HomeMy WebLinkAboutPermit Building 1985-11-5
Owner j/ ili.lA frA; -' Y
Address /7 ~ IA.e4:i d' )yv~~
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Construction l~nder
Phone '3 Cf. <;
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e INFORlIATlON LINE
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
-1lew _ AddKA 1 ter -,~ep.
__Fence__Demo__ChangefUse
ValuE of wor~ ~~L) _Other
BuiloinQ Permit Info: Describe Work(i.e., Build Single
Famil v nes i dence IH th JI..ttached Gara.oe)
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Job Address
,
S35~
De<cription li-D 3 - ~ 5 - ,::<)(- J () 900
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
t~ater Heater
Ranqe
, Address
U<SIGN TEAH
(name)
Phone
(address)
. /J r/hIJ.-u~a.L,_
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IIIISPECTlON L1IIE
726-3769
Legal
(lfcs. no.l
(exoires)
(ohane no.')
Primary
*
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
(address)
11 ice;. no.)
(p'lCoirpc;. \
(ohnnJ' r'ln \
General
~A)
Plumbina
Electrical
f.1echanical
PLUIIBING
ELECTRICAL
r"~' NO
MECHANICAL
...Jill.....
FfF
rHARfiE' NO
>>>
I ""LIJ:l:!AB.IiE
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BlU's
l
IRelocated building
(new fix. additional)
I'S.F. Residence
11 bath)
IDuplex (1 bath) each
IAdditional bath
I ~Iater service
I Sewer
Istorm Sewer
_.; ~ circuits alts.
~ or ext~nsjj)ns T
I ~Ff'Ce,..~ .
SERVICES
. It:?-
Floor furnace
and vent
Recessed wall
S~~rp hp~tp~ ~nrl 'v~nt
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali1 until the
I
I
I
I
TOTAL CHARGES J'~......, TOTAL CHARGES
that the Electrical work be done by an'.Electrical Contractor, the electrical portion of this pen:lit
label has been signed by an Electrical Supervisor and returned to the Building Division
ITemporary Construction
IChange in existing
rpsjq~nrp
Imultifamily, COITlll. or
'nnlld,rilll
10f
ICOMfI./IND. FEEDERS
I Install/alter/relocate
rl;c:.t~;h fpprlprc:.
IOf
amps.l
Appliance vent
st='oarat.e
Stationary evap.
cooler
I Vent fan with
~inole duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust
hood and dur-t
I \'/ood stove/heater
I
i
I
amps.
ISSUANCf OF PFRIIIT
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 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 OCCUPAllCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon 1 and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
HAf.lE(please print)
Zone elf,
---,
Fire Zone
Flood Plain
f cTf.I2..
I<RYL
SIr.IIATURE
FOn OFF I CE USE OIIL Y
'0. Ftg.
Sq. Ftg.
~~ Sq. Ftg.
~').-~
DATE
I(~ t:; 4f
v
C/
TYDelConst.
Bedrooms
Stories
-;- /~Uni ts
Occy Load
Occy Group
I
BUILDING PERf.l1T
Charges and
Surcharges
__Lt2._~~__ ~~~~R~~~
~~ Plan Ck.
~ 7< 30%/Bl do
I Fence
I Delila
IcY. c:>C> I Sidewalk
-------:,.-ro-' AlC Paving
I Curb Cut
I
Co","fInd
Ppr ~pp
R-es
Per Fee
riain )(' Value
Access x Va 1 ue
Other z;bo::-:~rb'" Value
, TOTAL V ALUA TI Drl
K (.056 g d..
~c50
~........
syste. r.1S Development I
Charoe tl.5~) .
//s# .
PLUIIBING PERMIT
Cha rges and
Surcha rges
I
ELECTRICAL PERr:IT
Cha rges and
Surcharges
HECHANICAL PERMIT
Charges and
Surcharges
Total Comb. rermit
I
I TOTAL
20.801
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. lane County Map Reference
1/ oj 43
2. examole- lot 1. Block 3. 2nd Addition to
~prlngfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
1. example- heat/electrical ceiling/or forced:air Qas
2. examole- waterheater/electrical/or solar'
E. Square footage or valuation, etc. ~
L exam~le- 1250 sq. foof house. 500 sq. foot garage
2. examp'le- if new project. check new - if addition,
check add, etc.
F. ,Building permit informati.on:
1. examole - construct single family house with an
attached garage .
2. examole - 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
Structural Specialty Code
H. DESIGN TEAl.' 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
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
payab)e when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
II
PERMIT VALIDATION
,
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additlonal Project Information:
.,
PLANS REVIEWED BY:
L"'FFN.€" ~.';'"'t"''lk
name
date
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