HomeMy WebLinkAboutPermit Building 1985-2-21
JrISPECTION LINE
726-3769
.
CITY UF SPRINGFIELD
COMBHlATIDN APPLlCATIDN/PERMIT
EilERr,y SOURCES:
Heat
!~ater Heater
.
5'00
Legal Description \l~~ QCf:r~fr()\
Owner :Hf2O)V ~
Address /1.-0. ~ 7Rf;b Phone/o/7
~rJ4<fJ I O~ 97</cJ I ;;;.t1 J'
INFORltATION UNI:.
726-3753
Sq, Ftq, 1.lain
~q. Ftc]. Access.
Sq, Ftq, Other
New Add Alter ~ep,
-Fence Demo Change/Use
"/JUE of Hork: Cl-(J Other - -
~il~!~e,i(,,~ Describe Work(;..e,. Build Single
Ftz-n.e:t;~;:Ed ~~~
RaMe
\"
0<)
"-
~
O<J
Job Address
Construction lende~
Address
Ul:.~ j liN II:.Ar~
{name)
Phone
(address)
(lies. no.)
(exo; res)
(ahaM no.
Primary
Structura 1
Electrical
Mechanical
CDNTRACTORY.'
General (~
I~,el ,; ,
~([
U (j
I~.
(address) _ (lies. nn \
d8t>1(/ ~J~
C?uff?MR I oN. 97~()~
(p"lCl);re", \
(ohnnp nn \
~~q.o,;2691
Plumbino
Electrical
~'echan; ca 1
~~~
r"~l
I furnace/burner to
BTU's
Floor furnace
and vent
MECHANICAL
PLUfiBING
ELECTRICAL
--1!lh
FEF
rHARr,F
...tlO..-1
I Residence of
SQ, FT,
INew circuits alts.
or extensions
ISERVICES
I
I Fn'
r"ARliE..
Each single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
C1 bathl
IDUPlex (1 bath) each
jAdditional bath
1~later service
I Sewer
I Storm Sewer
Recessed wall
~n~rp hp~tpr ~nrl ~pnt
ITemporary Construction
IChange in existing
rE's.;rl~m'p
Imultifamily, comm. or
'nntJ~tri;d
IOf
ICDMM,/IND, FEEDERS
l'Install/alter/relocate
ni~trih fppnpr"
IOf
I
I
I
amps,
Appliance vent
c;poaratp
Stationary evap.
cooler
I' Vent fan wi th
sinole duct
I Vent system apart from I
hea t i no or A. C.
I Mechanical exhaust
hood and duct
I \'!ood stove/heater
I
I
I
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
I
I TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
ISSUANC, OF PFR!11T
Fire Zone
Flood Plain
I HAVE CAREFULLY EXArllNED the completed aprlication 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 110 OCCUPAUCY 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 ons 701.055. that if exempt the basis for. exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
UA)'IE(please print)---:) 1M R.,D S~' SIGUATURE h' ^f\A. ~ pJC) QJ;:V
FO~ OFFICE USE ~ . -
So, Ftg, !iain
Sq. Ft!J. Access
Sq, Ftg, Other
DATE~,
Zone
Type/Const.
Bedrooms
Units
x
Value
Value
Value
Stories
Occy Load
Occy Group
x
x
TDTAL VALUATION
BUILDING PERMIT
Charges ant:
Surcharges
. Q(j' 0-{) Plan Ck, Conm/lnd
QCl..,~ . 65%/Blda PE'r Fpp
------ ----""j5"fin Ck. Res
~ .S~ 3D%lBldo Per Fee
Systems Development I
Charqe (1.5~)
PLU'~BING PERMIT
Charges and
Surcharges
Fence
Oemo
ELECTRICAL PERI:JT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewa lk
I A/C Paving
I Curb Cut
I
Total Comb, rermit
I TOTAL q /- S d
,..&;&
q'/
.
.
~
,
Ill.
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example~ Tax lot 100: lane County Map Refer,ence
1/ oj 43
2, example- Lot 1. Block 3, 2nd'Addition to
~ ,.Springfield 'Estates' . .\
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcal/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,
check add, etc,
F. Building pennit information:
1. example - construct single family house with an
attached garage
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. OESIGN TEM4 ANO 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
0, 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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PERMIT VAll ~ATION P (P</;;;I7i
. !9.-l/~)'
fJL-. .
COMBINATION APPLICATION/PERMIT (CAP)
.,
V, FOR OFFICE USE ONLY
Permit Cl erk
dL!
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~~ ~~/~d~q.L ~
~~A. (,(Mfl fl)~X?-~c1(J~A-"-~1 ~~D Wfi.-L
(I~L1x1_ /1-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
..
PLANS REVIEWED BY:
I
name
signature
date