HomeMy WebLinkAboutPermit Building 1983-12-23
CITY Of SPRINGfIELD INFORlIATlON LINt
COMBINATION APPLICATION/PERMIT 726-3753
E!IERGY SOORCES: Sq. Ftg. 1.lain
Heat :q. Ftg. Access.
l'later Heater Sq. Ftg. Other ""
Ilew Add Alter Rep. V"J
Range -Fence Demo Change/Ose
ValuE of Hork: c() Other- - ()J
,). .C:;On I . ~
Builo;no P~rmit Info: Describe Work(i.e., Build Single I
Familv,nesidence With Attached Garaael ~
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(lies. no.) (exoires) (ohane no.\
I ItlSPECTIOl1 LItlE
726-3769
,
Legal
1077 C,~ {p
Description\'\1 D~ ? 2l ?_O
()'2.(;,()~
Job Address
n
Owner /7<7",,0<.,..,1.,,) () >,--<-i........
Address 1077 ~~ /( D
<'r ,-..,C~Ir( C5\J;-~
Construction Lender
La; J.e.--)
Phone
Address
UI:.~lliN nAr~
(name)
tvIM "'''' '^ j,;~
Phone
{address}
a<soc..,o,k ~
Primary
Structural
Electrical
Mechanical l?-o~'S
CONTRACTORS (na~\
Genera I i1A ,-/ / /.f" i1.ev-.
cS"~V'een:
G,^~l
(address.)
Co V\~,,~~r
Plumbina
Electrical
M"-~II\L\-<- cl.ecf.....c:..
j:Y"'><;~ ~ 5' '^'^
Nechani ca 1
PLUllBltlG
NO.1
Each single fixture
.
/
(li~c;, no.) (pxoireo;)
fru.;.e..Jnldif
ELECTRICAL
rahone nil. '.
I /7,r9~I/J;;)7
MECHANICAL
I FFF I CHARGE ..1JO I t I:F'F I rH~ NO_ I
Residence of furnace/burner to
SQ. FT. BTO's
.'
ITempOrary Construction
I'Change in existing
rps j dynr:e
Imultifamily, comm. or
Indllo:;tri~l
IOf amps.
ICO~1./IND. FEEDERS
I Install/alter/relocate
cli<:trih. h~cl~ro;,
Of amps. I
Relocated building
(new fix. additional)
\
New circuits alts.
or extensions
S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
SERVICES
\-later servi ce
Sewer
Storm Sewer
\~ \~cP
I
I
I
I
I
I <a.....' J:HARG.E.
Floor furnace
and vent
Recessed wall
Sn~r:p h~ntpr nnrl vpnt
Appliance vent
Sop-oarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C. .
Mechanical exhaust
hnnd and dur:t.
Wood stove/heater
I(~OO
I
IlDa;)
~~ \-..N-..... ~<<'\("('m,;"" ,
I
.~,\\ ",U\ 'Ill"" <:.r.... I
ISSUANCE OF PFR!\IT
TOTAL CHARGES TOTAL CHARGES \ S. CxJ TOTAL CHARGES \ {J. UJ
WHERE STATE L\\/ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that HD OCCUPAUCY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only SUbcontractors. and employees I<ho are in compliance I<ith ORS 7nl.055 w;?Jbe ~'f)on this project. _
NAlIE(please prino-1:>Clu,,J !VI S'\II\.J~ SIr.IIATURE Vall /2-. L1 DATEI~h3J~.::,
- ---. I
FOr. OFF I CE USE OIIL Y
Sq. Ftg. t1ain
Sq. FtlJ. Access
Sq. Ftg. Other---'e{"n
Zone C t-\ '\<
Tyoe/Const. 5- \. ~
Units
Occy Load -
Occ.y Group I-Y 1..
Fire Zone ~
Bedrooms
Flood Plain
"L.
Stories
BUILDING PERI.tIT
Charges an~
Su rc ha rges
o CI. ex:> Plan Ck.
(.. l). 65%/Bldo
------\-,i['-- Plan Ck.
, 30%lBl do
I Fence
I DeAlo
I S1dewalk
I A/e Pavi n9
I Curb Cut
I
COll1ll/lnd
P~r Fp~
Res
Per Fee
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
SurCharges
\5.00
-n----.c;.o--
----}-Q~~~--
. \.\0
!1ECHANICAL PERMIT
Charges and
Surcharges
/Z-I3K3fn?.JD C)
~/g6W CX!
I
I
I
I
I
I
I
I
I
.--- TOTAL
I
'.
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charge (1.5~1 .
"-\ l~
Total Comb. Permit
J
55, \2.
e
COMBII/ATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. ,example- Tax lot 100.' Lane County Map Reference
11 03 43
2. example- lot 1. Block 3, 2nd Addition to
Springfield Estates
c. IName. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilina/or forced air aas
2. examole- waterheater/electrlcalior solar
E. Square footage or valuation, etc. -----
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
1/. DESIGN TEM1 AI/D 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
Z. 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
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 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.
V. FOR OFFICE USE ONLY
,
PERMIT VALIDATION
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Permit
clerdtriU
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
namen\\hD"S:~ )R..r
signatu~A ~ ~Vd~~e\7~\Q,4~
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