HomeMy WebLinkAboutPermit Building 1986-5-13
INFORlIATlON liNt
726-3753
SQ. Ftg. I-Iaio
~Q. Ftg. Access.
SQ. Ftg. Other
Ilew Add Alter Rep.
-Feoce Demo Change/Use
Other - -
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CITY UF SPRINGFIElD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Ranqe
.
I INSPECTION LINE
726-3769
Job Address ? 5'10 GAt Z.w Rj
Legal Description f..7 0) .).,:1 .:lD
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Owner ~Art\G~ -::t:'NN
Address :;51./D &RT'tw~y
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1J1Ut\Of Hark:
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'Builciin'Q Pennit Info: Describe Work(Le.. Build Single
Familv ~es;dence With Attached ~araae)
NO. I . FFF 'rHARr,F .JJn
-----lEach single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
(] bath \
IDuPlex (1 bath) each
IAdditional bath Temporary Construction
Iwater service Change in existing
, re) j qp.nrp
I Sewer Imultifamily, COItlI1. or
TnrllJo;;triill
I IDf amps I
Storm Sewer i
I ICOMl'I.IINO. FEEDERS I
I [Install/alter/relocate I
di,trih_ fpprlpr,
I 10f amp~ I
I I l
I I I
I I I ISSUANCF OF PFR,lIT
TOTAL CHARGES TOTAL CHARGES /<::.tS4> I TOTAL CHARGES
WHERE STATE L'W REQUIRES that the Electrical work be done by an Elect~cal Contractor, the electrical portion of this penmit
shall not be valid until the 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 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 UO OCCUPAHCY 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 ORS 701.055. that if exempt the bas's for ex Ption is noted hereon, and that
only sUbcontractors; employees who ar~ in compliance with ORS 7QI.O~S w~r;.. us on thi ro) ct. _ /J
IIAr,IE(please print) 1\ (C1-J A klb yETtJDS t::.A- SIGN^TURE~, . ~
FOr. OFFIa USE OII[Y ~
Sq. Ftg. t1ain x Value
Sq. Ftg. Access x I\~falue
SQ. Ftg. Other~D62:. Value
TOTAL VALUATION
Phone l:;:iL
Construction lender
I-C).J;).. Q.'t.......ov~ 2)(,,,,-1',"") Co..............,!>..... lAJ~\ I
i \'>?1'''l\) ~""'f Ip.-"", p.,f"~"""
Address Phone
Ut~luN ItM~ (namel (address)
Primary ~e...\?o-e. SoV;h Cf."loS' Co'\"ir'?\l rl",b
(lies, no,) (exoires\
. ::l'i~9 fd"3DJCf-.
'Structural
,
Electrical
Mechanical
CONTRACTORS (namel
General ~,cl)"\e('),,> Q."1:,""I\Ot.) \ "',
(address)
l1i~>:;.,nn.\
(pxnirpc;.)
~a--, ~
JJ II <; /<;cL
, ,
Plumbina
Electrical
7iI~H~h R..t ~ .
~1echanical
PLUHBING
I.QlABE.JJlo.......!
I furnace/burner to
BTU's
Floor furnace
and vent
ELECTRICAL
MECHANICAL
I H'~
Residence of
SQ. FT.
V "'New circuits alts.
or6~ons
tf:-A )
SERVICES
Recessed wall I
~o~rp np~tpr ~nrl v~nt
I
I
I
I
Appliance vent
<ieoaratp
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
hea t i no or A, c,
I Mechanical exhaust
hnnd ilnd durt
WOOd stove/heater
Zone .:::;,e.
Fire Zone
TYDe/Const.~~i'~
Bedrooms
Units
Occy Load
Occy Group~
Flood Plain
Stories
BUILDIIlG PERmT
Charges and
Surcharges
~.., .... Plan Ck. Comm/lnd
_ _ _:;?kt...;;?_ t?_ _ 65%1Rl do PJ"r Fpp
.., " Plan Ck. Res
~ ...... Z 3D%lBlda Per Fee
Fence
"3:>. '<:;s3
Systems Development
Charae tt.5~) ,
PLUr1BING PERMIT
Charges and
Surcharges
IDero
, ____t5_-'-~~Jslde,;alk
. 6.0 I AlC Paving
i Curb Cut
------------1.
TOTAL
ELECTRICAL PERr~1T
Cha rges and
Surcharges
MECHANICAL PERMIT
. Charges and
Surcharges
Total Comb. Permit
(ohane no. I
~lr7J''1.
(onnnp nn_ \
~Y'5- ;,'6"'lL
H L 1.LIlABEf.
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DATE~hJ~~
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
II U3 43
2. examole- Lot 1. Block 3, 2nd Addition to
Spr,ngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examDle~ heat/electrical ceilinqlor forced air Qa5
2. examole- waterheater/electrical/or SOlar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new,- if addition,
cneck add, etc.
F. Building pennit information: ,
1. example - construct single family house with an
a ttached garage .
2. examole - 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 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, & 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
O. 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.
. PERMIT VALIDATIDN
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
" Permit applicant exempt from registration with the 1Builder's, Board because:
".Additional Project .Informa,tion:
PLANS REVIEWED BY:
.' "
name ~~ .?t~ignature~~~ .~a~e ,)"O-B~