HomeMy WebLinkAboutPermit Building 1983-8-4
~ INSPECTION LIIIE
1726-3769
.
CITY Uf SPRINGfIELD
COMBIilATION APPLICATION/PERMIT
E!1ERGY SOURCES:
Heat
t~ater Heater
Range
.
INFORlIATION LINe
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Iter Pep.
Fence_Demo _ Change/U se
_Other
Job Address 7"11 M~
Legal Description \ -, r,-')?"S 'YL ()'14(l)
, I
Owner .r;~r~ke.hJ y~..-z;;_ ~r~ .
- 7-7'"-- "
Address .s; ~~ 747:;;-:J4~hane
ValJ!! of Hork: c>-c.-
J:;f '7177-
BuiidinQ Pemit Info: Describe \~ork(Le..
Familv ~es;dence With Attached Garaael
Build Single
0()
()J
-
...D
uJ
~
~
Construction lender
'7..eA'-4' n../~ J h~.-.e-~r.""',....-u-
'>~- v
~~-"- '? 20 .,....~ ~ J!
Address
DE~ I GN TEAll
(namel
Phone
(address)
(1 ics, 110.1
(exoirFlc:.)
(ohane no.l
Primary
~
\If
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
flies. no.)
(exDires)
11/4/n.
(nhonp M_ 1
General .li'D ~ /{rYo-r/,u,,;. / /1/C.
-::z.w't)74 c;.;)(OW A1:J .t:f no"?
~c.e- o/'l'Jf~ 7-
U4()2,1'1'
Plumbinq
Electrical
~1echanical
PLUIIBING
ELECTRICAL
MECHANICAL'
--1JQ."
FEF rHARr., 'Ir'
~~~ r~~ NO
':.EL ..cJiARGE
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
/
I Relocated building
(new fix. additional)
IS.F. Residence
(] bath\
IDuPlex <I bath) each
IAdditional bath
Irlater service
I Sewer
I Storm Sewer
New circuits a1ts.
or extensions
Floor furnace
and vent
ISERVICES
1
Recessed wall
Sl'lr'lrp hpiltpr ilnn I/pnt
ITempOrary Construction
IChange in existing
rp'l i r1J'Jlrp
Imu1tifamily, comm. or
Inrluc:trial
IOf
COMM./INO. FEEDERS
Install/alter/relocate
r1;c:t.r;h fpprlprc:
amps.1
1
I
Appliance vent
c:.t:!oaratp
Stationary evap.
cooler
Vent fan with
c:ino1e duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and rluf"'t
Wood stove/heater
IOf
1
I
I
amps.1
ISSUANcr OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\1~ REQUIRES that the Electrical work be done by an.'Electr'ical Contractor. the electrical portion 'of this pemit
shall not be va1iJ 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 al' work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Orel]on pertaining to the work described herein, and that NO OCCUPAllCY 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 701.055 will be used on this project.
IWIE(please print) M I r: 1/ A E I- ,l[f)V A"1?E" SIGUATURd~......../ /f~..r/L.-,.
FO~ OFFICE USE OIILY
So. Ftg. 'Iain
Sq. Ftg. Access
Sq. Ftg. Other
DATEffh/r;-3
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
x
Value
Value
Value
x
Stories
x
TOTAL VALUATION
BUILDING PERfIlT
Charges an~
Surcharges
_____L8JJO
I./~
Plan Ck. Comm/lnd
6S1/Bldo P~r Fee
Plan Ck. Res
30%/Blda Per Fee
Systems Development
Charqe 0. 5~) "
PLUtIBING PERMIT
Charges and
Surcha rges
Fence
I Demo
I'Sidewa 1 k
I A/C Paving
I Curb Cut
I
I
ELECTRICAL PERI:IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
ITotal Comb. rermit
I
'I
I
I TOTAL
$Zq.IL
~
.
.
.
.
. .
,;
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electricalJor solar
E. Square footage or valuation, etc.
I. example- 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. exa~le - remodel existing garage into family room
3. exa~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 TEM1 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 ~ivision 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.
'l,yXS
'0
~~
V. FOR OFFICE USE ONLY
Permit Clerk
(0
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
,'".
name
signature
date
c