HomeMy WebLinkAboutPermit Building 1982-12-1
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Owner {(lcHHk.D D. ~t.UnL
Address .:J/t)/ ,!j//R6ER PR.
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ffZ(6- ~Ra
Construction Lender~~~~~ ,('~~e>t1A\1'
Ranqe
ValuE of Hor4~ .A
7<#8:9~ 7hj:1?d.~4./, I
I~ n -Builriinq Penmit Info: Describe Work(i.e..
Phon~J'/'c?~~ r-Familv Residence Hith Attached Garaae'
INFORllATION LINt I
726-3753
Sq, Ftg, "fain.c>-::>v ,
:q, Ftg, Access.z.:;>.::>ST)
Sq, Ftg, O;)ler
--.-!lew_Add~AI ter _Rep,
Fence Demo Change/Use
Other- -
Job Address3.5013 6/17 ff 1..)1'1'/ .:5,T,
Legal Description /7'(}3.2?'~O_ OO/t::JO
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CITY UF SPRINGFIELD
COMB IllATION APPLICATION/PERMIT '
EIIERGU01!RCES: C' '1
HeateL'.6ff /-. /7.
"Iater Heater 6A'.:5
jlNSPECTION LINE.
726-3769
Build Single
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G\
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16\
E#c..c?'..se:- . /lEeK
~p~
Address
Ut~I{jN TtN1
(name)
Phone
(address)
(1 ics. no.)
(exn;res)
(ohane no.
Primary
CwA/Ee
Structural
Electrical
Mechanical
CONTRACTORS
enamel
(address)
nics. no.)
(exoires)
(ohane no. )
Genera 1
;jtVN'Ek!..
PlumbiOCl
; Flp,ctrical
Ml?'rh..~nir:al
I ... ..
PLUllBING
ELECTRICAL
MECHANICAL _
NO,'
lEaCh single fixture
I Relocated building
(new fix. additional)
IS.F. Residence
(] hath]
jDuplex (1 bath) each
jAdditional bath
I~Jater service
I Sewer
FEE
rHARGF
Nfl I HF
I Res i dence of
SQ, FT,
I New circuits alts.
or extensions
ISERVICES
I
rHAR~F Nn
...
rHAR.~F
/
/ ...
furnace/burner to
Brll's
Floor furnace
and vent
Recessed wall
~D~ce he~tpr nnd vpnt
, -f
IICF :.-
I~
!TempOrary Construction
IChange in existing
rp5J dpnr:p,
Imultifamily, camm. or
Inrlu<;.trinl
IOf amps,l
ICO~1,/IND, FEEDERS
IInstall/alter/relocate I
di<;.trib. fpedpr$
Of amps.v
, A / ~ ,(/11> I
j'1Y'1 I
I I
I App 1 i ance vent
seDarate
I' Stationary evap.
c.ooler
I' Vent fan wi th
sinole duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust I I
hood and duct
: \load stove/hea~i~~ I
I ~ I
I I I
Storm Sewer
ISSUANCE OF pmr1IT
TOTAL CHARGES TOTAL CHARGES rOTAL CHARGES
WHERE SrATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this per~it
shall not be vali~ 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 here9" 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 OCCUPArlCY'will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
IlAI'fE(please print) .8C/f"4~ A /ltvEL-L SIGIIATlIRE Lf;.~d2 ~-cee. DA.TE/,;l,;?/t'Z--
For, OfFICE IISE miL Y
Sq. Ftg. riain x Value
Sq. Ft9. Access x Value
A-3 Sq, Ftg, OtherEMCc.c:>.5E' :Z~'541R: Value~0_ 00
rOTAL VALUATlON48Q:::>.-
Tyoe/Const,_ S-N
Bedrooms
Stori es 2
Units
Occy Load
Occy Group
Zone t:: c::
Fire Zone
Flood Plain
BUILDING PERfIlT /ts, .-:> Plan Ck, Comm/lnd' i'I,7" f/t:f. 12-'
Charges and ------------ 65%/Bldo Per Fee F~:!>?
Surcharges 72 Plan Ck, Res I
, 30%IBlda Per Fee
PLU'1BING PERMIT Fence I
Charges and ------------
Surcharges D~mo I
ELECTRICA.L PERI~IT Sidewalk I
Charges and ------------ I
Surcharges A/e Paving
MECHANICAL PERMIr I Curb Cut
Charges and ------------
Surcharges I
L~_
Systems Development
Charqe (1.5%)
TOTAL
/&.72
/e, 72.- J
Total Comb. Permit
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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 I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ce;li~Q/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1, 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 single family house with an
attached garage
2. exa~le - 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 rEM4 AND CONTRACrORS
T~ ~v~id design or con_s~ru~.tion,qel~rs, Bl!tldi~g '-',J
DWlslon Staff must be able."to contact appropnate'
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 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 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 USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk ~~
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name~,7;'.M:E" n ~ ~
Signatur~~
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