HomeMy WebLinkAboutPermit Building 1987-7-9
I HlSPECTION L1IIE
726-3769
,
,.?;35 m ~
Legal Description I') 0 ~ :35 3 I / (J '1j[)
(~/ /2e.LZL~
Owner F j) A~ A /(,.I-Y:
Address ,'\';J ") tYI aj;;J Phone? Cf3
/ O~C)
oV 7'1'70'3 <.)7
Job Address
CITY UF SPRINGFIELO
CqMBIllATION APPLlCATION/PERMIT
EIIERGY SOURCES:
Heat
!-Iater Heater
INFORlIATION UN<
726-3753
Sq. Ft~. 1,Iain
~q. Ft!J. Access.
Sq, Ftg. Other
Ilew Add Alter ~ep,
Range -Fence Demo Change/Use
ValuE of ~: 5.:!XJ!J ~, -Dther- -
Builo;nQ Pernlit Info: Describe Work(i~e" Build Single
Familv Residence Hith /I.ttached Garaoe)
fI'&j---
~
Address
U<Slull TlAl'1
(name)
Phone
(address 1
\Xl
~
;S
W
I
Construction Lender
flies. no.)
(exn; res)
(ohane no.l
Primary
4 -J() 1(;./It)
(o'? (1./00
l!/ 1/7.,
(pxo) rpo; \ , (ohnnp nn
~-fJ-Y'7
Structural
Electrical
Mechanical /)
CONTRACTORS (name I / J
General (/~/J1{J/ ~A/7f_V
Plumbino " tr
(addrpss) (lie:" nn.l
PlUI.IBING
ELECTRICAL
MECHANICAL
A
""l.
~~
,
Electrical
~lechani ca 1
110,
I="~r= n'Mr::r= NO
t't:"t:" ("'::lARG.E.....liQ......
t't"C" r:.HAR.G..E..
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
IS.F. Residence
(1 bath)
10uplex (1 bath) each
IAdditional bath
I ~Iater service
Sewer
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Temporary Construction
IChange in existing
rP'ijqeflce
Imultifamily, comm. or
Inrlustrial
Of amps,l
COMH,/IND, FEEOERS I
Install/alter/relocate I
rli~trih. fppdpr~
Appl iance vent
o;.poaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
"
~
\VI
Of
amps.1
I
I
I
TOTAL CHARGES
WHEnE STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CHARGES
that the Electrical work be done by an
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 EXMlINED the completed apr>lication 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 rm OCCUPAUCY 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 ORS 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 701.055 will be used on this project.
IWIE(please print) '?e..+~r \~'\ 11 \
Zone
Fire Zone
Flood Plain
Tyoe/Cons t.
Bed rooms
Stories
Units
Occy Load
Occy Group
SIGIIATURE~ Y fr..t:(
FO~ OFF I CE USE OIIL Y v tY
Sq. Ftg. f1ain
Sq. Ft!J. Access
Sq, Ftg, Other
DATE
7-9-~1
x
Value
Value
Value
x
x
TOTAL VALUATlOII
BUILDING PERI,l!T
Charges anC: "
Surcharges tT
~/ SO Plan Ck,
=0' 65%/Bldo
-;OTn~-o-;:'-Pian Ck,
.:>( n "<' bOo 30%/Bldo
Fence
CommlI nd
Pj'r Fee
Res
Per Fee
Systems Development
Charoe (1.5~)
PLU'~BING PERMIT
Char.,ges and
Surcharges
Demo
Sidewalk
A/C Paving
Total Comb. Permit
ELECTRICAL PERI~IT
Cha rges and
Surcharges
HECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
59-3d.-
~
-
.
'-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Reference
1I 03 43
2, example- Lot 1, Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. ,example. heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examDle- 1250 sq, foot house,' 500 sq, 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
a ttached 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 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 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, ---
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
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.
B ~o5t(D
1/9/~ 1
V, FOR OFFICE USE ONLY
Permit Clerk
{1/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registration with theiBuilder', s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
.
~