HomeMy WebLinkAboutPermit Building 1986-4-18
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INFORllATlON UN"
726-3753
Sq. Ftg. "'ain
~q. Ftg, Access.
Sq, Ftg, Other
New Add Alter Pep,
-Fence Demo Change/Use
Other - -
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I INSPECTION LINE
726-3769
TL 09400 ..
Owner' / -Springfield
Don ,Carter Leasee - ~:-nt::\::: :'.::::'
Address Phony
f,p"""" - Ii')') Nnrt-h A Snrinofrp ,LOr
Job Address
Legal Description
Construction lender
Address
DESIGN TEAli
631
Main Street
1"("117 0(\'4,
"o~
(namel
p.'i.Jn9.r..,yv r..Y't=:>'l RQY'c,...hT~7,o; 10";"
Structural
Electrical
Mechanical
CONTRACTORS' I name I
Genera 1
P1umbina
Electrical
~lechanical
--.llih
Robin DeZur
PLUIIBI NG
Each single fixture
FFF r."AR~F Nn
Relocated building
(new fix. additional)
S.F. Residence
(] bath)'
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
/5". DO'
, -, 'CD
';,) ,.
;rr;n;:::at-;nn ':vc::.'t-pm'~'
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'/dM1
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.;.f4.h.00
crT;"of SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERr,y SOURCES:
Meat '
I~ater Heater
Ranqe
ValUE of Hork.:
,~
~uiloinQ Permit Info: Describe Work.(i.e., Build Single
Fami1v nesidence With Attached Garaael
"
POCKET PARK oro;ect
Phone
(address)
(lies. no.)
(exni res)
(oh'one no.
<;if; f 9.J?' ~ 11
,<y ,Po.. ,"''''' " P" "g" 0 "-<'~
(address \
11 i('o:;, nn. \
(pvr:drpc;, ,
(ohnnp nn, ,
ELECTRICAL
MECHANICAL
~~~ r~ NO
r;r;r; r~
Residence of
furnace/burner to
BTU's
SQ. FT,
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
lremporary Construction
IChange in existing
rp~ i ~p"nrp
Imultifamily, comm. or
Tnrlll<:tri"l
I Of amps,l
ICOMH,/IND, FEEDERS I
IInstall/alter/relocate I
r1ic;.trih_ f~prlprc;.
10f amps.1
I
i
I
Appliance vent
o:;,poaratp
Stationary evap.
(':nol~r
Vent fan wi th
sinole duct
I Vent system apart from I
h~atino or A.C.
I Mechanical exhaust
hood "od durt
j Hood stove/heater
-I
I
I
I
I
I
I
1
I I
,1-1
FenCe;; /j/l}J;//fJ ()
((!If j I
/
ISSUANCE OF PFR!lIT
TOTAL CHARGES
co
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
.. ~ TOTAL CHARGES
Zone
Fire Zone
Flood Plain
BUILDING PERHIT
Charges and
Surcharges
PLU1iBING PERMIT
Charges and
Surcharges
ELECTRICAL PERllIT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
that the Electrical work be done by an,'Electrical Contractor, the electrical rortion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division'
Plan Ck, Comm/lnd
____________ 6Sf;/Bldo P,rr Fpp
Plan Ck, Res
30X/Bldo Per Fee
____3Qoo Fence
I ~.d,()' Demo
. -, I
I, ' 'Sidewalk
------------, A/C Paving
I Curb Cut
------------
I
x
Value
Value
Value
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. berformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO 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 exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7n1.0S5 will be used on this project.
IW1E(please print) C:r",.,. "",r"''''bw",i lpr 1-", SIGtlATURELl n~bE",L~ATE 11/16/66
ROi-i-y ,. M"; 1 1 co _ eT"\7\, FO!1 OFFICE USE dULY / / ~
Tvpe/Const. Units Sq. Ftg. t1ain
Bedrooms Occy Load Sq, Ftg, Access
Stories Occy Group Sq. Ftg. Other
x
x
TOTAL VALUATION
syste,ms Dev~lopment
Charoe (1,5%) .
I
I
~Total Comb. Permit
I
I TOTAL
_~~l ",_",
-rJ,. v--V, . ~I
$:;. :;;"c:.,a~ !II
1.00 (JY'(..,
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A. Job Address
B. .Legal Description
I, example- Tax Lot 100, Lane County Map Reference
1/ OJ 43
2. example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, examole- 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
attached garage
2. examele - 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 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 Schedule'"
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
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
11:
Pennit Clerk
0;
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Permit applicant exempt from,~egistration with the Builder's Board because:
Additional PrDject Infonnation:
PLANS REVIEWED BY:
name
signature
..
date