HomeMy WebLinkAboutPermit Building 1984-3-14 (2)
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CITY OF SPRINGFIELD INFORflATION UNt. \
COMBINATION APPLICATION/PERMIT 726-3753
ErlERGY SOURCES: Sq. Ftg. f.1ain
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other,
New Add Alter Rep.
Range --Fence Demo Change/Use
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Buildino' Permit Info: Describe Work(Le., Build Single
Family nesidence With Attached Garaoe)
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(exnires)
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I INSPECTION LINE
726- 37 69
Job AddressJ7CTO (~i~jJ ~-6.uf
Legal Descriptionj..7-dZ"'3'J_/<... de::>\
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Constru;tio,( Linder (
Owner (N" ;1'1'- '
Address 3 7 8;;
Address
DESIGN TEAM (namel
Primary /i!. .L../j/,- I.
Structural
Phone
(address)
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(lics. no.)
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Electrical
Mechanical
CONTRACTORS (name)
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Genera 1 "--I-1t ~ .1!.A:':iM.J ( ',,~.
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(address)
f..6. (:x{ ~ S- '1 Q -J/dJ.
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(ohone no. )
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Plumbina
(lics. no.) (exnires)
/ 3~7 70'-0 51? /~ <(
Electrical
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ELECTRICAL MECHANICAL
FEE CHARGE NO. FFF rHARf,r NO. FFF rHARf,F I
Residence of furnace/burner to
SQ. FT. BTU's
New circuits alts. Floor fu rnace
or extensions and vent
SERVICES Recessed wall
Soace heat~r and vpnt
Temporary Construction Appliance vent
seoarate
Change in existing Stationary evap.
residenc~ cooler
multifamily, comm. or Vent fan with
Industrial sinole duct
I Of :2~a amps. 3S:~ Vent system apart from
heatino or A.C.
COMM./IND. FEEDERS Mechanical exhaust
hood and duct
Install/alter/relocate Wood stove/heater
d;c;tr;b. feeders
Of amps. (:\I.~".,Q'~
~
~lechani ca 1
PLurlB I NG
NO.
Each single fixture
Relocated building
(new fix.' additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
~la ter servi ce
Sewer
Storm Sewer
ISSUANCE OF PFRrm
TOTAL CHARGES TOTAL CHARGES ,~~ TOTAL CHARGES
WHERE STATE L'\H REQUIRES that the Electrical work be done by an,Electrical Contractor, the electrical portio'n ofthisr"permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to ~he Building Division " .'
I HAVE CAREFULLY EXNIINED the completed application for permit, and do hereby certify that all information hereon is tru~
and correct, 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 OCCUPAIlCY 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
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FOr. OFFICE USE O~Ly t
Sq. Ftg. r1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other~' ,. ~~'t Value~~"
, (\Y1'-(~~Z ~A~~~ TO L VALUATION '
. ,15//.<:: .:::z ___r'systems Development A/ ~
~~ .~~ Char~e (1.5%) , ~~.~.
Zone M#
Type/Const.
Bedrooms
Units
Occy Load
Occy Group M-;2
Fire Zone
Flood Plain
Stori es
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BUILDING PER~IIT
Charges and
Surcharges
~~__ 'Plan Ck.
____-5M1_f!.___ 65%/Blda
"?L Plan Ck.
I v . ~... 30%/Bl do
CommJI nd
Per Fee
Res
Per Fee
PLUI1BING PERMIT
Charges and
Surcha rges '
Fence
D~mo
ELECTRICAL PERfm
Charges and
Surcharges
, .C'" Clt:>
___~_:5~.____
/. Yt:>
Sidewalk
A/C Paving
I Curb Cut
I
/1ECHANICAL PERMIT
Charges and
Surcharges
, ,
I
Total Comb. Permit
TOTAL
~~s. 76
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A.' Job Address
B. Legal Description
1. exam~le- 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. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
r. example- 1250 sq. foot house, 500 sq. foot 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 room
3. example - 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
fu 11 schedu 1 es
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. -
'111. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wi 11 prepa re 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.
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V. FOR OFFICE USE ONLY
Penn it Cl erk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
6;Z:>c:t:::/A~ /NSrt!:~r/e::>h /$ 5~~/RF.b ~R :
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1- -srh'o<r"Je"AL It/.r~,1'':)S r~~h?~ a.. THE ck
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3'-S;4:L/4tC. CX~YATA:S~ ~ H~'P~ ~L &4'o/h~~~ A'e-~ l?/
F _ r _ _ ,
Permit applicant exempt from registration with the Builder's Board because~
Additional Project Information:
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PLANS REVIEWED BY:
name~RNc 7zG~~
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Signature~ ~~~
,/,. , .
date Y"-9-.g 0/