HomeMy WebLinkAboutPermit Building 1983-9-26
CITY OF SPRINGFIELD
CDrIBIIIATION APPLICATION/PERMIT
~ _ E!lERG'(..'iOURCES: /,
Job Address I07'?~:r.e WA'~ L~p Heat HEZT. "....?,
Legal Description 17~~.2<:.2C>. o2~4 l'later Heater
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ValuE of Hark:
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BuiiriinQ Permit Info: Descr,be Work(i.e., Build Single
Family nesidence With Attached Garaoe)
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(lies. no.) (exoires) (ohane no.
I INSPECTION LIrIE.
726- 37 69
.
Owner ~<lII#7E1:> ~~
Address ~"'.Me
Construction lender
G:..s;.:;&i"?S
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Address Phone
UI:.:>HiN Il:.N1 (name) I address I
Primary 7~ ~.....~..v #5SCC.
Structural
Electrical
!1echani ca 1
CONTRACTORS Inamel laddress]
General &N~M/4~~';~~__,
Plumbino ~/7_j n:"'......,21'/~. .
Electrical M~A"i=:.N':</.e= &EZ=7-.
.Iechanical FYe4":l./~" ~.N
PLUIIBING
NO.
I
Each single fixture
FFE
CHARr.E
J!(l
Relocated building
(new fix. additional)
s:-
Residence of
S.F. Residence
11 bath)
Duplex (1 bath)
Additional bath
Hater service
Sewer
Storm Sewer
Zone C/rfR
Fire Zone
Flood Plain '.
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BUILDING PERIIIT
Charges an;::
Surcharges
~
PLur1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
.~
MECHANICAL PERMIT
Charges and
Surcharges
-
INFORIIATION UNL '
726-3753
Sq. Ftq. 1.lain ~.::c
~q. Ftg. Access.
Sq. Ftq. Ol.h,er
Ilew AddXAlter Rep.
-Fence Demo Change/Use
Other - -
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,
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(li~s. nn.1 (exoires)
(ohnnp M.)
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ELECTRICAL
MECHANICAL
...
rHIlRliE. NO
r IJARG.E
/,
...
SQ. FT.
furnace/burner to
BTU's
...........,New circu~ts alts.
~~~s~,.,.,~.
SERVICES
Type/Const.5i~"~~.
Bedrooms
Units
Occy Load
Occ.v Group B- 2
each I I
I' ITempOrary Construction Appliance vent I
seoarate
I IChange in existing Stationary evap. I I
re~j1en~p cooler
I I multifamily , corrm. or ....., Vent fan with "='~I L_
lndustrial ~ sinale duct ~ ~
I IOf amps.1 I Vent system apart from I I
heatina or A.C.
I ICOMI.I./IND. FEEDERS I Mechanical exhaust I I
hood and dur.t
I I Install/alter/relocate I I Hood stove/heater I I
rli~trih_ fpprlpr~
I 10f amps. 1- ;iL.~ Zkrw,J,.__ I
I I I ';-0 <. /1.7> k:"'I/-<~-
I I I I I I
I I I I
TOTAL CHARGES M"d, /0, - TOTAL CHARGES IS: -I TOTAL CHARGES /B, ...,
. WHERE STATE LA\/ REQUIRES that the Electrical work be done by an'Electrical Contractor, the electrical portion of 'this pennit
shall not be vali1 until the label has been signed by an Electrical Supervisor.and returned to the Building Division. .
I HAVE CAREFUllY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and 1 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 IlO 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 ~liance with OP.S 701.055 will be use~ this project.
IlAI-lE(please print) PClV\'..\ M C;-Vl"d~-- SIGIIATURE ,-~Ll DATE''3/~c../~
FOr. DFF I CE USE BiiL'y
Sa. Ftg. J1ain ~aCo
Sq. Ftg. Access
Sq.' Ft9. Other
Stories
____?~_'t.,_4C
8.9~
'<<:> , ":>0
Plan Ck. Comm/lnd
65%/Rldo Ppr Fp2
Plan Ck. Res
3D%/Blda Per Fee
Fence
. go Demo
____.1.-2...., """1 Sidewalk
,60 I AIC Paving
____7-~_._c::...~_ Curb Cut
/.. 7''1
IS-
Floor furnace
and vent
Recessed wall
~n~cp hp~tpr ~nrl vpnt
+5'':'un''UL ,"'i
"'-,hI14 .*
x
Value :?!",~....
Value
Value
x
x
TOTAL VALUATION
I Xl {').~...,..ll Systems Development
~ ~~'~ Charae (1.5%) .
~'C q-~J-,-e:3 (o[f}4S
I :if . ~B<G rEi!: 73c..~c.D/hC-"
I 1lc..M/iV#(.1 M~~,
I 1 ~~MIT.s .(-$q~ liM</rI
I Total Comb. Permit ~tP6.- 8C>
I -
I I TOTAL t;a {, 80
1J/S: 00
.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100, lane County Map Reference
II U3 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. ,Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. example. waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. . Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - 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
H: DESIGN TEN1 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 ~ivision
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. BUILOING 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. ---
III. 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
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 ~harges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
.
;.
.
PERMIT VALIDATION
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Permi t
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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:
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a.c- ON,F/ ~/S 117' FZ:>
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PLANS REVIEWED BY:
name/~~~C<r~ signature ~:
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