HomeMy WebLinkAboutPermit Building 1985-2-21
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I UlSPECTlOIl LlIlE
726-3769
Job Address J~O If''''fi~W ~
Legal Description "-67-"2.7.,_ (1J';;~
CITY Of SPRIIlGFIELO
COMBHIATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranoe
INfORlIATlON ll~c
726-37S3
So' Ftg, I,;ain
~q. !='tg. Access.
So. ft9, Other
~lew_Add>>1 ter _~ep,
_Fence_Deme_Change/Use
_Other
,Owner J(/ P/AI-s<:-.N.M.a;>r z::eV_
Addressp'".ll"'~'241.P ~D"A.Id. ~ ~..rJ'j'Y<
, ~)~~. 7'17."/7~
ValUE of I-Ior.:
~~,~,-
Builriina Permit Info: Describe Work(i.e..
Fami 1v nes i dente I~ith /'l.t tached l1a raae)
Build Single
I
()()
~
I~
Construction lender
tbp R~NEc:s@~/~rE,.p,
,1?~ ~ ~..........~/~.
Address
Ut.~lliN Tl::.AI.'
lname)
Phone
(address 1
(1 ics. no.}
(exo; res)
(ahone no.l
Primary #)SS,,1Nt:.. .. 1'.(f>,/p:!Y :r~"'4 ~~""".' <::Ao,
Structural
(9/.o~"I- r3S"5'
Electrical
Mechanical
CONTRACTORS Iname)
General ~.....u~..~~ L'_~
Plumbina
(address)
(1;r:<;. no.'
(pllll;rpc;'
(ohnJ'lp '1n \
/~ ~NuJtiW~. ~'1(.~: ~,~~~ q.~ ~)~~,
Electrical
~1echani ca 1
PLU'1B IrlG
ELECTRICAL
MECHANICAL
NO,
FFF rHARGF ~~
Each Single fixture
Residence of
I ~~~ I niAR.G..E.I...l!.Q......1
SQ, FT.
furnace/burner to
BTU's
I ~~~ Ir~1
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath \
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~t~r ~nrl v~nt
Storm Sewer
Of
amps,
Appliance vent
<:;~oaratp
I'Stationary evap.
r.nnl~'"
I Vent fan wi th
sinole dUC".t
I Vent system apart
heatino or A.C.
I Mechanical exhaust
hnnd and duC"t
!l'/OOd stove/heater
I
from
~Iater service
Temporary Construction
Change in existing
rp~ j qpprl)
multifamily, COIml. or
Tnrluc:.tri;l.l
Sewer
COffi1,/INO, FEEDERS
I Install/alter/relocate
r1ic:.t,..;h f~~rl~rc:.
IOf
I
I
I
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valil until the
TOTAL CHARGES
ISSUANCf OF PFR!IIT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
J HAVE CAREFULLY EXM1INED the completed apr1ication 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 OCCUPArKY 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 basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 Wi~e us~. on t~oject.
IlAI-1E(please prinW fG~,'1 eLl ~k AJ ,S, ~ SIr.!IATVRrA.",:~/AJ4~ - OATE;Z -)",1- ~I
FO~ b'FFICE USE Q!II. v
Sq, Ftg, r1ain
Sq. Ftg. Access
So' Ftg, Other
Zone~
Fi re Zone
TYDe/Const.s~~ .units
Bedrooms Occy load
Stories/~:< 1ijA?T Occy Group
x
Value
Value
Value
x
Flood Plain
If-''2
x
TOTAL VALUATION
BUILDING PERfllT
Charges an~
Surcharges
___'i_,2L~
17. '-is
Plan C., Comm/lnd
65%/Bldo P.r F..
Plan Ck. R'es
30%/Bldo Per Fee
Fence
':2 8 ~c5
Systems Development
Charoe (!,5~)
A/.A.
PLU'~BING PERMIT
Charges and
Surcharges
------------,
Demo
I Sidewal.
I A/e Pavi ng
I Curb Cut
I
Total Comb. Permit
,/S''I. '/8
738':'5"5
ELECTRICAL PERI:IT
Charges and
Surcharges
r1ECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
..
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Appl ieant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Referenc@
11 oj 43
2, examele- Lot I, Block 3, 2nd Addition to
5prlngtield Estates,
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilino/or forced air Qas
2. examole- waterheater/electrlcat/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq. foot house, 500 sq, foot garage
2. examp.le- 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. example - 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
Structura 1 Specia lty Code ' '.
H, OESIGN 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 OOT ALL FEES AND
CHARGES ON THE SCHEDOLES
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.
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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 Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
'5 i gna ture
date