HomeMy WebLinkAboutPermit Building 1981-7-6
I INSPECTION LINE
726-3769
I Job Address
I
I
I Own., ect.>r-;.e e
t Address ~ 13 t7 :;'E ; :;,";:
/.. '3,.:; 7~ all/U rJL. '7
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
2/.Q/;- CeA/TE/l/A//A.I. &///)
ENERGY SOURCES
Heet
Water Heater
Sq Ftg Mam
Sq Ftg Access
Sq Ffg Other
_New~Add_Alter_Rep ,
_Fence_Demo_Change/Use
_Othe"
.X)
~
-t,
,
L.J
legal DescriptIon Range
'I) O~ d"SL{ '::) 0 ?-;QOU Yalo.afWa,k
ff, PE"/V' DE" L,I_
.";""'\ h Buddmg Perm.t Info Describe Work Ie, Budd Single
/'"!_! ~J~ PhonJ~-3.2.0 7 Family Residence With Attached Garo!=le)
~t!Jr J),e,g/A/S 7O.BE ,g.J/U Od:T ,<;}A/7)
7fI,e/)IJGh' "71.t.€ LJ./E?A 7;? S.P/'FP7,'
ConstructIon Lender
Address
Df51GN TEAM
Phone
(nome)
(address)
(lies no)
(expires)
(phone no)
PrImary
Structural
Electncal
Mechanical
CONTRACTORS
(name)
(oddress)
(lIes no)
(expires)
(ohone no)
General
Plumb,nq
U/J b7 e/J 1.1 J.u r:: p
Electncol
Me'c'hanlcal
PLUMBING
ELECTRICAL
MECHANICAL
NO
FEE
CHARGE NO
fEE
CHARGE NO
fEE
CHARGE
SERVICES
furnace/ burner to
~TU's
Appliance vent
separate
Stationary evap
cooler
Vent fan with
slnqle duct
Vent system aport from
heating or A C
Mechanical exhaust
hood and duct
Residence at
Each sln(lle fixture
Relocated bUilding
(new fix additional)
S F ReSidence
(1 bath)
sq ft
New circuits, alterations
or extenSions
Duplex (1 bath) each
Temporary Construction
11
I
Additional bath
Amps
Water service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10000 CFM
.1
I
I
'I
I
Amps
ISSUANCE OF PERMIT
TOTAL CHARGES Me? me
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel
I HAVE CAREFUllY EXAMINED the completed application for permit, ond do hereby certify that 011 Informohon hereon IS true and correct, and I further
certify that any and all work performed 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 descnbed herin, and that NO OCCUPANCY Will be made of any structure without the permiSSion of the BUilding DIVISion I further
cerHfy that my registration With the BUilder's Boord IS In futl force and effect os requlfed by ORS 701055, that If exempt the baSIS for exemption IS noted
heron and thot only subcontractors and employees who are In compliance With ORS 701 055 will be used on thiS prolect
BaSIS for BUilder's Board exemption
I .?L,c.p 1"'. /:::f.:A/LJ/.=" L /
NAME (please pr~ntf~~ __-:-_ __
.1
SIGNATURE _l\~ ~ ~ ~ ~ 0 0
FOR OFFICE USE ONLY ....
DATE~,ftL
Zone Type! Canst Ilnlts <" ftg M.:lln
Fire Zone Bedrooms ncey load Sq Ftg Acce~.
Flood Plain Ctone- Ocey Group Sq ftg Other
BUILDING PERMIT Plan Ck Comm/lnd
Charges and 65%/ Bldq Per Fee
Surcharges Plan Ck Res
30%/ Bldq Per Fee
PLUMBING PERMIT
Charges and Fence
Surcharges
Demo
ELECTRICAL PERMIT
Charges and Sidewalk
Surcharges
AI C Pavlna
MECHANICAL PERMIT
Charges ond Curb Cut
Surcharges- -~-----~
.
.
Value
Valu"
Value
.
TOTAL VALUATlO~'
Systems Development
Charae (] 5%)
I Total Comb Permit
TOTAL
COMBINA nON APPLlCA nON/PER",,, r (CAP)
I Applicant to furmsh
A Job Address
B lege I Oeser! phon
1 example-tax lot 100, lane County Mop Reference 17 03 43
2 example-lot 1 Block 3, 2nd AddItIon to Sprlngf\eld Estates
C Name, efc of owner and construction lender
D Energy Sources
1 example-heat/electrical ceding/or forced Olf gas
2 example-water heater/electrical/or solar
E Square footage or valuatIon, efc
1 example-1250 sq foot house, 500 sq foot garage
2 example-If new prolect, check new-If addition, check
add, efc
F Budding permIt information
1 example-construct Single family house With an attached
garage
2 example-remodel eXisting garage mto family room
3 example-convert Single family residence mto
restaurant (change of use)
G Value of work as defined In Section 303 (a) of the
Structural Specialty Cade
H DESIGN TEAM AND CONTRACTORS
To avoid desIgn or construction delays, Budding DIvISion
Staff must be able to contact appropriate persons regardmg
design mformatlon or lob 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 adlacent to the appropriate
ltem(s) to be Installed
B Full Plumbing, Mechanical, and Electrical Schedules
are available at the Budding DIVISion
1 To conserve space on the permit form the schedules
have been abbreViated
2 If the Item(s) to be IOstalled are not covered on the abbrevl~
ated schedules you should consult the full schedules
C BUilDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
III Applicant to SIgn and date
Whenever pOSSible, the IOltlal application will be usea as 0---
worksheet only Where pOSSible, Budding DIvISion Staff Will
prepare a typewntten 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 appltcalton,
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
Additional PrOlect Information
PLANS REVIEWED BY
namp-
"'1gnatur<:>
PERMIT VALIDATION
Permit Cler~
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