HomeMy WebLinkAboutPermit Building 1981-10-29
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Job Address
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Address
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[namel
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{addressl
(1 ics. no.)
(exoi res)
(ohone no.
Primary
Structural
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Electrical
Mechanical
CONTRACTORS
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Genera 1 /J.
Plumbino J;joLtJ 17 AJ
Electrical ~
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(address) (1;r:". M,)
fu hAJ' fA;)
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(pxo;rpc:)
(ohnnp nn, ,
;;) L/ (" -775 /
~1echanical
Plll1lllING
ELECTRICAL
MECHANICAL
I
. t"t"t"" . rYAR.G.E.
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. J=H" I rI-lI\Rr..~ ~f'
I C'C't' I I""Uflli.G.E.-HQ
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Each single fixture
5!J4,
Relocated building
(new fix. a~;t;cnal)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Residence of
SQ, FT.
furnace/burner to
BTU's
~ New circu~ts a1t5.
,,/ or extens 1 Dns
? &>:Rp-<;Rt1!'
SERVICES
~9
Floor furnace
and vent
Recessed wall
~O~I""P hp~tpr ~nrl vpnt
Storm Sewer
Of
COMl-I.IIND. FEEDERS
Install/alter/relocate
rlic:,trih fpprlprc:.
amps
Appliance vent
"poaratp
Stationary evap.
cooler '
Vent fan with
!;inole duct
Vent system apart from I'
heatinq or A.C.
Mechanical exhaust I
hood and r1urt
Sewer
Temporary Construction
Change in existing
re", j d..e.ncp
multifamily, comm. or
Indu",.trial
Water service
Wood stove/heater
Of
amps.
ISSUANCE OF PFR'1lT
TOTAL CHARGES 1':4//1 /5" - TOTAL CHARGES 22- $'0:::::> TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valij 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 infonmation hereon is true
and correct~ and I further certify that any and all work oerfonmed 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 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 oAf this r ect.
IWIE(please Prin~?fZ.~~k J' Aft' mriATU . U. ~
/ v FO~ OFFICE USE miL Y
Tvpe/Const. Units Sq. Ftg. riain .l( Value
Bedrooms Occy Load Sq. Ft9. Access x Value
Stories Occy Group <::;7>/1, Sq. Ftg, Other ~,W#"~At7'.//hValue ~~-
(7\'" TOTAL VALUATION
r I) 1("\-.;J.Cj.ii"'1
Conm!lno- /} ,I Systems Development
Ppr Fpe "12..'63.. 10..,3'1: CharQe (!.5~)
R-es
Per Fee
DATE)O ~ ~9 ~.Yr
Zone
Fi re Zone
Flood Plain
BUILDING PERfIlT
Charges and
Surcharges )...
_nS:~"-120
2.-:0
Plan Ck.
651:/Rlrlo
Plan Ck.
30%lBldo
PLUMBING PERMIT /~ ~ Fence
Charges and S ____Lv.
Surcharges , 7 S- D~A1O
ELECTRICAL PERr~IT '2-:?-.:;Fc:::::> ISldewa 1 k
~~~~~=~g:~d y -----;~ /-3"-' AIC Paving
MECHANICAL PERMIT I Curb Cut
Charges and ____________
Surcharges I
Total Comb. Permit
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
8. legal Description
1. example- Tax Lot lOa. lane County Map Reference
11 0'3 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/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. examEle- if new project. check new - if addition.
eneCK add, etc.
F. Building pennit 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 (al 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 OIVISIDN STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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. ---
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.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
/ ()ft; 2-1/
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Permit Clerk
(11" ""
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date