe \~ork(i.e., Build Single
Family Residence With Attached GaraQe) "
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~PD 2 #€A-T ~.,..,..p ~ .
IS:-
I I Recessed wall I I
Soace heater ~nd vent '
I 121 l!59-rFtnlPs .~."II<..c
I 1 I Appl iance vent I"
seoa ra te
I I Stationary evap. I I
cooler
I I Vent fan with 'I I
sinole duct
I I Vent system apart from I I
heatina or A.C.
I I Mechanical exhaust I
hood and duct '
I I I \-load ~tove/heater I
1~4 I I
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I I I
I ISSUANCE OF PFRr1IT /e:7. OJII'l
-;;z~ TOTAL CHARGES '" 2<. CIO ,
HHERE STATE L'\l~ REQUIRES that tile Electrical work be done by an. Electrical Contractar, the electrical portion of this permit .
shall not be valid until the label has been signed by an Electrical Supervisor and ,returned to the Building Division
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Address
DESIGN TEAll
Phone
(address)
(name)
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Primary
Structural
Electrical
f~echani ca 1
CONTRACTORS (name)
Genera 1 (} -("' cf) /?-.l/ CA~i----;--' C<t
(address)
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PlumbinQ
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. Electrical Cl\'I b",__/c,;,..-t.7 ~;/<7_/;7~~_/ ~
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, ~lechanical
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PLUtlBING
ELECTRICAL
NO.
FEE I CHARGE NO
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
)t
New circuits alts.
2 e~e~~o~c!;
SERVICES I
I
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comm. or I
IS.F. Residence
(] bath)
I Duplex (1 bath)
Additianal bath
each
Temporary Construction
Change in existing
residence
multifamily,
Tnrll/strial
Hater service
'-,,~
I Sewer
I Storm Sewer,
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I
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}aQ
TOTAL CHARGES
1
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II Of
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I
I
J TOTAL CHARGES
amp's. I
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Of
amps.1
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COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
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(1 ics. no.)
(exoires)
(ohone no.)
~ P (---" J.I-7 ~
(lics. no.)
j
(exoires)
(ohone no.)
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:~ '7-1<f 4!J/e;, ,,<:-:-f d~t III
72-.( ...../7..,-/
MECHANICAL
FFF r.HARGF NO.
FFF r.HARGF'
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furnace/burner to
BTU's
Floor furnace
and vent
I HAVE CAREFULLY EXNllNED the completed application for permit, and do hereby certify that all information hereon is true
and carrect, 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,OCCUPANCY will be made
of any structure without the permission of the Building Dfvision. I further certify that my registration ~Iith 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 subcontractars and employees who are in compliance with ORS 701.055 will be used on this project. "
S I Gtll\ TURE ~,Q.--c'h 9t.. 1'?~-<
FO~ OFFICE USE Oi~U{ \J
So. Ftg. r1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Othe~R7/"/6~/;J~ Value
C)'It>7/,A/~ #)1'EAt'TOTAL VALUATION
IW1E(please print)
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J LJ Q~ CVf ?1 7"'!-1
Zone ~ c::::.-.
Fi re Zone--'l.L! .
Flood Plain fI~
Type/Const.~')V ~nits
Bedrooms Occy Load
Stories / Occy GroupY-2.
DATE '7""'-"2.,,-<?l.---
BUILDING PER~lIT 92'. AC Plan Ck. Comm/Ind ~.,. So Is~stems Development
Charges and ------------ 65%/Bldo Per Fee C arqe (1. 5%)
Surcharges '3.68 Plan Ck. Res I
30%/Bldq Per Fee
PLur~BING PERMIT I Fence I
Charges and ------------
Surcharges I D@ma I
ELECTRICfl.L PERr~IT :::a-$: -~ I S i dewa 1 k I
Cha rges and -------I-=-~I A/C Paving ITotal
Surcharges Comb. Permit
MECHANICAL PERMIT ____ _~~..:~J Curb Cut l-oT .. 2.G-\ ~LP ~
Charges' and
Surcharges .~ I' AL ~
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furntsh
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane Couhty 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 ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot hause, 500 sq. foat 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. examole - convert single family residence into
restaurant (change af use)
G. Value af work as defined in Section 303 (a) of the
Structural Specialty Code
H. DES I GN TEAt.1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information ar job site
correctians, 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 Divisian '
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 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 af the
application, and no plans will be pracessed until these
fees are paid. All ather 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 VALIDATION
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~ 50.181
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4%
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490
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
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