HomeMy WebLinkAboutPermit Building 1986-7-28
~
I IrISPECTJON LINE
726-3769 .
Job Address /O./f 5' (; c::r:t:i4c/ ~ ,/ I.
Leg.l Oescription /7-o~'Z2'20 a-::fhr~ I
, - I
/ ~ I I
Owner Ikw-/JI../aicl ;(mL~ /.t;4CtfZ1/
Address I () Y'? C, o:l~~o ~~ Phon.j tf
rf
-~
IO~rAJ .
CITY Of 5PRII/GFIELO .. . INFORllATlON liNt I'
COMBIIIATION APPLICATION/PERMIT. 726-3753
ErIERGY SOURCES: Sq. F tq. ,.1. i n
Heat ~Q. Hg. Access.
ll.ter He.ter Sq. FIg. Other
lIew Add Alter ~ep.
Ranqe Fence_Oemo_Change/Use
V.1UErt~ ,_Other
Builrifno Penmit Info: Describe Work(l.e., Build Single
Fami1 tlesidence \~ith ,lI.ttached l'iaraaet
ryA(1F{JM JI}.J., ~ aA t!....-
tJM..ritnJ I
IJ
Constructinn Lender
~
~
Z
Address
Dl5tGU TEAl'
lname) ,
Phone
(address)
(lies. no.l
(exniresl
(ohane nO.1
. Primary
Structural
Electrical
Hechanical
CONTRACTORS in.mel
Gener.l rn ILLUOU~I\.J
(address)
l~o /
(lies. no.) (pxoirp,,) (ohnn"" nn.)
Cf - /3 -RIo I);:] L, - ::5P?;
Plumbina
Electrical
f..lechanical
PLU'IBlNG
ELECTRICAL
MECUANICAL
..J!Q.." '..nL1 CHARGE
E.ch Single fixture I
IRelocated building I
(new fix.....ddition.l)
IS,F. Residence I
(J b.th)
IOuPlex (1 b.th) e.ch I
IAddition.1 b.th I
-I\-later service ,
I Sewer I or I
I Storm Sewer I Of amps.1 I
-I . I r COI~'1./lNO. FEEOERS I
I I I I Install/alter/relocate I
,dis.trih. fppders.
I I I Of amps.1 I
-I I ,- I I
I I I I I
I I I I / ISSUANCf OF PFR!I1T
TOTAL CHARGES I TOTAL CHARGES .1 TOTAL CHARGES
WHERE STATE LAII REQUIRES th.t the Electric.l work be done by .n Electric.l Contr.ctor, the electric.l portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
~ Residence of
I SQ. FT.
INew circu!ts alts.
or extenslOns
I SERVICES
I
Floor furnace
and vent
1..f.ELI.J:IJAB.IiE'-1lll......1
furnace/burner to
BTU's
1.llL...1
I Recessed wall
Sn~~p hp~tpr ~nrl
I
\11""" I
ITemporary Construction
~Change in existing
I rP'ljOY.I1f"P
Imultifamily. camm.
, tnrlll<;.trii'll
Appliance vent
c:eoaratp
Stationary evap.
cooler
I Vent fan wi th
sinolt=> duct
I Vent system apart from I
heatino or A.C. .
Mechanical exhaust
hood i'Ind durt
WOOd stove/heater
I HAVE CAREFULLY EXN1INED the completed application for ~ermit, and do hereby certify that all information hereon is true
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 rlO OCCUPArKY 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
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IlAHE(ple.se print) M/J.t.NDUF# 6F;V,
(o;J fA
5IGr1ATuR~g ", -iZxt tJt.t: /',eprf' ,.
.......--. .." 5"._
FO~ OrFICE USE Q;ILY
50. FIg.
Sq. Ftg.
Sq. ftg.
riain
Access
Other~
x
J
OATE~ ..1)5, y~
, / ,
Zone
C;L.
Tyoe/Const.GX'/S-r-
Bedrooms
Stories
/
Units
Occy Lo.d
Occy Group /f'- Z
x
Value
Value
Value
/~~
Fire Zone
Flood Pl.in
BUILOII/G PWlIT
Charges anC:
Surcharges
C::6P~ H' 8'2 <I
. ___j2:~~__
. ?t:>
Plan Ck. Comm/lnd
65%/Bldo ~~r Fee
Plan Ck, Res
30%/Bldo Per Fee
I Fence
I Oemo
I Sidew.l k
lAIC P.ving
I Curb Cut
I
~
/1 :30 -;:,. I <l'1 tllsystems Development
, ~ ~V>I:> '/ Ch.rQe (I.S~)
-I
I
I
I
ITotal Comb. Permit
I
I TOTAL
Jv1~F
TOTAL VALUATION
11-;,4.
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PER'~IT
Cha rges and
Surcharges
/8.<'0
/8.20
I
MECHANICAL PERMIT
Charges and
Surcharges
,--
.
.-- ,
~
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot -IOO? lane County Map Reference
II OJ 43
2. example- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
~. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or SOlar
E. Square footage or valuation. etc. -
1. examole- 12S0 sq. foot house, SOO sq. foot garage
2. examp.le- 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. examEle - 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 TEN~ 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 AND
CHARGES ON THE SCHEDULES
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. ---
Ill. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building ~ivision Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture.
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.
~~~~\O~~
C{;/0
V. FOR OFFICE USE ONLY
Permit Clerk
CV/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
. .
~
PLANS REVIEWED BY:
name.Lo..e<i'€~~~ signatur4_-~,." date 7"29-:fl(f;
.