HomeMy WebLinkAboutPermit Building 1982-11-15
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Job Address
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CITY OF SPRINGFIELD INFORlIATIDN liNt II
COIIBIiIATION APPLICATION/PERMIT 726-3753
C:....l1N)f.t-li/! E!/ERGY SOURCES: So' Ftg, l'lain
" J ,t:.. _ _ Heat ~q. ~tlJ. Access.
Ha ter Hea ter Sq. Ftg, Other
Ilew Add A lter ~ep,
Ranqe -Fence Demo Change/Use
Valu' of Hork: Other- -
.j;et'~. .." eJ7.. .
7"/1 . Buil'ci'inQ Permit Info: Describe Hork(Le., Build Single
Phone- -,- ~/if:,1 Familv ~esidence Hith JI..ttached ~araQe)
jll/SPECTIDlI L1IIE.
726-3769
Owner :h!\ l (\ (,
Address ,..:;l,-=l- Li ,~
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Construction l~nder
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o fliJ '77
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(lies. no.) {exoires} {phone no.~\
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Legal Oe,cription 17~~.~~-3/, ~ ~e:>
Address
DESIGr, TEAll
(name)
Phone
(address)
Primary
Structural
EI ectri ca 1
Mechanical
CONTRACTORS
F'lumbina
(name)
[2)/ .\ \ (\ o.....i\j
l\
(address)
(lie5-. no.1
(pxoires.1
(ohone nn.1
(;enera 1
Electrical
'\
~lechanical
I)
PLUI1BIIIG
ELECTRICAL
, MECHANICAL.
r"ARGl. -1lQ.....
-1!Q.,.
FFF
fHhRr.F
"0..... /-IFF
SQ, FT,
furnace/burner to
BTII's
FFL .cHARliE.
/
Each single fixture
, ~~P. ~/NI<.
Relocated building
(new fix, additional)
6~O
Residence of
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Sewer
ITempOrary Construction
IChange in existing
re1' i d~ncp .
Imultifamily, COTllTl. or
IndlJo:;.trial
IOf amps,l
I COI1!-1. /I NO, FEEDERS I
IInstall/alter/relocate I
rlic:t.rih_ fpprlprc:
IOf amp..1
I
I
Appliance vent
Sf'oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
~s~
~Iater service
Storm Sewer
/ 6';JEA$cS.!N~..J'>>oE 5:-
ISSUANCE OF PFRlllT 10 ~D
TOTAL CHARGES It) ~D TOTAL CHARGES TOTAL CHARGES I V~
. WHERE STATE L.\H REQUIRES that the Electrical work be done by an.-Electrical Contractor, the electrical portion of this pernit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAr1INED the completed aprlication 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. UO OCCUPAIKY 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 O.S 701.055 will be used on this project.
I
llGilATURE
FO~ OFFICE USE Q;ILY
Sq. Ftg.
Sq. FtO,
R..:z. Sq. Ftg,
c.c.
Ty:ek!ns t~
Bedrooms
&1 (./ G
DATEJJl1i../:71- --
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Au.A4......
HAIIE(please print)
Zone
~ ...A/
Units
t1ain
Access
Other
x
Value
Value
Value
Fire Zone
Flood Plain
Stories
I
Occy Load
Oecy Group
x
x
TOTAL VALUATlOII ~~."""
BUILDIIlG PER1'IlT
Charges anc
Surcharges
_____~_..,__.~. ~. Plan Ck. Conm/Ind
~ ~ 65%/Rlda Per F~e
o Plan Ck. Res
I. 2 C> 30%/Bl do Per Fee
./,!} . "0 I Fence
----- --,-~-I Demo
I Sidewalk
I A/C Paving
1,/, S''' I Curb Cut
------ ,-Sa-I
2c::::>.8C
~, yr!" ,..~,p.
Systems Development
Charoe (!.S~)
PLUI1B ING PERMIT
Cha rges and
Surcharges
I
I
I
ELECTRIC~,L PERi:IT
Cha rges and
Surcharges
ITotal Comb. Permit
I
I TOTAL
5~. ;>(!.
79.56
,
IIECHANICAL PERMIT
Charges and
Surcharges
..
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COMBINATION APPLICATION/PERMIT (CAP)
. PERMIT VALIDATION
I, Applicant to furnish
A. Job Address
B, Legal Description
1. examole- Tax lot 100. lane County Map Reference
II 03 43
2. examele- Lot 1. 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. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1, examDle- 1250 sq. foot house, SOD sq, foot garage
2. example- if new project, check-new - if addition.
chec K add, etc,
F. Building permit information:
1, examele - construct single family house with an
attached garage
2. exa~le - 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 TEM4 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 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.
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V, FOR DFFICE USE ONLY
Pennit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's BDard because:
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Additional Project InfDnnation:
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