HomeMy WebLinkAboutPermit Building 1987-11-25
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
Range_
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I INSPECTION LINE
726-3769
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Job Address ~ ") 2' 0 ~A-r--= Ju-A- <;;- <57 .
Legal De'cription /7-"~'-:2?-?= e>6'~
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, Owner -;:;",c/F/C. ~~c:>~.<=z~,..,..,
Address "")0 //,..,,4' 9"9 ,,1/
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Phone
Construction lender
Address
Ut~l(jN TEAl'!
(""me)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS lname)
General K.;r;...,-.t:>-.::",r;C"
(addr~c;,,,)
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INFOR/1ATION UNt
726-3753
SQ. Ftg. "lain
~q. Ftg. Access.
SQ, Ftg, Other
~ew Add Alter ~ep,
-Fence Demo Change/Use
Other- -
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(ohone no.l
ValUE of Hork:
")7"00. .-.
BuilGina Permit Info: Oeser be Work(i.e., Build Single
Familv nes;dence With Attached Garaael
~R~c:. r #w-...v....."..,....,.....~ ~.-IV
po/€. TY, r.#-~-
nics. no.)
(exoires)
(l ;r'c:.. no.)
(pxni rp<;. \
(ohonp nn.)
Pl umbi no
~q--5"r /O//Y ~"'-~""".A/=~~. gG;:>:9>:2 __
L"~~ -=<'_~
Electrical
~'echanical
PlIJlllllIN.G
-..!!Q"
fEF rHAI!l;F No..-
Each sil191e fixb.lre
Residence of
'.,
Relocated bujl~in~
(new fix. additional)
IS. F. Resideoce
(J bathl
IOuple. (1 bath) each
IAdditio"l bath
I ~Iater service
1 Sewer
IStorm Sewer
I
1
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INew circu!ts alts.
or extenSlons
I SERVICES
I
ELECTRICAL
MECHANICAL
ccc r':lAllliE jjQ....
~~~...c.HAR!iE.
SQ. FT.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~rp np~tpr ~nrl vpnt
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I ~l5C.r.;r:r./~ 1/5 I
lu~~ ,P~/}-
1#..s?7ob '/601 I
ITempOrary Construction
IChange in existing
rpc;idpnrp
Imultifamily, camm. or
Tndlld.rial
10f
ICO~1./INO. FEEDERS
1 Install/alter/relocate
rl;~trih_ f~prlpr~
10f amp~1
TOTAL CHARGES
WHERE STATE l,~ REQUIRES
shall not be valHuntil the
TOTAL CHARGES
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from 1
heat;na or A.C.
I'MeChanical exhaust I
hond and duct.
I ~Iood stove/heater I
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(lmps.1
I SSUANC, OF PFR!lIT
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
label has been. signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
I HAV[ CAREfUllY EXAr11NED 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 Springfi~ld and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CY will be made
of any str~wre 'Witho'ut the permission of the l3uilding Division. I further certify that my registration with the Builder1s
Board is in f~11 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 in compliance with OP.S 7nl.055 will be used on this project.
NAf.fE(p1ease print) 1__iG (3,,r/<:/7n
DATE //-;;zS-!?7
Zone~.c TyPe/Const. C-k
Fire Zone Bedrooms
Flood Plain Stories: /
SIG~ATURE
FOr. OFFICE USE O~I
Sq. Ftg.
SQ. Ftg.
. Sq. Ftg.
Units
Occy Load
, Occy Group ?....?
BUILDING PERJollT
Charges an'::
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. Res
30%lB1 do Per Fee
Fence
___S~_$.c>
"2- B 3'
PLUt1BING PERMIT
Charges and
Surcharges
I Demo
I Sidewalk
---------~-..~I.AlC Paving
1 Cu'rb Cut
I
ELECTRICAL PERIl IT
Cha rges and
Surchafges .
- "
MECHANICAL PERMIT
Charges and
Surcharges
t1ain x Value
Access x Valu~
Dther~......s?/~_ Value (~'~,~
TOTAL VALUATION
7/-."/3
syste,ms Development
Charqe (1. 5~)
#4
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ITotal Comb. Permit 5"'7'- ? ;>
I 7'6.66 ~
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
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PERMIJ_VALIDATION
l . _ .''- .",
III.
I. Appl icant to furnish
A. Job Address
B. Legal Description "'''. '.. \
1. example. Tax Lot 100, LaneCounty"'Map Reference
II oj 43
2. ~xample- lot I. Block 3, 2nd Addition to
Springfield Estate~. .. .,.,
.. C~ Name ,_. etc. . of owner' 'and cons truct ion 1 ender
D. Energy Sources _
1. examole-"'heat/electrical cei1inq!or: for'ced air Qas
2. eX3"!ple- waterheater/electnca(/or solar
E. Square footage or valuation, etc. ------
I. example. 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct singl~ family house with an
attached 9ar~ge
2. exam~le - remodel existing garage into family foom
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
....... ..... Struc.tura1 Specia1ty_~o~e _.. '. ..
Hr. DESIGN TEAl.! 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 OIVISION STAFF WILL FILL OOT ALL FEES ANO
CHARGES ON THE SCHEDOLES
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 penmit 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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Permit Clerk ~~
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE' OCGUl'ANCY r-""/7,:>// /S5,e;..".~2- "
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
- naine:LP8~?~~ignature~~~.....:.S) date //"/'/-li??
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