HomeMy WebLinkAboutPermit Building 1987-10-29
1- INSP~CTION LINE ~ CITY Of SPRINGfIELD
726.3769 COMBINATION APPLICATIONIPERMIT
Job Address / 0tJ 3-:7; ,/{:1.d.i~av,/. '1E~~~GY SOURCES:
Legal oescriPtipn f~' /,/,'flO_J" /Ld ater Heater
l I . - I ange
17-t)3'J:;:;2 -"2...a>/ d.:'S. 6= ~ -'
ValUE of Hork:S/ A1ntJ
Owner .. M~ cf- 11/1 LLIk'_ , , iN
Address .....J,., - /20 v /0- (/ - Phone. BuilGinQ Pennit Info: Describe l~ork(ioe.,
~f) ~ ~ ~ Familv nesidence With Attached Garaae)
au4I trdrla..i-D Y3 ?() / r /
Construction Lender I ~ . ---z:u,../
/ Z 0 g 3,-/g. fa 'I- 3n~ IJ
1 address)
Genera 1 /I.
PIUmbinQ/;:!.tJ ill) ~
Electrical ~
NO.1
I Each single fixture
$PA.
Relocated building
(new fi.. additional)
each I
I
I
I
I
I
I
I
I
I
I
TOTAL CHARGES t:4/~ /~ - TOTAL CHARGES Z2, $"0 TOTAL CHARGES
WHERE STATE L'l~ REQUIRES that the Electrical work be done by an "Electrical Contractor, the electrical portion of this peroit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULlV EXAMINED 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 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 rw 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 ORS 701.055, that if exempt the b s for exemp' 'on is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will b ed 0;' this r ect.
NAHE(please prin~J:p~~ I!?:v/;; )' ...rr' SIGriATU . r.J.,~. DATE) 0 ^ :;}9 ^S'{
I \7 FOr. OFFICE OSE OHL Y
Type/Canst. Units Sq. Ftg.
Bedrooms Occy load Sq. Ft~.
Stories Occy Group...:2?At. Sq. Ftg.
-',}
'.'
.
Address
DtSIGN TtM
Primary
Structural
Electrical
Mechanical
CONTRACroRS
~lechanical
S.F. Residence
(I bathl
Duplex (l bath)
Additional bath
~Iater service
Sewer
Storm Sewer
ZonE'
Fire Zone
Flood Plain
BUILDING PERHIT
Charges ant:
Surcharges
PLOt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr:IT
Cha rges and
Surcharges
t1ECHANICAL PERMIT
Charges and
Surcharges
, .
.
INfORllATlDN LINt
726-3753
Sq. Ftg. 1.lain
~q. !='tg. Access.
Sq. Ftg. Other
Ilew Add A Iter Rep.
-Fence Demo Change/Use
Other- -
c()
-V
o
Build Single
~.
"J
---a
Iname)
"
(ahoM no.
(1 ics. no.)
(exoiresl
I_I
(address'
/: .
(;J -0tT
\.....
(lics. no.)
(j:>xoirp<;.)
(ohnnp no.)
Jiu fM;)
. d./
A~}
,;) Ljc, -775/
PlUllllIlIG
ELECTRICAL
MECHANICAL
. FEf I r.HARr,.I='
I ~~~ I r\.lAQr.~ Nn I
I ~~~
I r\.lARG.E
Nn
Residence of
furnace/burner to
BTO's
SQ. FT.
~ New circuits a1ts.
,,/ or extensions
-::> 4>R?4jR<:
SERVICES
~9
Floor furnace
and vent
Recessed wall
~n~~p hp~tpr ~nrl vpnt
!TempOrary Construction
IChange in existing
rps i rtpnrp
Imultifamily, corrm. or
Tnnll<;.trial
IOf
ICOffi1./IND. FEEDERS
I Install/alter/relocate
Iii dri n, fppnprc;
Appliance vent
C;Pnarate
Stationary evap.
coolpr
Vent fan wi th
<;.inole duct
Vent system apart
hpil.tinq or A.C.
Mechanical exhaust
hood and durt
amps.
from
Wood stove/heater
Of
amps.
ISSUANCE OF PFRllIT
~in x Value
Access x Value
Other ~ k~~7"//hValue
TOTAL VALOATlON
.")2-.....-..-') -=-
Pl an Ck.
65li1Bldo
Plan Ck.
30t/BldQ
I()-~q-Ii'"/)
~2-.'6 3.- /O'b 'l ~h:;~~s (~~5~lopment
Conm!l nd
P~r Fp~
Res
Per Fee
_n5~~1)o
2.53
__uL;i: -
.75"
'27-2~ I Sidewalk
___u/~ /-3'-1 AIC Paving
I Curb Cut
I
Fence
D~RlO
I
!Total Comb. Permit
I
-I TOTAL
'7<.7'/
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
'1. examl?le- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project, check-new - if addition.
cneclc add, etc.
F. Building pennit information:
1. exam~le - construct single family house with an
a ttached garage
2. examEle - 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,-
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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. ---
Ill. 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
". .' --.
" .
- \
.. '..
~
PERMIT VALIDATION
.- )-
/ ()iP Z,V-
rz - 3 -0 1
Permit Clerk
(11' "
". '":,
Permit applicant exempt from registration with the Builder's Board because:
}\ddi ti ona 1 P,:o~.ecLInfo.n]1ati on:
," :-
PLANS REVIEWED BY:
name
signature
. ..
date