HomeMy WebLinkAboutPermit Building 1985-1-7 (2)
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INFORJ1ATION LINl:. .'
726-3753
Sq. Ftg. 1.lain
~q. ~tg. Access.
Sq. Ftg. Other
"ew Add Alter Rep.
--Fence Demo Change/Use
Other - --
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I IrISPECTIO" U"E
726-3769
Job Address 7'1'/ 1114,')1 A~)-'----
Legal Description \l 03?J"S-4-7 . n~lXJ
7J'~}~'
&..., -_.~,
a~~,~~ OJ-z-
Construction lender~/ il_
/V,;}/u<",~
Owner ./'F/t:...,
Address <;I~ ~
Address
Ut.~l(jN TE-Ar,'
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~'echan; ca 1
CIIY UF SPRINGFIELD
COMBlilATION APPLICATION/PERMIT
, EIIERGY SOURCES:
Heat
l~ater Heater
Ranqe
Phon".lI._!;'73~
ValUE of Hork:
..:.2.s-CO. :~\.-o'
Builciino Permit Info: Describe \~ork(;..e.,
Familv ~es;dence With Attached Garaae)
Build Single
(name)
tJ - 7 '11-1 v75 x/~c./t:.. ..... /Ai,'>>A"... ") 1.::< /J/rrZ.. #lJ fcu,,__' (
./')~ '. -.- -1"'L.~ &/ .....oe.,~ r- ~/;';X t, <} '.
~ "/-,.3:<..,?, !;<.,Lurf /L, 7; h,~./2a.,",Jl-~
t--l1ics. ~.) . (exo;rec;.) (ohone no.i
Phone
(address)
r.JtA'Jn '<?Ie.
(namel
(address)
(lire;,. no.)
.s E /..fJ- - /Jc..--7~
,.,.,~.~...
no)
PLUllB I NG
ELECTRICAL
MECHANICAL
NO. .
I Each Single fixture
Relocated building
(new fix. additional)
S.F. Residence
(j bath \
Ouplex (1 bath) each
I HAVE CAREFULLY EXM1INED 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 un OCCUPAIKY 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 OR$ 701.055, that if exempt the basis f is ~re9.1 hat_
only subcontractors and employees who are in compliance with OP.S 71"!1.055 will be se 'ec;] 'PW~ l-Iy_,F~_
>l_~_L~4E-L=.?-J~ ~
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Additional bath
Water'service
Sewer
Storm Sewer
/
LV'..t,d<<
1lAf.IE(please print)
Zone
Fire Zone
Flood Plain
BUILDING PWIlT
Charges and
Surcharges
PLU'~BING PERMIT
Charges and
$urcha rges
ELECTRICAL PERI~lT
Charges and
Surcharges
r1ECHANICAL PERMIT
Charges and .
Surcharges
. FFF . r.HARGF NO
liL'..lli!.B.liL NO.
... 1..lli!.B.liL
c-
Residence of
furnace/burner to
BTU's
SQ. FT.
f/ New circuits alts.
Q!..extensions
7. e>% .l'1hCIII r-;
SERVICES
IS"" ,
Floor fu rnace
and vent
Recessed wall
Sn~rp hp~tp~ ~nrl vpnt
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//,vG!
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Temporary Construction
Change in existing
rE>o;jrleflcp
multifamily, comm. or
Indu<:;triitl
Appliance vent
s~oar:iltE>
Stationary evap.
cooler
Vent fan wi th
sinalE> duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood nnd duct.
from
~-
Of
COffi1./IND. FEEDERS
amps.
Install/alter/relocate
di<:;trih_ fpprlprc:
IOf
I
I
I
Wood stove/heater
amps.
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,I,~"" TOTAL
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!SSUANCF OF PFRIIlT
57Hi,/ec.
;/
&___fnA'~,~4...(' SIGrIATU
FO~ OFFICE .USE ONL Y
Sq. Ftg. 11ain
Sq. Ftg. Access
Sq. Ftg. Other
Tvpe/Const.
Bedrooms
Stories
IInits
x
,
x
Value
Value
Value
Occy load
Occy Group
TOTAL V ALUA TI ON
.-, ~ ~ Plan Ck. Comm/Ind
~ ,J(_- 65%/Blda Ppr Fpp
----- --qL"- Plan Ck. Res
. II'#:;> 30%/Blda Per Fee
/t:::>. ~ I Fence
--n----.-r~1 Demo
-____-Ls:-' Sidewalk
.6c AlC Paving
I Curb Cut
I
IJ.~C JI"P~oI!t.rSyster.ls Development
#'~~YOtS!A...-- Charqe (1.5~1
#4
ITotal Comb. rermit
S~9'
$""~'~
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
11 03 43
2. examr.le- Lot I. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilina/or forced air qas
2. examDle- 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. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examele - 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 on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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 penmit 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.
ee)
V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"~"
PERMIT VALIDATION
~# to 4/J-/
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name'~~/S'~ ~,~;_ __~signature
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_ "l-'::t-date /-/';''::S-
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