HomeMy WebLinkAboutPermit Building 1986-6-30 (2)
CITY OF SPRINGFIELD
COIIBIIIATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
14ater Heater
: Ran!'}e .,.
P~~\ I V~~av>
- ".- PhoneQ......7.. ..-auildina Permit Info: Describe I~ork{i-.e., Build Sfngle
. 'Y~-f""/ff) Far.lilv flesidence Hit~ JI.ttached Garaael
,~~ ~ ~(7:~/."~
.
IUSPECTION L1UE
726-3769 .
Job Address ~ 0 1l1IfA:"',$ r
I.egal De.cription/7_c:r. '={,):....,,/, O<96ai:'
,
.Dwn@b/l/J1.J-
A~drJss tf.?,<;'7J
(l1l;2.{ Z
>>t~ sf
Constructi~n lender
.~
Address
.Ut~lliU I tAl'
(namel
Phone
(address)
Primary
Structural
Electrical
fiecha"ical
CONTRACTORS
(namel
r address \
General
Plumbina
Electrical
f\ - / . ./1_' 1'.. '
,~-U/W~ .);./($ '""1.' 7I.~ /,V.
PLUI1BIIIG
~,'echani ca 1
//0.1
lEaCh single fixture
-----'Relocated building
~new fix. additional)
IS.F. Residence
(J hathl
-----'Duplex (1 bath) each
IAdditional bath
------'water service
I Sewer
IStorm Sewer
-----I
I
I
I
1
I
FEF LQ!ABJiL.Jlll
,I I
~ -----I New circu~ts alts.
I or extenSlons
/SERVICES
-----I
Residence of
SQ. FT,
I-=-I~~
I I
I I
(I ics. no. 1
(l ics. no.)
/~.~e/hF.
,
ELECTRICAL
Temporary Construction
Change in existing
rP'ijq'i:;ncp
Imultifamily, comm. or
'nrlu<t.ri~l
Zone CC
Fi re Zone
Tyoe/Const,~"~
Units
Bedrooms
Occy load
Occy Group
1J--:z
Flood Plain
/
Stories
BUILDIrlG PERflIT
Charges anc
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpe
------------Pian Ck. Res
30%/Bldo Per Fee
I Fence
I Demo
I Sidewalk
I A/e Paving
L___/~~_J Curb Cut
I. GO I
PLU/1BING PERMIT
Charges and
Surcha rges
ELECTRJU.L PERr~1T
Cha rges and
Surcharges
------------
flECHANICAL PERMIT
Charges and
Surcharges
amps.]
9', 7.r
~~ili
NFDRlIATlDN
726-3753
SQ. FtQ, '.Iain
~q, FtQ, Access.
SQ. FtQ. Other
flew Add Alter :~ep.
Fence_Demo _Change/Use
_Other
Cexniresl
{,(
(exoires)
MECHANICAL
furnace/burner to
BTlI's
I Floor furnace
and vent
/1_ I ~ecessed wall
lifl'''(,Pkl'',,,tP..,,,nri
I Appl iance vent
q'Darilt~
I Stationary evap.
cooler
I' Vent fan wi th
sinole duct
1 Vent system apart from I
heatino or A.C. .
/ Mechanical exhaust
hood and du,.,..
I Uood stove/heater
I
I
1
I SSUANCF nF PFR'lI T
Systems Development
Charoe (1. 5~)
LI/~d
I
I
I
I
I
I
I HAVE CAREFUllY EXN1INED the completed application for ~ermit, 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 SDringfield and the laws of the State of OreC)on pertaining to the work described herein, and that tlO 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~. used on.~roject,
/lAlIE(please print) CA ~L G,ATE\JJVO.o SIr.'IATl1~4~~-;_ XTEh-30-&t-.
FO~ nFFICE U;f"U11ty ~ --
Sq. Ftg. '1<Iin )I Value
Sq. Ft!]. Access x Value
Sq, Ft9. Othe~..'............~ ~"""Value '::('~.c>oe:>
TOTAL VALUATlOII
ITotal Comb. rermit
: TOTAL
~
I~
II);)
r OhOOf~ no.' I
(ohnnp nn,)_
iT
I I
"..+-1
I I
I I
I 1
I
IS: -,
I
I
I
I
I
1.5"': 66
/1. '3;)
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
t. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ oj 43
2, example- Lot 1, Block 3. 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
~. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheatertelectrical/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house. 500 sq. foot garage
2. examyle- 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. -examOle - convert sjngle famfly residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. OESIGN TEAM ANO 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 ~ivision
1. To conserve space on the permit fonm 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, BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. 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.
. . ~
~~~~o'~~
\g .
V, FOR OFFICE USE ONLY
Permit Clerk
~.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's BDard because:
Additional Project Information:
PLANS REVIEWED BY:
d;fQ"# ~..9~'"
name Lt!>7'5~ 7t~E'lf"
1
signatur~_
,. r
date ~-~c>-B'6