HomeMy WebLinkAboutPermit Building 1988-9-21
CITY Uf SPRINGFIElD . INFORlIATlON LINe
COMBINATION APPlICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq, Ftg, '.Iain
Meat ~q, Ftg. Access,
Water Meater Sq, Ftg, Other
-1lew _AddXA Iter -Yep,
Range _ Fence Demo Change/Use
ValuE of Work!~ t7flJ. Other- -
Buildinq Permit In'fo: Describe Worl<(Le.. Build Single
Family Residence With Attached Garace)
/Ia-:h,~ P; /ltJ/11/llJclJ (J
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-::27_56 TOTAL CMARGES :::?::<?-SC> TOTAL CHARGES
that the Electrical work be done by an.-Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Surervisor and returned to the Building Division
t.
.
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J.
I INSPECTION LINE
726-3769
Job Address
/1)0 r,(
Legal Description 17.0'3.7?__
I) - t r
owner~ M.-I.d-lk
Address II) 0 k
02~a ~
Phone
Construction lender
Address
Ue~ IliN I eAI1
Phone
(address)
(name)
nics. no.)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS,,",
~
(name)
General
f Y; /' vl, lad::") J
- J~
f1i~<;,. no.l
Plumbina
v
Electrical
t1/1..6
~1echan;cal
PLur.mING
ELECTRICAL
NO.
HF r,HARhF NO
~~c ru~ Nn
:3
Each single fixture
Residence of
;1,fb 2<-5.:>
SQ, FT.
Relocated building
(new fix. additional)
~ New circuits alts.
,.... or extensions
'7 L>~ ~",AE:
SERVICES
??-S"
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S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Iremporary Construction
I'Change in existing
rp,," i d_pnrp
Imultifamily. camm. or
Indu<;.trial
IOf
ICO~1,/IND, FEEDERS
I Install/alter/relocate
di,trih fppdpr~
Of amp~1
~Ia ter serv; ce
Sewer
Storm Sewer
amps.
~
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
DC)
gj
~
~
..........
~
(exo;res1
(ohane no.'
0).''...1, '. rn~)
(pxoirpc;.) rohnnp nn \
68""1-c?!'L/I
MECHANICAL
~t"t" r....11R.G..E.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
Appliance vent
c;.poaratp
Stationary evap.
cooler
Vent fan wi th
c;.inole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood rind rllJrt
Wood stove/heater
ISSUANCf nF PFRlIIT
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 rw OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Buil~er'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 are in compliance with ORS 7~1.055 will be used on this project.
SIGNATURE
FOP. OFFICE USE DilLY
Sq. Ftg. tiain x ValuE'
Sq, Ftg, Access x Value
Sq, Ftg, Other~A?::>"~(,x . Value /<':"~.~
,
/2-3 '5'] TOTAL VALUATION
7( (7'2 a (I -crl syste. ms Development A/ ""
- D vl- '" all Charqe (1.5~) , /Y,H- '.
IIAI'lE(please print)
Zone c.~
Fire Zone
Flood Plain
Type/Canst, ~:-/.k'
Bedrooms
Units
Occy Load
Occy Group
11-2
I
Stories
BUILDING PERHIT
Charges and
Surcharges
~ Plan Ck,
___./j~_<2f:_...illIBlda
c'"' Plan Ck,
,/ D .53 30%JBlda
____~::~E_ Fence
/./3
____~__:::-:..~_Sidew~lk
/./"3
(f)
ComnlI nd
Ppr FpF>
Res
Per Fee
':;r
PLUI~BING PERMIT
Charges and.......- r;;
I Surcha rges
I ELECTRICAL PERI\l1;
Charges and '1
Surcharges
\ MECHANICAL PERMIT
I Charges and
Surcharges
i
A/C Paving
I Curb Cut
I
De:lno
DATE
I
ITota,
I
I TOTAL
Comb. Permit
I /&;;5.:2 '7 .--1
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..
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'.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
,.
I. Applicant to furnish
A. Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
II U3 43
2, example- Lot 1, Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources _
1. examele- heat/e1'ectrical ceilinq/or forced air Qas
2. exa~le- waterheater/electr;cal/or solar
E. Square footage or valuation, etc. ------
I. 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. 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 TEM4 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
fu 11 schedu I es
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 b~ 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 penmit is issued.
V, FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
, Additional Project Information:
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PLANS REVIEWED BY:
. name
~3~ 7L~?-t=T"
signatur
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da te '9-::? r B'S