HomeMy WebLinkAboutPermit Building 1984-2-21
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CITY OF SPRINGfIELD
COMBIilATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat f /h'_
I~ater Heater /./~r~
I ItlsPECTIOil LItlE
726-3769
INFORllATION LINo
726-3753
Sq. Ftg. I"ain
~q. Ftg. Access.
sq, Ftg.Mlllliit; -=lQ.",CP
-1lewKAdd_Alter ~Rep,
Fence Demo Change/Use
ValuE of l'lork: Other- -
2t4<'~"iJ '
Bui1lir~rPermit Info: DescrIbe Work(Le" Build Single
Family Residence With Attached GaraQe)
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Range
Owner ~-khA/~ i~r,?td ~~
Address ,!J~A /!1;~~1 ...~>VAJ.' /a~'/ Phone~7_
tYIHlK JW4lJIV~'4i>"l>M "")~'~P?i 'f'?7"
Construction Lender A/L7.1'1/h
Address
Ut~ J liN 1 EAf4
(name)
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Phone
I address)
~,O H.~.v. ~dSM ~dd"EbJ.
7SV'?~
Mechanical
CONTRACTORS (name) (addrpss1 (lies. no.1
General ///~;w AI. 9'6,Il';;~N'j Jv1/J1&..J .57- +d~j
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TOTAL CHARGES 3$. -= TOTAL CHARGES ~ ~Ol TOTAL CHARGES ::::?~
WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Primary
Structura 1
Electrical
Electrical
~'echanic'al C Ao.",,^,~ T ;::"OlN ~n",..r. ,
PLUIIBING
ELECTRICAL
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FEE CHARGE Nn
2
Each single fixture
Residence of
,:-- It?,-
SQ. FT,
Relocated building
(new fix. additional)
~ New circuits alts.
s.ex~~E'
IsERVICEs
I
S.F. Residence
(1 bath)
Ouplex (1 bath)
each
Additional bath
!remporary Construction
IChange in existing
rp'i; rlj"n~p
Imultifamily, camm. or
Inrlustrial
IOf
ICOMfl./INO. FEEOERs I
.,- Ilnstall/alter/relocatp I
r1;~tr1h_ fppdpr~ I
IOf amps.1
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amps,
~Iater service
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Sewer
6.-
V'" Storm Sewer
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t!Jp.
(lies. no.1
(exoi res 1
rohone no. I
(exnires1
(ohnnp nn_ 1
~
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~,.P7-.5'$'f#
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r"~' NO
':E.L J:JJAI!GE.
MECHANICAL
furnace/burner to
BTU's
rSQC
Floor furnace
and vent
,
Recessed wa 11
~n~rp hp~tp~ ~nrl vpnt
'I I/~< (.:.)HI'..7'S
Appliance vent
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Stationary evap.
r:nnler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd and du~t
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Wood stove/heater
~ r"~hG
J.&6~."1G[ Ar PrRf1I'F
I HAVE CAREFULLY EXN1INED 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 \~rk oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~on 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 my registration with the Builder's
Board is in full force and effect as required by ons 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 will be used on this project.
SIr,r1AT~/d~/ d/!
FOr. OFFICE USE DriLY
Zone .c;'~ Tyoe/Const. 3-.tV Units s~. Ftg, 11ain ,~R" _~S 11' Value
Fire Zone Bedrooms Occy Load Sq. Ft~, Acces;~DA.T4!!N Value
Flood Plain Stories 2 Occy r,roupll~~A'4f?q. Ft'l..o Othe~~G. x//7/1)z Value
N41'J;; rdPNPAP4NJERJ/#/r' /,r$CoI40 ~-":18'-8'1 j$"r ~..P..~ TOTAL VALUAT I 011
I~ /N<u.J.'f.?t!C"J:> /N 7lI-4 ?~M/T: -dJ;/n'1,l./ln1, 0UOl '
BUILOING PERIIIT ~/8 _, I Plan Ck. CO"",/lnd ~..- ~ rA_Z.i-i"~yster.ls Oevelopment !'b_." ~/
Charges anc ___~.Jp_ ....:._ 0" 65'URldo p.pr Fp~ r,-'''' -1/ CharQe (1.5":) . J:I!I> 74, .
SJlrcllil.Qjes&9~qP'1lf jl.r,72 ,Plan Ck, Res ~E'DD"'" VA'Uf!rtf1~....
4IlV:L.....:;l""..M_- '- '. "'130%/BldO Per Fee _.~, 1/.2';, ./~y.
PLUt1BING PERMIT A'", ~b Fence
~~~~~:~g:~d ----..../~~-~-I D~o I
ELECTRICAL PERr~IT ____ UA_ _.,0 l's1dewalk"?A'~*
Charges and ~
surch~r.ges I . 6tt:> / A!C Paying' , I
. 00C> I -,
____;?~____ Curb Cut .
1.tt:>t,I I
IlAl,IE(please prin~W;..t..:r< ;;;'/"M.,.{'/ ~k<,
11ECHAN I CAL PERMIT
Charges and
Surcharges
OATE ah( /.5..y
-'
~ -==-
.ITo_tal, Comb,
I
I TOTAL
Permit
,f9~' 7~
Z'387:67
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. legal Description ,
1. example- Tax lot 100, lane County Map" Reference
II 03 43
2. examole- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air qas
2. exa~le- 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 gar~ge
2. examyle - 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 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 appropri a te item( s) to be ins ta 11 ed '
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 insta~led 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 SCHEDOLES
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. -
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.
,
Ill.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
Permi t C1 erk
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Permit app1 i cant exempt from regi strati on with the Bui 1 der I s Boa rd because:
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.AddjtioQa1 Project Infon1!atign:-
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PLANS REVIEWED BY:
:~~me L'bRNe: n.€~ ~ signatur4~
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