HomeMy WebLinkAboutPermit Building 1984-10-16
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Bliiltiinq 'Pennit Info: Describe Work(Le..
Familv nesidence With Attached Garaael
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I ISSUANCf OF PFR'llT
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
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II[~~PECTION LINE
nti-376g ,
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
,'~ EilERr,y SOURCES: ~
'1./_ Heat -l~~
~ Ir:() Hater Heatert-It-.: --
Job Address ~R.s-'Q.
Legal Description \'1 ()'(> ~
owne~o.i~ 1/uJJp1A/ilJJL U)b1~AV
Address 'J$'K 6' d fjiirJJd~, 'l,St- Phone 74/-
s.~~.. (5~ u Q71./77 a.tl7,,/
Constructlon lender
Range
~
~
~
~
~
,.5 ..
1
~
Address
DESIGN TEAM
Phone
{addres-s-r-- -
(name)
(lies. no.)
Primary
Structural
Electrical
Meehan; ca 1
CONTRACT~~~ ,} 'J'~~ I,
General ~1
Plumbina
lr~
~&~
a<O(:(J;e;~3 ~~~'Jnfl1~~:~~~
{jot '7')ffl."~ - Pdiir" J1~ c:'o ~O 0
Electrical
~lechan; ca 1
.
PLUMBING , I ,
oJ \
,.
-1i!h FFF rHARr.F Nn
Each single fixture
ELECTRICAL
1=1=1= rl:iAR.G..E.. Nn_
Residence of
SQ, FT,
jRelocated building
(new fix, additioral)
S.r~ Residence._
f1 bath) I
Dup I ex q ba thY eac'hJ
Additional bath
New circuits alts.
or extensions
-1
.J
SERVICES
/
/
,
/
ITemporary Construction
I'Change in existing
rps i ripnrp
Imultifamily, COTm1. or
Tnrttlc;,trial
IOf amps,
ICOMM,/IND. FEEDERS
I Install/alter/relocate
rtic:.trih_ fppl'1prc:.
IOf amps.1
~Iater servi ce
Sewer
Storm Sewer
, ,
, /
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an,
shall not be vali1 until the label has been signed by an Electrica)
INFORJIATlON UNe
. 726-3753
Sq, Ftg. /.Iain
~q. Ftg. Acce~. ____
Sq, Ftg. Othek:~~\
IIew Add A Her Rep.
-Fence Demo Change/Use
Dther- -
~
0-
'-..9
II C
I~
Oc
Build Single
s' 9/'
(exoires)
(ohone nn 1
*
(Pf~b.;/rPL/
(ohonp no.)
!nkC;.-a (,/,1: '
~/,fU
2<1$'- ;yqtl.q
MECHANICAL
J:FF fl-lllRGE
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrt vpnt
Appliance vent
c:;po"r..t",
Stationary evap.
coolpr
Vent fan with
sinolp r1uct
Vent system apart from
heatino or A ,C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
I HAVE CAREFUllY EXM1INED 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 Orel)on pertaining to the work described herein, and that llO OCCUPAIKY 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.
SIGIIATURE ~~
'-'FO~ OFFICE USE O;IL Y
Sa, Ftg. llain..s..'\(\'7\\ ,
Sq. Ft/]. Access
Sq, Ftg. Other
IIAI,IE(please prin~ La l(E'to,\ 1<05 S
\
Zone ~ ~ Type/Const'{::"'\~, Units \
Fire Zone -
Flood Plain ---
Bedrooms
Stories \
Occy load
Occ,V GroupB,- 7_
D~.TE /o.c. If. -t"S'
I
x Value
x Va 1 ue
x Va 1 ue
TOTAL VALUATION ~ ,(""!"')(")
BUILDING PERflIT
Charges and
Surcharges
_~_~0-,,~_ ~~~~B~~~
<:.J:) Plan Ck,
\. 30%tBlda
COIllTlII nd
Ppr Fpp
R-es
Per Fee
{},f 9/;1'7/iN I) ;./
..if '" 0-0 fJ "', I Sys tems Deve 1 opment
f!'..d.~. Il11o"~" Charae (1.5~) ,
\\,~
PLU,~BING PERMIT
Charges and
Surcharges
Fence
------------1 DeRlo
I Sidewal k
I A/C Pay; ng
I Curb Cut
I
ELECTRICAL PERr:1T
Charges and .
Surcharges
rlECHANICAL PERMIT
Charges and
Surcharges ~ ..
ITotal Comb. Permit
I
I TOTAL
I 1...\ \ ' CoO
~L/ 00 9 r;
.
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I '
_ A
\' ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I l.
I, Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference'
II oj 43
2. example- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name. ete: of owner and-construction lender
D. Energy Sources
1. example. heat/electrical ceil;~Q/or forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. example- 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. example - construct single family house with an
attached. garage
2. exam~le - remodel existing garage into family room
3. exa~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 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
0, 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. ---
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.
. .
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V, FOR OFFICE USE ONLY
Permit C1 erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'~ ('("',~ ()~\.~c. ~YFC\~L \\.'\..~()~,~\\.JC'':' Q~\:>\~
\("-0. 'Q.,P: -.:~ '\"\) \. ..,""\~ Fn ~ ~"O;? \, 'C'..,,~Fl 't". G\ ,",C"'_ ~~\~\~ '\ ~Q
- ~""'.....vt"'A ~l "'Y;?:\(")~ ~ t"'"1:"c\ 'Vr::>.\, V-'-{
, Permit applicant ,exempt 'from registration with the Builder's', Board because:
Additional Project Infonnation: E\ FC',~\('~ ~t'-"\.<'\"\~ \,,\0i\
\\.'l' 11 \~, \ 'It \.\.~\~ ~~\, - ~\;r ~ll=C\~\r \.('""\...j~~i\~\.)
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PLANS REVIEWED BY:
nam~~"'-':J' ('\..p.\..\\:"
s;gnatu~w...r'~~~
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flOSS
BUILDING
SYSTEMS
COMPANY
. Licensed
. Insured
,
~ .1
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Loren Ross
Owner
686,2615
. Bonded
.
,
For Your Convenience We Offer:
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.....R'ep;jrs-=:- inCIUdir19pl-umbinQ&.'ltrical
~"'.' "'~~-'_ ......~.~Sl
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