HomeMy WebLinkAboutPermit Building 1986-7-8
CITY u, SPRINGFIlLO
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
. Water Heater
Range
V~, of Hork:
c'fI -,?, t~c:;,
~;lGlnt Permlt Info: Descrlbe Work(l.e..
Familv Residence With Attached Garaoel
Ij~
o
-,
.
I INSPECTION LINE
726-376g .
Job Address -'( ZIJ J- 4,;2 4 Iff a.e;.J-
Legal DmriPti~n/ '7 () ~ ::5. C)'3 /
Owner
() 1St(yf)
') bo/J
'1111 ~ /J jJ /,-L"tJ ~ /):..
?iJ Cf /.:::J/tbAtltlB- 7t1 Phone 1'/0-
~dI ~I.~h
Address
Construction (end~r
Address
OlSIGN TlAr1
(name)
Phone
(address)
. Primary
Structural
Electrical
Hechanical
CONTRACTORS I name) rJ /7 (addre" I
General .flMoI Lf &A..flJ iKnKU~
...1 --""'l ~
Plumbina .
~tj ,n^~& ~
INFORlIATlDN liNt
726-3753
Sq, Ftg, 1.lain
~q. Ftg. Access.
. Sq, Ftg _ Other
..Jlew_Add_AI ter -,~ep_
_Fence__Demo__Change/Use
_Other
;?
<0
~
~
Build Single
flies. no.)
no,[
(exo;res)
(ohane
IT;'
l~
(1 ir:~^ no.)
(pxoil"pc:.\ (O.b,MP' nn_
6 c:t ~ f/'f
/
q 2tz.k. 2100
Electrical
~1echanical
PLUllB WG
ELECTRICAL
NO. I FFF
Each single fixture
nIARr,~ ~n
Residence of
SQ, FT,
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
11 bath \
Duplex (1 bath) each
IAdditional bath
1~later service
I Sewer
I Stann Sewer'
I
,
I
I
I
I
ISERVICES
I
ITempOrary Construction
IChange in existing
rpo:; i dJ'.nrp
Imultifamily, COJm\. or
Tnrtu<:.trii!.l
IOf amps.1
ICO~1,/INO, FEEDERS
'Install/alter/relocate I
rtic;.trib. fppdprc;
10f amp~1
I
I
I
MECHANICAL
ITLIJ:.liAIlG.E...I:lO.......'
I furnace/burner to
BTU's
Floor furnace
and vent
I ""L '.clJABlif.
Recessed wall
~~~~~ hpater and vpnt
,
I
I
I
I
,
Appliance vent
o;,eoari'ttp
Stationary evap.
cooler
I Vent fan wi th
sinale duct
'Vent system apart from I ,.
heatina or A.C. .
I Mechanical exhaust I
hood il.nd riur t.
I Hood stove/heater ., I
I I
, I
, I
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\l/ REQUIRES that the llectrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
ISSUANCf OF PFR!IIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAr1INED 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 Ore(]on pertaining to the work described herein. and that rw OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 compliance with OP.S 7~1.055 will be used on this project.
SIG~ATURE~~
FO~ OfFICE USE miL Y
Sq: Ftg, ltain
Sq, Ftg, Access
Sq, Ftg, Other
1lAf.IE(please print)
Ce. Me hf,{1"
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bed rooms
Stories
Units
Occy Load
Occy Group
-.
BUILDING PER/lIT
Charges an~
Surcharges
//d ~ Plan Ck,
_____:t:':t.:.___ ~/Bldo
I /'7t'Y Plan Ck,
, . I 1i 30%IBlda
Fence
ComnlI nd
PJ'r FpF!
Res
Per Fee
PLUt1BING PERMIT
Charges and
Surcha rges
-------------1
Demo
.
I Sidewalk
, A/C Paving
I Curb Cut
I
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMtT
Charges and
Surcharges
u
DATF'7-?,f-.?
x
x
Value
Value
ValuE'
.X
TOTAL VALUATlDtI
Systems Development
Charae (1.5~)
ITotal Comb. rermit
I
I TOTAL
%c2f".1
.~
COMBINATION APPLICATION/PERMIT (CAP)
1, Applicant to furnish
A, Job Address
B, Legal Description
I, ~xample- Tax Lot 100, Lane County Map Reference
17 03 43
2, examEle- Lot I, Block 3, 2nd Addition to
~prlngtield Estates ,
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or sOlar
E. Square footage or valuation, etc. ------
I. example- 1250 sq, foot house, SOD sq, foot garage
2. examp'le- if new project. ~heck-ne~ - if addition,
cneck. add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garoge
2. example - 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 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. ---
Ill. 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
signa ture.
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.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
6 b60 fg
-1- g /~0
Permit Clerk
(!t,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:.
name
signature
date
t"""':
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