HomeMy WebLinkAboutPermit Building 1987-8-12
'jl1lSPECTIOII L1flE
716-3769
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IIIFORIIATlON LUI,
716-3753
Sq. Ftq. "lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A lter ~ep.
--Fence Demo Change/Use
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CITY Uf SPRINGFIELD
COllBlIlATlON APPUCATlDN/PERMrT
Job Address '=' I OS / ' / E!IERGY SOURCES:
~ l..,~t~IIJ/J.v. Heat
'Legal De,cription/7o?2"2 2.n I'l ~ 00 I.later Heater
Ranqe
Owner -;;;....../-;" ~~A/ Y-kr.. ,..
Address%dR" ~/E,z: .,~~.n~~
g/~/~,~-.i"h; .~/7HS; :ffI>r=2>/~
Construction lender /
ValuE: of Harle
foo, (JOO
Buih:ino 'Permit Info:
Far.lilv r-esidence Hith
Describe Work(;.e., Build Single
/l.ttached Gara<1e)
Address
OESIGII TEAll
f/VC; k" / ? "'iLl /,,, /? JI'}" It.- -k.
//v Olt:/c'h',vj /64I2K:,'....; Jo f .
(name)
Phone
CaddresSl-'
(lies. no.)
(exn; res)
(ohonp no.)
Primary
Structural
Electrical
r1echanical
CONTRACTORS Iname)
f4~ j.,(, ..... .L
Genera 1
r...
(address)
Rd. f>bY 1013
f1 ;r:c:. nn.
(pxnires) (ohone no.
-g.",~ V
7t./t, , ~C1t:j~
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Plumbina
PlUflB I NG
EI.ECTR I CAl , MECHAN I CAl
FEE r:HARGF tin ~H rHARr,~ flO.
Residence of furnace/burner to
SQ. FT. BTlI',
1
Electrical
t.lechanical.
1:0.1
Each single fi,xture
nT nlAJ:U:;~
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
IDuPlex (1 bath) each
Additional bath
INew circu~ts alts.
or extenslons .
Floor furnace
and vent
SERVICES
Recessed wa 11
Sn~~p h~~tpr ~nrl vpnt
~Ia ter servi ce
I Sewer
! Storm Sewer
Temporary Construction
Change in existing
rf's.i d~n~f'
Imultifamily, corrrn. or
InnlJ<:trial
10f amps.1
COI1r1.!IND. FEEDERS
Install/alter/relocate
n;<:trih. fppdpr<:
Appl iance vent
"~I).:lr~te
Stationary evan.
cooler ~ '
Vent fan wi tn
S;OClle OllCt
Vent system apart
heatino or A.C.
1'\leChanical exhaust
hood ~nd duct
f rom-
Wood stove/heater
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I ISSUANCF OF PFR'HT
TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penilit
shall not be va,lH until the label has been signed'by an Electr:ical Sunervisor ,and. returned to: the~Bui1ding Division.
) ." J . ~ ... . -. ".. .. " ' " -.: "" . . '. - ~
I HAVE CAREFULLY EXN1INED the completedr.aprlication for permit, and do hereby certify that all infprmation hereon is true
and correct,. and I further cert,jfy that anyand aU, wor~ r?erfqrmed.shall be do.ne in ascordance with the Ordinances of the City
of Soririgfield and 'the Laws of the State of Or'egon pertaining to the work described herein, and that IlO OCCUPAIKY will be made
of any structure witho.ut the nermission of the Building Division. I further certify that lTly registration'..../ith the Builder's
Board is in full~ force" and effect as. required by ons 701.055" that if exem'pt thebasis"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.
IWIE(please print) Eal2/ r.::~;1i' t- S;Gfl;;U:E-~ ~ .
FO~ OFFICE USE DHlY
Sq. Ftg.
Sq. Fta.
Sq. Ftg.
Of
amps.
om Ft-, 2~~7
Zone
c.L.-
Tyce/Const.
Bedrooms
Stories
5*
Flood Plain
I
Units
Occy Load
Occ'y Group-M-J
riain x Value
Access!2<;-a ~7/~~lue-b1~-
Other )( ValuE'
Fire Zone
BUILDING PERl'lIT
Charges an~
Surcharges
I ~ I Plan Ck.
___2J_?':...____ 65%/Bldo
".,. Plan Ck.
;' <)". C>~ 30%/Blda
ConmlI nd
Ppr ~pp
ROes
Per Fee
8;-12. -f; 1
"70'" ,,-. 9:-,~_c-n ISyste.ms Development. aOr erl>
(_ "".'-1.") 0 '- 0 I Chacoe (1.5r,) /< <--"j """
-I W/7"'#E'<:2> C:;1y7/L / -~~
~~~T/~ k4e/-YF/?
7}?"r"",ES:;';:=~ :::>
TOTAL VAlUATIOII
PlU'~BING PERMIT
Char.ges and
Surcharges
Fence
ELECTRICP.l PERI~IT
Charges and
Surchar~~s
11ECHANICAL PERMIT
Charges and
Surcharges
I Demo
I Sidewalk
AYC, Paving
Total Comb. Permit
L . -.-
I --------::.~-I
Curb Cut
-., .
'-.~
TOTAL
IZZ&,~.:,-l
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIT VALIDATION
II.
I. Applicant" to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, lane County Map Reference
II U3 43
2. example- Lot I. Block 3, 2nd Addition to
, Sprlngtield Estates
C. 'Name, etc:\o'f owner and construction lender
D. Energy Sources ,
1. examole- heat/electrical ceilin%r forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage.
2. examDle- lfInew project. check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole. 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
.~ Structura.l Specialty Code \',
H: OES I GN 'TEAI.I 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.
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 ANO
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to Si9n 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.
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 ;s issued.
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be delivered to the
by his electrical
is not authorized
Ill.
IV.
V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt.frbm.'registration with the Builder's Board because:'
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Additional' Project Information:
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PLANS REVIEWED BY:
name
/ O~b-?CA;;r:;;:g;?f> signature ~.,,__
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