HomeMy WebLinkAboutPermit Building 1983-11-16
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I INSPECTION LlIIE
726-3769
Job Address k.\ -:;\ 'l \\'?~\ ~/'>u n
Legal Dmription\"'\ ()~ "?-'S 1\\
INFORlIATION LINL
726-3753
Sq, Ftg, r.lain
~q. Ftg. Access.
Sg, Ftg. Other
New Add Alter Rep,
-Fence Demo Change/Use
-Other - -
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Owner ,) s. .AJ~.~t, "'II~, I f)..o ~ ;,_
Addressp,....+ If?:' j (j """.^'~
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CITY OF SPRIIIGFIELD
COMB illATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Ranqe
i Va 1 Uf of Hark: t'
\(; (') f'.}::) .
~ilri;nQ Penmit Info: Describe Work{i,e"
flf.~ t.r2..4 Familv nesidence Hith ~.ttached Garaoel
c..
\ \ ?J::;()
Build Single
e'en',,:; -{"<.<<1-, ;rf.. 7" ./1..' <' 'vi r /,,::.,..,....
Construction lender
Address
UL~ HiN I LAI1
(name)
Phone
(address)
(lies. no.)
(exni res)
,
(ohane no.)
Primary
Mechanical
CONTRACTORS Inamel
Genera 1 k/n f'-/ "'1 /.J'l', ,.-1
/
Prr7('.o
faddres!d (1ir.~ 00.,1
C1R SO .C;-l.,) T". /....J .oJ. R. ..--i,
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(p~oirp~l (ohnnp n~ \
Structural
Electrical
~/'J.O" '.~/1~/'il1 .2.9:!..(,~:n
Plumbina
Electrical
N~.. {"" {:/~.-k,;t
~'echanical
PLUliB ING
ELECTRICAL
MECHANICAL
NO. I
I HF I r.HARGF jln
H~' I r~l!.R.G.f. Nn
SQ, FT.
furnace/burner to
BTU's
. 'H-1.rJiARli[
/~.
Each single fixture
Residence of
IRelocated building
(new fix, additional)
I'S.F. Residence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
Iwater service
I Sewer
_____Istonm Sewer
New circuits alts.
\ or extensions
\~~
Floor furnace
and vent
SERVICES
Recessed wall
~n~~~ h~~t~r ~nrl vpnt
TOTAL CHARGES
WHERE STATE L'W REQUlnES
shall not be vali1 until the
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IOf amps,l I
-!cOI-iH,IIND. FEEDERS I I
IInstall/alter/relocate I I
rH<:.trih fppnp.rc:. .
IOf amps.1 I
-I I I
I I I I
I I I I I SSUANC, OF PFRlilT
TOTAL CHARGES \ 5. CO I TOTAL CHARGES \ rJ. ei=>
that the Electrical work be done by an,'Electrical Contractor, the electrical portion 'of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Temporary Constrvction
IChange in existing
rp'S--jdf.:l:n~p' .
Imultifamily, corrm. or
Tnnu<:.trial
\
Appliance vent
seoaratp
Stationary evap.
cooler
I. Vent fan wi th
sinale duct
Vent system apart
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 UO OCCUPAr~CY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 7Ql.055lZWill be used on this project.
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IlAlIE(please print)-t:" u t--..., tJ Vl) Un '" t! 5 If,IIATURE no ~:~ . ' '. . //:;:._ ~ oim /cV~ I!~
, FO~ OFFiCE USE OIIL Y " "
Type/Consn\) .-\ ~r Units Sq, Ftg, liain, Value
Bedrooms -" Occy Load Sq. Ftl]. Access x Value
Stories \ Occy Group \-)- () . Sq, Ftg. Other x Value
Zone C C
Fire Zone -
Flood Plain
TOTAL VALUATION
BUILDING PERfIlT
Charges ant'
Surcharges
k C') 00 Plan Ck, COllllllInd
___~_c.:.'______ 65t/Bldo PJ'r Fpp
? C::>'Cl Plan Ck, Res
_ _ 30%/Blda Per Fee
r,"l Q () """I !l. rlSystems Development
--",r;).0 r /.14 A ,- ~barCle (1.5":)
H-4.-~.~ D\QSZ.
\ ':Y)_ 00
PLUr~BING PERMIT
Charges and
Surcharges
Fence
------------1
Demo
I Sidewalk
I A/C Paving
I Curb Cut
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ELECTRICAL PERlm
Cha rges and
Surcharges
___~~.co
~
----\_Q~~--
.40
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____._1
ITotal Comb, Permit
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I TOTAL, ___.
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2. ~.oB
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
'PERMIT VALIDATION
J. Applicant to furnish
A, Job Address
B. Legal Oescription
J, example- Tax Lot 100, Lane County Map Reference
1/ 03 43 _
2, example- Lot I. Block 3, 2nd Addition to
~pr;ngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check new - if addition,
cneck add, etc. I
F. Building permit information:.
1. exam~le - construct single family house with an
attached garage \
2. examole - 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 (aJ of the
Structural Specialty Code
H, OESIGN TEM1 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. Abbrev.iated Plumbing, Mechanical, & Electrical Schedules
A. 'Ex~-ept 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 OIVISION STAFF WILL FILL DOT ALL FEES AND
CHARGES ON THE SCHEOOLES
D, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
'- : -'-,--.---- ~ 5upcrvisor. The general contractor is .not al!tho\"'ized ~..,
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 penmit 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
(l, AdJJJ
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ ,\:J('"",,-\\..\~\-\?B~ Q~.~~,-, (')~ "b,<:2_\.Y"T\W~\
T\'\\'t=- ('...~,,~ C":J't- "t-,\~~~", \ \\~LL
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY: , .
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nameD4)\\") ~ "'?J,-;\)\ signature'~Y'-c..\. <:::,\" '--)~\-- date \\-\{f"'\~
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