HomeMy WebLinkAboutPermit Building 1983-9-30
'I IrISPECTION LINE . CITY Of SPRINGfIE~D
726-3769 COMBIIIATlON APPLICATlDN/PERMIT
/' -----, E!IERGY SOURCES:
Job Address T ..) _ '3.\Q.f'> C""="-<"'~. ,='-~ I Heat
~egal Description,'! e:><-. <;\.(~ ':l.f"I ""'''' ~ r Hater Heater
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Range
vali"\J!...l-Iork:
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Builoina Permit Info: Describe Work(i.e.;
Family nesidence With Attached Garaae)
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Owner
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crphlA..o7'
Address
C~nstru~tion Lender
Phone
Address
Ut~Ju" ltM1 (name)
Primary --;H;; 1'fJh'IC/../A<'
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~1echanical
NO.1
Each single fixture
Sewer
Storm Sewer
TOTA~ CHARGES
Phone
(addressl
flies. no.)
INfOlUlATlON LINt
726-3753
Sq, Ftg, I,'a;n
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Pep,
-Fence Demo Change/Use
-Other- -
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/,-,r,: 4/'Z'GS
3'16/ itJas#/.I'.G: JgAl12.
(name)
(addr~ss 1
(lies. no.'
Build Single
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P~UI1BING
E~ECTRICA~
-
-
{exoiresl
(ohone no.
?q.~ I ~ 1.(
(pxo;rpc:.l
(I)hnnp M. \
MECHANICA~
I FFF I rHARr,F ~I 1....E1='1=' I r...AB.G.E. NO_'
Residence of furnace/burner to
SQ, FT, BTU's
C,'7;:h,/~ CJ I
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SIGrlATURE
Relocated building
(new fix. additional)
S.F. Residence
II bath)
Duplex (1 bath)
IAdditional bath
~Iater service
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'2. 5.OJ I TOTA~ CHARGES
WHERE STATE UU REQUIRES that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
\
New circuits alts.
or extensions
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1~r:LI..t.HARG..E..
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
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I\Dq-iV)~
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each
I SERVICES
I
I App 1 i ance vent
seoarate
I Stationary evap.
rnnlpr
I Vent ""fan with
sinale duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood i'l.nd nlJrt
I Wood stove/heater
ISSUANCE OF PFRt1IT
\0.00.
this permit
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
ana 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 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 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 7nl.055 will be used on this project.
~/~../-~~OATE q AdQ J"
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Zone CC Tvoe/Const,f-. \.. "
Fi re Zone --- Bedrooms ,~
Flood Plain :~or;es f
NN1E(please print)
BUI~OING PERMIT
Charges and
Surcharges
P~U'~BING PERMIT
Charges and
Surcharges
E~ECTRICA~ PERIHI
Charges and
Surcharges
MECHANICA~ PERMIT
Charges and
Surcharges
\
!TempOrary Construction
IChange in existing"
rps i qPJlre
Imultifamily, corrm. or
Industrial
10f
ICOMfI./IND, FEEDERS
Install/alter/relocate
di~trib. fppd~r~
\O~ \[),rP
I
I
amps.1
Of
amps.l
TOTA~ CHARGES
FO~ OFFICE
Units --
Occy load --
Occy Group R- ? ,
USE DilLY
Sq, Ftg,
Sq, Ftg,
Sq. Ftg,
r1ain
Access
Other
x
Value
Value
Value
/
/
x
x
TOTAL VA~UATION
n l"\ 00 Plan Ck,
__ _:-1.L.,_____ ~/Blda
'J. c..8 Plan Ck,
.) , 30%/Bl do
Fence
COIllllII nd
PJ'r Fpe
Res
Per Fee
'n J ratJ I() -'5 -Kg I U
,=" 00 ~~ ~""I;ystems Development
- .11,/\ 'P1.u...LIl,}J5=harQe t1.5~) ,
Oe:mo
'2.~. CO I Sidewalk
------\~DO--I A/C Paving
____\..~...;~~_-' Curb Cut
.(DO I
Total Comb. Permit
I
I TOTA~
\~1 :18 I
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,
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I, Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 03 43
2, example- Lot I, Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D, Energy Sources
1. exam21e- heat/electrical ceilinqjor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq, foot house', 500 sq, foot garage
2. exam~le- if new project, check:ruew - if addition.
Check add, etc.
F. Building permit information:
1. exam~le ~ construct single family house with an
attached garage
2. exam~le - remodel existing garage into family foom
3. exam~le M 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 TEN~ 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 P1~mbing. 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
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. ---
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
'app1ication. 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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V, FOR OFFICE USE ONLY Permit Cler
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PROJECT CONDITIONS TO BE SAT.ISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: (\(t)()"("0..'\.\" "\Cl."'-te
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PLANS REVIEWED BY:
name UW.h~ "":\ \?\M:;\)\ Signatu~~t\~~\
/
date \\-\ ~~~
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