HomeMy WebLinkAboutPermit Building 1987-11-25 (2)
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CITY UF SPRINGFIELD
COMBIIIATJON APPLlCATJONfPERHIT
EilERGY SOURCES:
Heat
Ijater Meater
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INFURlIATJON LINE
726-3753
Sq. Ftq. "lain
~q. Ftg. Access.
Sq. Ftq. Other
Ilew Add Alter Pep.
-Fence Oemo Change/Use
Other- -
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1 Irl5PECTION LINE
726-3769
Job Address ~ "):2 0 ~ 4- r"'" ",",~.o/"' "57" .
Legal De5Cription /7-1):;;;-""27-'?;"') t::!'..p~
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Owner ~ .c/.F/c. h7:%?'r.>I!.,.e:/)~
Address "')0 //~4- 9"9 #
G"~~;..C
Phone
Ranqe
ValuE of Work:
.",)SI"~O. .-.
Builriina Permit Info: Describe Work{i~e.. Build Single
Familv nesidence With Attached Garaoel
F,zrEc::r #W:~/,..,.........~ ~-"U Cr.....-s;>o
Construction Lender
F~.l/'- 7?/~ r#-C'~ ~
Address
UI:.~Il.iN ft:JV1
(name)
Phone
(a-ddrp$~ \
(lics.no.)
(exo; res)
fohane no.
Primary
Structural
q;:)l \ ~2,0()
El ectr; ca I
~"1"6
Mechanical
CONTRACTORS (namel
General RA...,.-.t:J-<"r~
(addrps<;l
(li('s. nn. \
t""Yr'Ji..p,,\
{nhnnl'l nn \
-=:y &.........
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/~/....v ..."........~/.A/CLo<<; ~. g6"c>~,:2
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Plumbina
Electrical
~1echanical
PlmliHlG
ELECTRICAL
MECHANICAL
NU.
fIF r.HAR~F NO
~~r r~A~r.r NO.
HI=' rl-IAIU~r
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated bu;l~i"~
(new fix. additicnal)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. P.esident2
(] bath I
Dup 1 ex (1 Ilath) each
Additional Ilath
SERVICES
Recessed wall
~n~rp kp~tp~ ~nrl vpnt
Sewer
Temporary Construction
Change in existing
~PS jd_pnrp
multifamily, COITlIl. or
Tnrfllc::.tr;~l
Of amps.!
COffi1./IND. FEEOERS I
Install/alter/relocate I',
rlic::.trih fpprlp~~
Of amp..1
6:..I5C.T/'f;~,c. I/s
U~~ ?~/;r
#.$? 706 '/601 I
Appliance vent
<;eoaratp
Stationary evap.
cooler
Vent fan with
5inale dur.t.
Vent system apart from I
heatina or A.C.
Mechanical exhaust
11('\('\rl ~nrl rlurt-
Water service
Storm Se~
Wood stove/heater
I SSUANCf OF PFR!\IT
TOTAL CHARGES
WHERE STATE l~ REQUIRES
shall not be valii until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this penilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREfUllY EXAMINED 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 cerformed 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 110 DCCUPAUCY will be made
of any structure ~ithout 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who ~re in compliance with OP.S 7~1.055 will be used on this project.
UAI'IE(please print) \~h (],r/<:/1Y1 SIr.IIATUREg/'",j/~
FOn OFFICE USE OIllX/
f)"-.;V Units Sq. Ft;. I'ain x Value
Occy load Sq. Ftn. Access x Value
Occy Group 7?--? Sq. Ft~. Other~'."'..J'-"'~ Value t'S" ~,-"--"""
TOTAL VALUATION
DATE //-;:1.$-P7
Zone
~<::
Tytle/Const.
Bedrooms
Fire Zone
Flood Plain
Stories
/
BUILOING PER/>IlT OC-./ c-<:::>
Charges an~ ~ _ ___.c...l1lo:2.'~'
Surcharges ~ "2~ B 3'
PLur~BING PERMIT
Charges and
Surcharges
Plan Ck.
65t/Bldn
Plan Ck.
30%lBldo
COIlll1/1 nd
ppr~PP
Res
Per Fee
m
7":(,-;>3
Systems .Development
Charoe (I.5~)
//,4
Fence
ELECTRICAL PERr~1T
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I OeRlO
I Side,;a 1 k
------------
I AIC Paving
____________, Cu"rb Cut
1
ITotal Comb. rermit
5"'~- f ;>
I
I TOTAL
'76".6b
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100. lane County Map Reference
17 O'j 43
2. example- Lot 1. Block 3, 2nd Addition to
~pr.Jngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-nfw - if addition,
check add, etc.
F. Building permit information:
1. examole - construct singl!?- family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - 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 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. BOILDING DIVISION STAFF WILL FILL OOT ALL FEES AND
CHARGES ON THE SCHEDOLE5
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. ---
Ill. 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
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 OSE ONLY
&e . II- Ie> 6q 1
Permit Clerk ~~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY ~O'//.7/r /S5?-",/ ~'c- "
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4z-";;"/'f(-';;;S' h-7.'~ -:;. 7'" 7' /B:,::--z:- C=-/ 1/ c=7;.)
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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C)q".b 73 '7'
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PLANS REVIEWED BY:
i.-..o8~ ?LBi:"~ignature~~...-C~..J) date //""'/'/-E??
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