HomeMy WebLinkAboutPermit Building 1982-8-6
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INFORlIATION liNt _I
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other- -
I IrISPECTION LlIIE.
726-3769
CITY UF SPRINGFIElD
COMBIiIATION APPLlCATION/PERMIT
EIlERGY 50URCES:
Heat
Hater Heater
Address
(J... c..; /, 'c.. ~ ," ll",;
-7o~v ("h:Wd"
I
Range
ValuE of Hark:
""
/200-
I,Buildina Permit Info: Oescribe Work{Le.,
D 7 I r Fami 1 v nes i dence Hi th A.t tached GaraQe)
Build Single
lK}
IN
~
~
\J
Job Address
5'/1/. ~€WA-r'S7'-
1?030l0l ;200~1I,)6
Legal De5cription
Owner
Phon"loJ l
(name)
Phone
(address 1
l.~.... <2 Ct.df c.,,- {1Ic- cF/I-Dbyy,r
('rJ.. J I"-St."I) rJ ev,,,d,,,,,
_ ~/ H:' -+16- I ~ .io-l~ f.e.J-
~. (li~. no.)f-o (f!xoire.=.~~ _:.. ;...
i
.tf
Construction Lender
Address
DES I GN I tAr.,
~
(ohoM
no. 'I
~;'-r)"i"<>
l
Primary
,--
Structural
Electrical
f1echanical
CONTRACTORS (name)
~ General L~",Q C~....~t.~c...~(\.... Co
Plumbina
(address)
If {'f D Oh.\~ Sf
(lks. no.
(pxnirp.s)
(ahane no.)
6 H-- <) n1.
nf\
c~rt
Electrical
~1echani ca 1
PlUllB I NG
ElECTRICAl
MECHANICAl.
NO. '
Each single fixture
. FFF . CHARGF NO . ~~~ I r\.lAIU~1= NO_
Res idence of furnace/burner to
SQ. FT. BTU's
. 1=1=1= . rHARr.[
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath]
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp. hentpr ~nd vpnt
Storm Sewer
Of
amps.
Appliance vent
sp.Qarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood nnd duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res j d~JKP.
multifamily, COI11!1. or
Industrial
~Iater servi ce
COMH.{INO. FEEDERS
Installlalterlrelocate
dht.rih. fpprh'r<;
Of
amps.
ISSUANCE OF PFRt1lT
TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES
WHERE STATE L"~ 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 EXM1INED 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 NO OCCUPAi~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bu;lder1s
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 ;n compliance with OP.S 7Ql.055 will be used on this project.
IWIE(please print) SIGIIATURE
FO~ OFF! CE USE DillY
Zone CC Type/Const. s: "I Units Sq. Ftg.
Fire Zone Bedrooms Occy load Sq. Ft9.
Flood Plain Stories Occy Group___~ ~ Sq. Ftg.
D~.TE
t1ain
Access
Othe".0<;~Lt
x Value
x Va 1 ue
W<wn:sW5Value
TOTAl VAlUATION
/"<'C6. ..0
/40::>. -.
BUllDllIG PERflIT
Charges anc
Surcharges
/ -:::> .. "" Plan Ck. Conm/lnd
~ . 65X/Rlrln P@r ~ee
____n~y&- ~6~~B~~~ ~~~ Fee
I Fence
I O~mo
I Sidewalk
- un ~_~:' ~.~:~:lA/C Paving,
{, I Curb Cut
Systems Development
Charqe (1. 51,)
Plur1BING PERMIT
Charges and
Surcharges
ElECTRICAl PERI~IT
Charges and
Surch~rges
/IECHANICAl PERMIT
Charges and
Surcharges
"
. Jotal Comp:" Permit
I
TOTAL
/ 2. SIB
.
-,.
COMBINATION APPLICATION/PERMIT (CAP)
,
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. .examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house. SOD sq. foot garage
2. examyle~ if new project, check-new - if addition,
cneck 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
Structural Specialty Code
H. DESIGN TEM4 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
fu 11 schedu I es
C. BUILDING DIVISION 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 b~ 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:
.
\. .-1 :,..
PERMIT VALIDATION
\".~,\ ,"
or
Permit Cl erk
sq S)-q
c;70
/2.00
. '-If
~
Permit applicant exempt from registration with the Builder's Board because:
AdditJ ona 1 Project.:Informati on:
~" '-- ,-' - - '"..-'
-"'-"..-
PLANS REVIEWED BY:
name ~?1N'e ~~ Er-;;zj' signature
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