HomeMy WebLinkAboutPermit Building 1984-3-20
~
, . INSPECTION LINE
1,726-3769
Job Address
1..050
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Legal Description 17."~.'Z?-~
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CITY Of SPRINGf IELD' INFORlIATlON liNt
COMBIIIATlON APPLICATION/PERMIT 726-3753
E!lERGY SOURCES: Sq. Ftg. 1.lain
Hea t ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
Ilew Add A Her Pep.
Range -Fence Demo Change/Use
ValuE of Work: -Other&f~"'~
~9.t.t:? t>t:> jf?~' ~
Buih;;na Pennit Info: Describe Work(Le., Build Single 1
Familv nes;dence With Attachpd Garaae)
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Owner Ih.L 1>ni n *"~ Condi)
Address I n<:::(\ -l1rLr Lo II) frj. Phone
rJL q,1.\
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s.. .n.J...-\ r\.
Construction Le~de~
~ Address
__Jl Ut~ I uN TtAl1
~ Primary
cr- Structural
~, Electrical
\r) Mechanical
'( CONTRACTORS
(name)
(name)
, Genera 1 ~ ~bri ng (\ N. ,,,--t
~ Plumbino .
~~' Electrica,1'-e.-M>r ~tn-{\.L
~1echanical
,
<:l PLUI1BlflG
M NO. HE fHARr.F
~ Each single fixture
~ Relocated building
(new fix. additional)
S.F. Residence
(J bath\
Ouplex (1 bath) each
Additional bath
I Water serv; ce
I Sewer
l Storm Sewer
I
I
Zone 2?...."
Fire Zone
Flood Plain
BUILDING PERMIT
Charges and
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlnT
Cha rges and
Surcha~ges., ~
MECHANICAL PERMIT
Cha rges and
Surcharges
Tyoe/Const.
Bedrooms
Stories
.t:;"-N
I
Phone
(address)
(address)
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(flY' nx()J{(l~ +
n I ~I'l i rj;j'1() ~ \\ ~l-k
flics.no,)
(ohone no. 'l
(exoiresl
(lic~. nn.)
(pxoirpc;,)
(nhnnp I'ln l
~40 '?a o..m1a,.\~ ~~'3\~
q~p>-/t6ZZ
ELECTRICAL
Nn
Residence of
SQ. FT.
INew circuits alts.
I or extensions
I SERVICES
I
MECHANICAL
r:f.LI..IJlAB.liE. Nn
I..EEL ..IJlAB.liE.
furnace/burner to
BTU's
/
/t:2IC
Floor furnace
and vent
Recessed wall
~n~rp hp~nrl vpnt
ITemporary Construction
IChange in existing
l"'P~irtPnrp .
Imultifamily, comm, or
I nrltlc:.trial
Units
Occy Load
Occy Group M.. /
. U", ....Plan Ck. COlll1llInd
____._L~'____ 65%/Bldo Pj"l'" F~~
., Plan Ck. Res.... '
/.It?t'> 3D%l81do Per Fee
-----_:.........:~---
_____t~~_
. it' C>
Fence.
. ,.
I
I
IOf amps.1 I
ICOMfl./IND. FEEDERS I
I Install/alter/relocate I
r1idrih fppdprl:.
10f amps. I I
I I I
I I I
I I I I ISSUANC, OF pml1lT
TOTAL CHARGES TOTAL CHARGES /". -I TOTAL CHARGES
WHERE STATE LAII REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be valiJ 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 performed 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 Builderls
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 are in compliance with ORS 7Ql.055 will be used on this project.
lW'lE(please print)~/2L)~ .J,L3AL~/J .SIGIIATURd~~,//r~
FO~ OfFICE USE OilL Y
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
D_
ISide"a 1 k
I A/C Pavi ng
I-Curb Cut
I
Appliance vent
~'poar:~t.p
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A,C,
Mechanical exhaust I
hnnd and clul"'t
Wood stove/heater
DATE~
riain
Access
Other
x
Value
Value
Value
69l'J'e>. -
~/,.
x
x
TOTAL V ALUA Tl ON
Systems Development
Charqe tl.5~) .
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l~otal,Comb. ~ermit
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I TOTAL
~7'" 00
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
II!.
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100. Lane County Map Reference
11 03 43
2. example- Lot I. Block 3. 2nd Addition to
sprfngtield Estates
C. Name, etc. of owner and construction .lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air qas
2. examole- waterheater/electrlcal/or solar
E, Square footage or valuation, etc. ------
I. example- 1250 sq. foot house. 500 sq. foot garage
2. examyle- if new project, check new - if addition,
check add, etc.
F. Building permit information:
1. example ~ construct single family house'with an
attached gar~ge
2. exam~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 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 descri'ption
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. 8UILOING 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. ---
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.
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V. FOR OFFICE USE ONLY
II d 'D
Permit Clerk U~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl i cant e,xemPt.from, regi strati on with the Buil der I s Board because":
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Additional Project Information:
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PLANS REVIEWEO BY:
name
LoRM:E"~~~
Signature~~ ...
date ?...pt7-,&"