HomeMy WebLinkAboutPermit Building 1984-3-28
I !rlSPECTIOti LWE
1726-3769
Job Address <r-<i C') 71 \\ ~\" \ S\\? r- H
Legal Description \"\-a~-';\'5 -L\ L
Owner\\, \\n.>.\\'\s' "\. ,\-\"\:r-.0\(3\') \\r'i'q,~S.
Addre'W ~ ~ '\\ ~ '\.\.. '\ <;:..;, ~ r-;F.\ Phone 1~-:-,
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Construction Lender\ '()\ \F,
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Address
Ut~lur. 1f.m-1
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INFORJIATID:i ':'~
726-3753
SQ. Ftg. 1,Iain
~q. ~t9. Acc,ess.
Sq. Ftg .".mher
-'lew L1\'dd..Jol ter _Pep.
Fence Demo Change/Use
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CITY UF SPRINGFIELD
COtIBIiIATION APPLlCATION/PERMIT
EilERGY SOURCES:
Heat
(,)~~\aJ Water Heater
Ran~e
\J\~
ValUE of Hork:
\\,~
Buildina Permit Info: Describe Work(;-.e.. Build Single
Family l'Ies;dence Hith .A.ttached Garaae)
~~ ~'""'\("\.\ \=(") '\L. \. \HD
~'C')'C'"'\'\\'\,-.,\." C'\ \J\. '-II
(name)
Phone
(address)
(ohone no.
(1fe5. no.)
(exniresl
Primary
l \\. 'Ie'..... ~ ~s..q' ,
~ SlP"\?N'')
Structural
Electrical
(oS\ ~.\.l\ ~WV~\ CC')'\\'Ju.ll \~
Mechanical
CONTRACTORS I name) (address)
General\.l...\,\.l ,~~ ~ '\.~'- W~'\.\..'&
Plumbina
Electrical
~1echanical
NO,
flies.nn.)
(~xoirps)
(nhnnp nn 1
'll\ '1, --:\~'1~
9(,,;\ '\-\~" '\~ S.V~\<\'
PLUf1BING
\\.~
FEr CIIARr,F 'IP
\\,~
~1~
~-~Rr,F NO
ELECTRICAL
MECHANICAL
Residence of
furnace/burner to
BTU's
Each single fixture
SQ. FT.
...
Relocated building
(new fix. additional)
S.F. Residence
(1 bat.h]
Duplex (i bath) each
Additional bath
Water service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl U~"t
Temporary Construction
Change in existing
reo~5r1.?.ncE'
multifamily, COJml. or
Tnduc:.trial
Appliance vent
~~Da ril. t~
Stationary evap.
coolE'r
Vent fan wi th
sinole duct
Vent system apart from I
heatina or A.C.
I'Mechanical exhaust 1
hood and dUI" t.
l Hood stove/heater l
II
1 I
I I
Of
amps.1
COffi1./IND. FEEDERS
Install/alter/relocate
dic:.trih. fpederc:.
Of
amps. I
I
I
I
ISSUANCE OF PER/lIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES ,
WHERE STATE LAW 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
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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i n i ng to the work deseri bed herei n, and that IW 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 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 7Ql.055 will be used on this project.
IWIE(please print)
Zone c..C
Fire Zone
Flood Plain
BUILDING PERflIT
Charges an~
Surcharges
PLU'1BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Tvoe/Const. ~- \.:}
Bedrooms
Stories
SIGflATURE
FOr. OFFICE USE OHLY
Sq. Ftg.
Sq. Ft9.
Sq. Ftg.
r1ain x Value
Access x Va 1 ue
Other..fu~('\~O\..)\~ Value \\,~ J...J
TOTAL VALUATION \",~~.~
DATE
Units
Occy Load
Occ.. Group~ '2... 't
\\-~
'L
~ 1<2'2.LlC?
~--g~'7_\ -qll
Systems Development
Char~e (!.5~) , ~\\~ \.T\'\I.\l:ii\\'\G
'7'\"I?-F. ~,~ '?-I=: -;r,f;1r- ":.C!)UII.l. rr-
C:l';: Vc=\-\~\~ \~~..)k ~r-:Q\-\,,~
I ' I
I I
ITotal Comb. rermit I
I
LT~TAL
1'0 00 Plan Ck. CorrmlInd
~. 65%/Bldo Ppr F~e
-----()--~a-- Plan Ck. Res
C-- 30%/BldQ Per Fee
--\J~-~----_ Fence
Demo
--~-t ~
__~\~\-___J Curb Cut
I
Sidewalk
A/C Paving
Co 2. ~o
,e . ... "
--,
'"
COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
>prfngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examDle- 1250 sq. fODt hDuse, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add tete.
F. Building permit information:
1. example - construct single family house with an
attached ga..ge
2. example - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use) .
G. Value of wDrk as defined in Section 303 (al of the
Structural Specialty CDde .
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 ND. Boxes adjacent
tD the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
I. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not cDvered 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 Dn the CAP, the label must be deli~ered tD the
electrical contractor for signature,by hjs electrical
supervisor. The general contractor is'.not authorized
to sign the electrical label. ---
III. Applicant tD 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 Permi t Clerk
II
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:"\\,~<i; \?r-:\?Y\.,'" \ s.. ,\-<">'V "\ \~R-
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PLANS REVIEWED BY:
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SignaturUA ~,--y- 'date ~~-~C\
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