HomeMy WebLinkAboutPermit Building 1981-8-11
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Job Address
-, CITY Of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
5.2/- MA'/;V ST:
,.
INFORMATION LINE
726-3753
INSPECTION LINE
726-3769
legal Description
I ENERGY SOURCES:
Heat
I Water Heater
Ran_ge
Value of Work: .
Sq. Ftg. Main
Sq. Ftg. Access.
Sq. fig. Other
_New_Add_Alter_Rep.
_Fence_Demo_Cnange/Use
_Other_
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Ow",,, .A?, 7)5/1P /CK
Add",.3426 -.506' AA/A/ Cr:
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~JI..:- ;'7,..., J!.uilding Permit Info: Describe Work \i.e.. Build Single
Pho~..:.;J - Y /"'T.'J !Family Residence With Attached Goroae\
- Pep4/k!S 7,.., ~aMLSP/lU~,-<;
Construction lender
Address
Phone
DESIGN TEAM
(nome)
(address)
(lies. no,)
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Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(oddren)
(lies. no.)
(expires)
(phone noJ
GAneml
Plumbino
Af~
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO, I
FEE
CHARGE NO.
FEE
CHARGE NO.
FEE
CHARGE
Residence of
furnace/burner to
ATU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
sQ. ft.
New circuits, alterations
or extensions
SERVICES
Duplex (l bath) each
Temporary Construction
Additional both
Amps.
Water service
Sewer
Wood stove'heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10.000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES A..6 k E
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
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 perforrrMd 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 herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building -Division. I further
certlfy that my registration with the Builder's Board is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and thot only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Board exemption'
NAME (please print)~
DERRIC.k SIGNATURE:;#~O.M"vv .t;;J./-b OATE ~II-~I
FOR OFFICE USE ONLY
Zon~
Fire Zone
Flood plain
Type/Canst
Bedrooms
~torie'
I 'nits
Occy load
JCcy Group
Sq. Fig. Main
ct!. fig. Access
Sq. Fig. Other
x
'.'olue
x Value
x Value
TOTAL VALUATION
BUILDING PERMIT
Chorges and
Surcharges
Pion Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per fee
Systems Development
Charae (1.5%'
Demo
Total Comb. Permit
I
I
1
PLUMBING PERMIT
Charges and
Surcharges
Fence
elECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
A'C Pavinl1
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
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,COMBI.NATlON APPLlCATION/_ (CAP)
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I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Ma'p Reference 17 03 43
2. example:Lot 1. Block 3, 2nd Additi<>.n to Springfield Esta'tes
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas, '-~,:\ ',',
2. examole;-wat.er: heater/electrical!~.r solar :"- ,,::~~
E. Square footage or valuation, etc.
1. example.1250 sq. foot house, 500sq. 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. 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 whe~e 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 abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES Ar;W
CHARGES ON THE SCHEDULES ' "',
to;
III. Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet on Iy., Where.possi ble,.Bui Id i ng..Division.Staffewi II~_
prepare a typewritten copy and return it to the applicant-at
the time the actual permit is issu,ed 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information,
PLANS REVIEWED BY,
nam""
"iignatur'?
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.\ PERMIT VALlDATI,ON
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