HomeMy WebLinkAboutPermit Building 1980-5-23
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I IriSPECTION LINE CITY OF SPRINGFIELD
726-3?69 COMBI;iATlON APPLICATION/PERMIT
Job Address A t-r:. ; '" f J - '" II fV'{) ~ ErIERGY SOURCE;: '
'i rJr I ULt'06l1fll/ ""':'+'.., Heat ~ ~ I fI t;U"" ,
I.egal Description Lot -'1'2 - ~J lJ 3. 11'1-0 ~-.23Nater Heater I e~ct/ld' ,
. -f1 Lj rJ :~' L i ~~ ,~ rL..~~:'" I Range.....Jl.~1Lur~_
Srx,,/I 'RJ t,,-!.:j_,U/1 -/J" lLUK.Wn'tf.{II I'Luli / ValUE of Hork:
Owner 00I)A/a.c, f\1(]f{)VJ 17~ e?;{-/, 7.s-
Address 11'~ la~"'''DI I AM' Phone Built;ino P~rmit Info: Describe \~ork{;.e., Build Single 10
.lI-U j I Jf(" 'L LJI)(JI Faml1v l1esldence \-Jlth ,l'I.ttached.Garaoe)
'~I'I~14~ -' ) 1~1--rB54- ~"1_ tYldJtfOVG wlL i
Construction Le r ~Jr Y1.- '1rr1~ ~
Add~ess Phone
DESIGN TEAM (name) (address)
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INFDRltATlON llNt
726-3753
Sq, Ftg. l'lain~
~q. Ftg. Access. -
..g-q. Ftg. Other -02.,,\
--1lew~dd___Alter--,qep.
__Fence__Demo__Change/Use
Other
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PLUIIBIrIG
ELECTRICAL
(] ics. no. ) (exo;res) (ohane no.
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(l; CS. no. ) (exoirps) (ohnnp no.
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MECHANICAL
Primary
Structura 1
,I
Electrical
\,(
!1echanical
CONTRACTORS
II
(name)
(address)
Genera 1
C'Jv-) \{\ e 'r S
\,1
PlumbinQ
Electrical
II
~1echanical
\\
NO.1
Each single fixture
I FEE I cHARGF
NO I
Residence of
I FFF I r~AR~F NO. I
I FFF
t r~ARr.F
I
I
I
I
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
y~- or extensions
Jl~ lleMOZJ!.
SERVICES
IS, CO
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (I bath) each
I Additional bath
~!a ter servi ce
Recessed wa 11
So~~P hp~tpr ~nrl vpnt
Sewer
I
I JIJ/XJ
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ITempOrary Construction
I;~~~~~n~~ existing
Imultifamily, comm. or
TnnlJ<;triill
IOf amps.
ICOMM./IND. FEEDERS
IInstall/alter/relocate
riic:trih. fpprlprc:
Appliance vent
seo?rate
Stationary evap.
conler
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnn duct.
Storm Sewer
Wood stove/heater
Of
amps.
",/ /J
/11 'f/'
TOTAL CHARGES
WHERE STATE L,\H REQUIRES
shall not be valiJ until the
fillY) I TOTAL CHARGES
that tile Electrical work be done by an.
label has been signed by an Electrical
IS'SUANcr OF PFR!1lT
/~,~ TOTAL CHARGES
Electrical Contractor, the electricar'portion of this perrilit
Surervisor and returned to the Building Division
I HAVE CAREFUllY EXMlINED the completed ap[11ication for permit, and do tlereby 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 iW OCCUPAIlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration'with the Builder1s
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 comoliance with ORS 701.055 \.lill be used on this project...
I~AIIE(please print)' Derorl1.h K, Ma&Jn SIG;IATURE'ft ~ .i".~ DATE5-Z3-30
For OFFICE U5E'OHLY
Zone: 2.-/ Tyoe/Const. ~ Units I Sq. Ftg. t1ain x Value
Fire ,Zone 1IL Be~rooms Occy load Sq. Ftg. Access x : Val ue
Flood Plain "/b Stories I Occ'y Group J2~3 Sq. Ftg. Other 3;)?;', 7 S" x Value
TOT^L VALOATION f-() r31/, 1S'
BUILO'ING PER~I!T
Charges and
Surcharges .
Plan Ck. Comm/Ind
_~_____':I9J)fJ 65%/Bldo Ppr Fee
Plan Ck. Res
1.'1& 30%/Bldo Per Fee
_______L(JJ)O Fence
I <(0 I Oemo
_______LS,_t:r>_ 'Sidewalk
. '"D Ale Paving
..-- I Curb Cut
, Jsyste, ms Development
Cha roe (1. 5n
/ ;2.0
:;<,. __ 4:-/'./- )
PLU'1BING PERMIT
Charges and
Surcha rges
ELEi:TRIC~.L PERI~IT
Charges and
Surcharges
I
Total Comb. rermit
liECHANICAL PERMIT
~hJ~ges and
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~'it. 1'='
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-'.\) , COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100, Lane County Map R~ference
17 U3 43
2. example. Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exa~~le- heat/electrical ceilinqfor forced air qas
2. examDle~ waterheate~/electr;cal/or solar
E. Square footage or valuation, etc. -
1. 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. example - remodel existing garage into family room
3. examole - 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 jab 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. ---
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.
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V. FOR OFFICE USE ONLY"
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VAll DATION
: Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:'
Additional Project Information:
PLANS'REVIEWED BY:
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_ name
Signature--L1i?u.- ~;,~
date S-,;l3-Es'O
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