HomeMy WebLinkAboutPermit Building 1985-6-19
CITY UF SPRINGFIElD
COMBII/ATION APPlICATION/PERMIT
E!IERGY SOURCES:
Heat
l~ater Heater
RanC'le
legal
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Description /7-()3 - ?:7-~()
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III/SPECTION lINE
726-3769
Job Address
~4-2.7
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'210 iNv/.c,. ~I-.
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Construction lender ,-' fY~ Cor e."
Address 1010 lJ.Jqrl- ?t.rf) "",,'/k
Ul)llirl IEAI'~ (n-ame)
Owner'
U / f'<:>
Address
Phone
lfB/- l&Z'L
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S,t.i:~e (;T.
f (address)
Primary
Structural
Electrical
Mechanical
, CONTRACTORS
Genera I WI f.~-eA~
Plumbino ~KG;
Electrical CI~Y L>ieu.>
'Iechanical (lone
(name I
ValUE of Work:~
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Builciino Pennit info: Describe Work(Le.,
Familv f'!esidence Hith Attached Garaae)
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flies. no.)
f.tx,a.
(addrflSS) (lies. nn_'
;~ f). JE5"':cJ.. S~ Ot. C}7/f77
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BPlpk.
'6YcD /.l,v/au ftti.
PLUlmING
NO,'
Each single fixture
, FFF 'r.~~...llO....-1
Residence of
Relocated building
(new fix. additional)
I
New circuits alts.
or extensions
S.F. Residence
(J bath 1
Duplex (1 bath)
Additional bath
SERVICES
each
ElECTRICAl
SQ. FT.
~Iater service
ITemporary Construction
IChange in existing
r~~jdpn('p
multifamily, camm. or
Tnrlll,,-tri;1.l
Sewer
I Storm Sewer
I
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Of
CO~~./IND. FEEDERS
amps.1
I Install/alter/relocate
rl;,,-tr;n_ fpprlpr,,-
IOf amps.1
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TOTAl CHARGES TOTAl CHARGES
WHERE STATE !,,\l/ REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
Zone r _ c..
Fire Zone
Flood Plain
~ -M...--Units
Occy load
Occy Group
J
A-'1
Tyoe/Const.
Bedrooms
Stories
BUIlDING PERflIT ____2P-.~~__ . Plan Ck. ComnlInd
Charges an~. 65%/Bldo P?r Fpp
Surcharges .!1~ Plan Ck. Res
30%/Blda Per Fee
PlU'~BING PERMIT Fence
Charges and ------------
Surcharges DfjIOO
ELECTRIC~,l PERIHT /ptH Sidewal k
Cha rges and ------------
Surcharges .1/J A/C Paving
MECHANICAL PERMIT Curb Cut ..
Charges and ------------
Surcharges
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INFORlIATJON U~t .1
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
Fence_Demo _Change/Use
_Other
Build Single
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C)
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'9-J
ICY'
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(exnires)
(ohane no .I~
(pyoirpc:.'
(ohnn~ no l
7C/t,-Q U3b
2<:J~ //0 ~c
bB? ~2'1~
MECHANICAL
furnace/burner to
BTU's
I..EEL 1..cJiAB.li.E..
I
Floor furnace
and vent
Recessed wall
~o~~p hp~tpr ~nrl vpnt
I' App 1 i ance vent
c:;poaratp
I Stationary evap.
cooler
I Vent fan wi th
sinale duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and dlJ~t
I
I
I
Wood stove/heater
I
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I ISSUANCE OF PFR!1IT
"'~~ TOTAl CHARGES
Electrical Contractor, the electrical portion of this penmit
Supervisor and returned to the Building Division
AfJbfll/')jt)
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x Va 1 ue
x Value
x Value
TOTAl VAlUATJON~~O ~
-Systems Development
Charae 0.5%)
30~
I ~.j"_,V //2._4>
Total Comb. Permit ~~___Gf>
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I HAVE CAREFUllY EXA~1INED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed 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 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 :om~liance with OP.S 7n1.055 W~ll be used on this project.
IW1E(please printJ ./JI1J1lh1fP uJ. 'PH/{,.l.-/IX SIr.IlATURE~ W. ~ 'DATE-.!?lJ1/~
Foii'OfFlCE USE iillLY
Sq. Ftg. Ilain
Sq. Ftg. Access L.1 "",
Sq. Ftg. Other
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.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
II OJ 43
2. examele- Lot 1. Block 3, 2nd Addition to ,"' ',' .
Spr,ngtield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examyle- heat/electrical ceilinq/or forced air Qas'/
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc, ------
l. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-niw - if addition.
check add, etc. .
F. Building permit information:
1. examole - construct single family house.with an
attached garage
2. exam2le - 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 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, & Eleetrical 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 Sehedules
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 sehedules
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. Applieant 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.
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V. FOR OFFICE USE ONLY
Pennit Cl erk
(1/3
I
1
PROJECT CONDITIONS TO BE SAT,ISFIED BEFORE OCCUPANCY:
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,
Pennit applicant exempt from registration with the Buiraer's Board because:
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Additional Project Infonnation:
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-' ...., . . .'-~
.,,,'1';'
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name ~,...(~ t.A(~
signature
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PLANS REVIEWED BY:
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