HomeMy WebLinkAboutPermit Building 1984-3-28 (2)
I IrISPECTION LirlE
726-3769
Job Address '?i C)~ \\ ~\.\.. \ 'S\'VFE\
Legal Description \ ~-()~-';l-,~ -L\ L
Owner \\\ \.,:c \.~ \.\. '\~ ~ "":~::r,\o\(;1;:) '\\()\T"'\cy S.
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Construction Lender\ '(')\. \ F.
Address
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INFORllATION UNt
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ft9....mher
--11ew~dd--^lter__Rep.
Fence Demo Change/Use
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
C":Yl~~~ Water Heater
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Range
ValuE of Hork:
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Buildino Permit Info: Describe Work{i.e.. Build Single
Familv nesidence With Attached Garaoe)
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~\2)'\.'"\,\\\."",,\,\ ("\ \..')\''-Il
(name)
Phone
(address)
(ohane no. )
(lies. no.l
(exoires)
l 'I.\. \ C'__ 4, ~~ ,
(~s..\. \..').\1..\~W~\ CO~ll \~
'I 51..\ -"1 'ZC:O. .
Primary
Structura 1
Electrical
(1ic~. no. \
,...,~~ ,."~. ~ ,
Mechanical
CONTRACTORS (name) raddress)
Genera1\..1..\\.Ll\.~~ ~_ ,~\ W~,\..~
I Relocated building
(new fix, additional)
Is.F. Residence
II bath)
IDuP1ex (1 bath) each
IAdditional bath
I Water service
Sewer
Plumbino
Electrical
~1echanical
---'ill.."
Each single fixture
Storm Sewer
I
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9c~~ '\-\~\.\ l~ ~\,'\.\A,.
" l.l. '1, -:\':\~
PLUlIBING
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HF fHARr,F 'll'
MECHANICAL \\."\,~
ELECTRICAL
\J'~~
~~L..c.HAB.G..E..
Residence of
furnace/burner to
BTU's
.t
SQ, FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
r~s. j d..eJ1ce
multifamily, COTm!. or
lndustrial
Of amps,l
CO~~./IND. FEEDERS I
Install/alter/relocate I
di~trih. fppder~
Appliance vent
spoarate
S~tatfonary evap.
coo1er
Vent fan wi th
~inole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust I
hood and duct
Hood stove/heater I
I
I
I
Of
amps.!
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I SSUANCf OF PFRrllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an"E1ectrical Contractor, the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMIINED 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 performed 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 rm OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard 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 comoliance with OP.S 7~1.055 will be used on this project.
HAlIE(p1ease print)~".t':;J 6muA/~/t;~ SIGrI'RE.:2W/~",~
FOr. OfFICE USE OrILY
So. Ftg,
Sq. Ft9.
Sq. Ftg.
Zone CC
Fire Zone
Flood Plain
BUILDING PERMIT
Charges and
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr~1T
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
DATEd/Z.f~ij
Tvpe/Const.
Bedrooms
Stories
~-\..)
r1ain )( Value
Access x Value
Other fi'll~"-,)<.o\.'\.'{ Value \\ ,~-
TOTAL VALUATION \ \, ~ .Q....
Units
Occy Load
Occy Group\b- 2. 't
\~-~
1-
-I%- r<2.'2..~.U~?
.~TI
"T/J'I.\-C6t.1
Systems Development
Charqe (I.5~l ' ~\\~ \.T"'Nt\~\\\'\A
"V"'\ '\?oF. ~,~ ?-t:;; 3;:>0 G L.<:RII~
0\;:i/F\-\~\\.'1",,, "?FQ~,,~
('O 00 Plan Ck. COnID/Ind
~. 65%/Rldo Ppr Fee
-----i)-(l6-- Plan Ck, Res
f\-' 30%lBl do Per Fee
\.) { ~ Fence
-- - -----, D~mo
--~-Lk.---J Sidewalk
, I A/C Payi n9
--k.)~~\-__n: Curb Cut
Total Comb. Permit
TOTAL
Co 2. 40
.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II U3 43
2. example- Lot 1, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. 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. examele - remodel existing garage into family room
3. examele - conve~~ 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 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 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
full schedules
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. ---
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
signa ture.
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.
fJJ ;)00'1
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V. FOR OFFICE USE ONLY
Permit Clerk r 1 Ylrllli
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl i cant exempt from regi strati on wi th the Bui 1 der I s Board because':
Additional Project Information~\.~~ ~~~'"
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PLANS REVIEWED BY:
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SignaturUA ~ ? -X- da~e ~~-~cl