HomeMy WebLinkAboutPermit Building 1983-1-13
INFORlIATION liNt 'I
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
Ranqe_ -Fence Demo Change/Use
ValUr of Work: Other- --
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v} J//:'./ f.:+r/ Pho 7,[77."'7~11(i'ino Pernllt Info: Describe Work(Le.. Build Single
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Address Phone a,~>>aJJ~ aJ~M.~k.Lu"
DESIGN lEAf-' (name) " (address) l iiies. no.) fexoiresJ (ohone 00:\
Primary (fi I tl. ~ ~<J!e~ ...J--A-!:.s~c '14:)- f<{~~
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CITY OF SPRlflGFIELO
COIIBIilATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
jlllSPECTIOil L IIIE.
726-3769
Job Address 11() /It"/~l s I..~"'-r
Legal Description /7-0"3'- 3~- 3 /
7: L 7.g~
Owner 80 1/+ ~<t
Address "3 () ( JXJ.
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Construction lender
Structural
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Electrical
Mechanical
CONTRACTORS Iname)
General (\.tCl--~ '{1tl~~'^-'" l{
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no.l
(~xoires)
....,4C.-5~~
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(ohone no.)
(address) _ flies.
'fO(a I i I-I-~ II +\.&..
Pl umbi no
Electrical
~'echanical
PLU1IBIflG
MECHAN I CAL .
ELECTRICAL
NO.
FFF [HARGF ~ rFF rl:lARliE .1lll..-
Residence of furnace/burner to
sq. FT. BTU's.
Each single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
(1 bath)
10uPlex (I bath) each
IAdditional bath
I ~Iater service
I Sewer
/1 Storm Sewer It? /f..... (,f= IP.-
y ~..n ~WR.M)", I~.-
I'New circuits a1ts.
or extensions
ISERVICES
Recessed wa 11
~~~~p hp~tp~ ~nrl vp~t
Floor fu rnace
and vent
Appliance vent
~eoaratl:'
Stationary evap.
coolH
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
ITempOrary Construction
IChange in existing
, rps i 4rn~p' .
Imultifamily, com. or
InrllJc;.trial
10f amps.
I COI1l.1. /I NO. FEEDERS
"Install/alter/relocate
di~trih. fppdprc;.
10f amps.
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I SSUANCf OF PfRllIT
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TOTAL CHARGES ~- TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pe~it
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArllNEO 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 NO OCCUPAI~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 compliance with ORS 7Ql.055 will be used on this project.
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S1GrIATURE I/-/'?7'i??,-, ....6:./<"", 6
FOR OFFICE USE DIlLY Y
Sa. Ftg. lIain ::';''3 /-?~CmValue
Sq. Ftg. Access.f""""'/~~~alue
Sq. Ft9. Other~cJC... "~~Value I~--
. TOTAL VALUATION /I~ a::>>.-
NAr.IE(please print) Ot"1i (i 'H r
<;-/=-rEIZFT
oATELJ) <:Y"?
Zone
c.~
Type/Const. ~~
Bedrooms
Units
Occy Load 5'6
Occy Group~-~
Fire Zone
Flood Plain
I
Stories
BUILDING PERNIT
Charges an~
Surcharges
~/ _ Plan Ck.
-'>40. 65%/Bldo
------------Pian Ck.
;il.:29 30%/Bldo
2~. - Fence
------------
.$6 O~mo
~. 'It::>
Systems Development
Charoe (1.5~)
It, ~ -=-
Convn/Ind
Ppr FF'P
R"es
Per Fee
PLU/1BING PERMIT
Charges and
Surcharges
ELECTRICP.L PERI~IT
Charges and
Surcharges
Sidewa lk
A/C Paving
____________1 Curb Cut
I
7.,. 0",
2$0..'1L1
Total Comb. rermit
I1ECHArlICAL PERMIT
Charges and
Surcharges
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TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100, lane County Map Reference
II 03 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. . Energy Sources
1. examt,?le- heat/electrical ceilinq/or forced' air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exarllPle- ;~. new project, check new. if addition,
cneck 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. exa~le - 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. DES I GN TEAI.I AND CONTRACTORS i .
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
11. 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 fonn 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
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 OSE ONLY
Cle~Lffi )
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Permit
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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5EE ~lRpo.(S2,e>II~ F~;q /1?A"-50~'7" s.~~c.. (P~~~ ')
PLANS REVIEWED BY:
. /' >0'
. name tJ>J9/A~ .n~~ signatur~ ~~A~? date /--1'"3 ~3
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