HomeMy WebLinkAboutPermit Building 1988-2-16
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'I ;~:PECTION LINE . CITY OF SPRINGFIELD
726-3769 COMBINATION APPLICATION/PERMIT
Job Address LtGo LtMd'ak.- (5ep,L(P/a /lpts J ~~;~r,y SOURCES:
Legal Description /1{ 0'3,,) 710 0 l(q ~ <) l~ater Heater
Range
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INFDRlIATION UNt
726-3753
Sq. Ftg. ',lain
~q. Ftg. Access.
Sq. FIg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
Owner.J'a.-e-s T. 'Bt-<clde'f
Address PO 80x .3 t.8
ft/oss ~ C!4J. '1'*'3fJ
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( J/l,-rJ ~-q?P~
ValuE of Work: ~
/Ct:>r 135(:). -
BuiloinQ Penuit Info: Describe Work(Le.,
Familv nesidence With Attached Garaae)
Build Single
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Address
UtSIGN IlAI-I
(name)
Phone
(address)
~ ~~~ ~~d:70A..o
~.<.or -/;f/~ ~ Zo e,e.:u-
~i .:- '-:' ..ja~ 64/Nt1/~_ V'
(lies. no.~ (exo;res)
"
(ohane no.)
Construction Lender
Primary
Structural
LA(""l 112, ~
1001
p' u
Electrical
Me'chan i ca 1
.CONTRACTORS Inamel
General AU-~F? IV. W. XIJc..
(address)
(1 ;ts. 00.)
(pxoirpo:;.)
(ohnnp nn_
Plumbina
?fl83 ~ toteS! j)P
-='~ C7K. 97 Yo5
"5~ztrl
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9-2-88 fi>87-zqp6
.3<fZ -ff/7 7
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MECHANICAL "
Electrical
~'echani ca 1
PLUIIBING
ELECTRICAL
NO.
Each single fixture
FEE rHAReF 1:10....- I FFF I rlJAB.liE. NO I
Residence of furnace/burner to
SQ. FT. BTU's
I HI=' Irl-ll1RG..E..
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~rp hp~tp~ ~nrl vpnt
Sewer
Temporary Construction
Change in existing
res j qence
Imultifamily, COl1lTl. or
Industrial
10f
ICOMM./IND. FEEDERS
I Install/alter/relocate
.dic;trih. fppdprc;
amps,
Appliance vent
c;eoa ra te
Stationaryevap.
cooler
Vent fan with
sinole duct
Vent system apart from "
heating or A.C.
Mechanical exhaust I
hood and rlllrt.
\10od stove/heater I
I
I
I
~Ia ter servi ce
Storm Sewer
IOf
I
I
I
amps.
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\li 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 EXAmNED the completed aprlication for permit, 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 NO OCCUPAI~CY 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 who are in compliance with ORS 701.055 will be used on this project.
IlAI-lE(please print) 'R/~ p. PV/PMeili!.....
SI(,IIATUREh f? ,~~
FOr. OFFICE USE orlLY
Sq. Ftg. t1ain x
Sq. Ft~. Access x
Sq. Ftg. Other x
2-/6-88
DATE
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Value
Value
Value
TOTAL VALUATION
BUILDING PERmT
Charges anc ~
Surcharges tJ
,"7"" U'7'\ Plan Ck. Conm/lnd
~~ '-'LI 65%/R1~o PPf ~pp
------------PTan Ck. Res -
(" ,\3 30%lBldo Per Fee
syste,ms Development
Charoe (1.5~) ,
PLU'1BING PERMIT
Charges and
Surcharges
Fence
I
I
I
I
I
I
!Tota, Comb. Permit
I
I TOTAL
(ZK(03
ELECTRICAL PERIHT
Cha rges and
Surcharges
DetIlo
_ ___ __ ___ __-,"Sidewalk
I A/C Pavi ng
____________1 Curb Cut
I
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot lOa, Lane County Map Reference
Ii 03 43
2. examele- Lot I. Block 3, 2nd Additio~ to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinQ/or forced air Qas
2. example- waterh~ater/electr;cal/or ~
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 permit information:
1. example - construct single family house with an
attached garage
2. example - 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., DES I GN 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
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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10 1 L(~
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V. FOR OFFICE USE ONLY
Permit Clerk
cv
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt 'from registration with the'Bui1der's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date