HomeMy WebLinkAboutPermit Building 1984-12-14
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lINSPECTION LINE
726-3769
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Job Address blS /)(~ .41.
Le9al Description )1(}~~ jfJJ//
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Owner ~ A tii-j.Po 1 _
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Construction 'L~nder
CITY U; SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
Hater Heater
,
lNFORl1ATIDN liNt
726-3753
Sq, Ftg, I~ain
~q. Ftg, Access,
Sq, Ftg, Other
New Add Alter Pep,
--Fence Oemo Change/Use
Other-- --
. - ~
Range
Phone 7'1 J. 7S 39
valUEJ! Hork:
29rJo.oo.
BUildinq Permit Info: Deser be Work{i.e., Build Single
Familv Residence With Attached Garaoe)
JLui ~.J> (l1I/'I~ If
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(l i CS.. no..) (axoi res) I (ahona no. I
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Address
Ut"GN TEAI1
(name)
Phone
(address)
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS . (namel
General o.1X7~aP.f/
~
"
(address) (1i~s. no.)
.R(l1J JJ. ~.;3ZS3 c'-ST,
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(pxnirpsl
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Plumbino
Electrical
Mechanical
PLUllB I NG
ELECTRICAL
MECHANICAL
NO.
FEF rHARr.F Nn
'OFF r"8.B.Iif..Jln
n.~ ru~
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTUls
Relocated building
(new fix, additional)
New circuits alts.
or extensions
I Floor fu rnace
and vent
Recessed wall
~n~rp hp~tpr Anrl vpnt
S.F. Residence
(] hath)
Duplex (1 hath) each
SERVICES
~Iater service
ITemporary Construction
IChange in existing
rp~ j dp'nr'~
Imultifamily, camm. or
Inrtu<:.tri<'ll
10f amps,1
ICOMfl,/INO. FEEDERS
IInstall/alter/relocate I
rli<:.trih, hprlprc:,
10f amp5-1
Appliance vent
c;eoarate
Stationary evap.
cooler
I V"ent fan wi th
sinole duct
I'Vent system apart from
heatino or A.C.
I Mechanical exhaust
hood olnd durt
I Hood stove/heater
I
I
I
Additional bath
Sewer
Storm Sewer
I SSUANCf OF PFRllIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that the Electrical work be done hy an,'Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Zone
Fi re Zone
Flood Plain
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 110 OCCUPAHCY 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 exem the basis for exemp' . n is noted hereon. and that
only subcontractors a~mpl0YeeS who ar~P1iance with ORS 701.055 111 be used on this oje .
IW1E(please print) H J..,J.,BrJ L DAVI ~ SIGNATU ~,tI DAT/>-jc.flf'!...
FOP. OhICE USE DIlLY
Sq. Ftg. riain
Sq. Ftg. Access
Sq. Ftg. Other
Tyoe/Const,
Bedrooms
Uni ts
x
Value
Value
Value
Stories
Occy Load
Occy Group
x
x
TOTAL VALUATION
BUILDING PERfUT
Charges and
Surcharges
. -:> 't """" . Plan Ck, Conm/lnd
____~_ :..____....Q2I/Rldo Ppr Fpp
~/' Plan Ck, Res
r/rP 30%/Bldo Per Fee
Fence
15". G>b
syste.rns Development
CharQe tl,5~) .
PLU!~BING PERMIT
Charges and
Surcharges
0"'0
I
I
I
ITota' Comb, Permit
I
I TOTAL
tlt.jO,;>b
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
A/C Pavi ng
I Curb Cut
------------1.
,
?<-!oMfI
-
. ----...
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
II U3 43
2. examole- Lot I. Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examp-le- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcallor solar
E. Square footage or valuation, etc. ------
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check-ruew - if addition.
check add, etc. -
F. Building pennit 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 3D3 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CDNTRACTORS
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 Plumbin9, 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
Q, 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 lahel, ---
III. 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.
(JJ la/;<I/~
'(Ji!- b 3 f/97
V, FOR OFFICE USE ONLY
Permit Clerk
fJtL
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date