HomeMy WebLinkAboutPermit Building 1983-9-18
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Address
OESIGN rEAf1
(name)
CITY OF SPRINGFfElO INfORllATlON L''''
COMBINATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftq. 1.lain
Heat ~q. Ftg. Access.
Water Heater Sq, Ftg, Other
Hew Add Alter Rep,
Range -Fence Demo Change/Use ,N
Va~ of Work: Other- - 1--....::1
..p, G, 2:,u-o ()
BU11rilnq Pernlit Info: Describe Work(i.e., Build Single
Familv Residence With Attached fiaraqe) n ('J
_ _ 7.0Wf, F ~
k~ - fr(~?: I~ Cv"t, '. ~
. t u (JJt~~
flies. no.) (exo;~es) {ohane ng(n
U
Phone
(address)
I INSPECTION lINE,
726.3769
(Ill}... ~g+
Legal Description \i 033c:s, S \ t5f-,~
Job Address
^
owner~! (/.JA.,t. #
AddresS" /u,{.,O :7(~"J~~, Phone7K'~~bj
YpUrI du./JV>\... 97 V77
Construction lKn~r / d
Primary
Structural
~".
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Electrical
Mechanical
CONTRACTORS
lname)
t1JJ,.....u-.'~
(address)
If o-fJA1 &~J
(lies. no.)
~S (., ? 51
(exoi re~d
Plumbino
httLu
(jf
(ohol1e no.)
d1( ?Y7~9~ V'
Genera 1
v
Electrical
~1echanical
Plur.IBIfIG
ELECTRICAL
""L J:JiARIiE.' NO
MECHANICAL
-.l'O.
"Ef rHARr,f NO
""" r IJARIiE.
SQ, fT,
furnace/burner to
BTU.s
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(I hathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole dlJr:t.
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rps i dJ>J'r~
multifamily, comm. or
TnrllJd.ri~l
Water service
COMM./INO, fEEDERS
Install/alter/relocate
rli,trih. fppdpr,
Of
amps.
TOTAL CHARGES TOTAL CHARGES
. WHERE STATE L\I~ REQUIRES that the Electrical work he done by an,
shall not be va1i1 until the label has been signed by an Electrical
ISSUANCE OF PfR!lIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
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 NO OCCUPArKY 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 701.055 will be used on this project.
~JA 1L#-4!L &. ~iV' I ~~1lt,d~". 9-1~-f.:3
NAME(please print) S I GrlATURF. DATE
fOR OffICE USE ONLY
Zone Tyoe/Const. Units Sq. ftg, riain x Value
Fi re Zone Bedrooms Occy Load Sq, ft9, Access .x Val ue
Flood Plain Stori es Occy Group Sq. ftg, Other x Value
TOTAL V ALUA Tl ON
BUILDING PERflIT
Charges anc
Surcharges
J.j" .-rl Plan Ck.
__L~:..{J_::::..___ ~fBldo
Plan Ck.
), W" 30%fBlda
Conm/l nd
Ppr Fpp
Res
Per Fee
Systems Development
Charqe (1.5~) .
PLUt1BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PER!~IT
Charges and
Surcharges
Demo
'Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
A/C Pavi ng
___________J Curb Cut
I
Total Comb. Permit
TOTAL
11 &-ol
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100, Lane County Map Reference
17 03 43
2. ~xample- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceiling/or forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole. 1250 sq. foot house, 500 sq. foot garage
2. exam~le- 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. exa~le - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
5tructural 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.
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 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 SCHEOULES
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. ---
. Ill. Applicant to si9n 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.
I)
t
V, FOR OFFICE USE ONLY
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
PERMIT VALIDATION
jJi I(
(IJ fp& 17
J~
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Permit applicant exempt from registration with the Builder's Board because:
.,...,
Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
,.,.U~<,.._..,,', ._'""".,~,,~~...._.L___.......___ '.", ...._..'":':'
I
date
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