HomeMy WebLinkAboutPermit Building 1985-1-7
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I INSPECTION LINE
726-3769
Job Address
Legal Description
Owner./{L
Address '/:2 '7
Address
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IHFORlIATION LINt
726-3753
Sq. Ft9, 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
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EIIERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of Work:
...2.s- CO. m::r '
BUildina Permit Info: Describe Work(i.e..
Familv nesidence With At~ach~d Garao~\
Build Single
Phon"?.lIA'73,
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l/A-<.;:e -r-t."'h 1,-;), ...v>t~.-
Structural
Primary (<)c.JH -€Iz:.
(name)
Phone
(address)
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b(l;cs. llfB.) r (exniresl (ohane no. I
Electrical
Mechanical
CONTRACTORS 'namel
General
Plumbino
E1 ectrica 1
~1echani ca 1
NO.
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Each single fixture
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(address)
f1 ir.e;,. no. 1
(p)(l];rpc;,)
(nhonp nn_ 1
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PLUI1BI NG
ELECTRICAL
MECHANICAL
FFF r.HARr,E Nn~
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Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new fix, additional)
S.F. Residence
Cl hath I
Duplex (1 bath) each
Additional bath
Storm Sewer
L '~/J,~~ //IJG
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~Ia ter servi ce
Sewer
j/ New circu~ts alts.
9L extellilOns
~ DK JJheR.r:;
I SERVICES
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ITemporary Construction
IChange in existing
rp$o.i dli::nr~
Imultifamily, camm. or
Indu<;.trial
(5"" ,
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Appliance vent
seoa ra tp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood and r1urt
~.e>
10f
ICO~~./INO. FEEDERS
I Install/alter/relocate
rli,trih fppdpr~
10f amp~1
Wood stove/heater
amps.1
from
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TOTAL CHARGES /~ft4 TOTAL CHARGES ,/,~., TOTAL CHARGES
WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an.'Electrica1 Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical 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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that gis ration with e~uil er.'
Board is in full force and effect as required by ORS 701.055. that if exempt the basis f n is ~re~ hat
only subcontractors and employees who are in compliance with OP.S 7t11.055 will be se 'e')j 'P~,,(. 1-1'1_.4'"
___-.!~IZE /-7-<1':
ISSUANCF OF PFRIIlT
N.
J11,,,'II<!si.c-.1I SIGNATU
FOP. OFF I CE USE OIIL Y
Sq. Ftg,
Sq. Fta.
Sq. Ftg.
IW1E(p1ease print) S7A-1d~
Zone
Fi re Zone
Flood Plain
BUILDING PER/lIT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
"
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riain , Value
Access x Value
Other x Value
TOTAL VALUATION
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Plan Ck.
fi,VRl do
Plan Ck.
30%/Bldo
COIl1l1!l nd
Ppr Fpp
Res
Per Fee
I.;J'~C ~""""lIUsyste. ms Development
#;qe:y~....- CharQe (!.5~)
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__n_{q=-~_ Fence
. '1~ O/jfllO
__n_LS;-(Sldewalk
" 6DI A/C Paving
I Curb Cut
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ITotal Comb. Permit
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I TOTAL
5'~ 9'
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COMBINATION APPLICATION/PERMIT (CAP)
r'
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example~ heat/electrical ceilinqlor forced air qas
2. examole- waterheater/electrical/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. exam~le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exam~le - 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 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 9n
the abbreviated schedules' you should consult the-
full schedules
C. BUILDING OIVISION 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:
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Permit Cl erk
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PERMIT VALIDATION
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Permit applicant exempt (rom registration with the Buil'der's'Board because:
Additional Project Information:
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PLANS REVI EWED BY: . .
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