HomeMy WebLinkAboutPermit Building 1984-7-24
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1l1lSPECTI01I lItlE CITY UF SPRIIIGFIELO
726-3769 COMBIOIATION APPlICATION/PERMIT
Job Address :~2> \ ~(\ ~ f\ Jtr ~ ~~;~GY SOURC~:
Legal Oescription r-'\ Q~:~S'3 \ - \~ !-later Heater'
'ci- Ranqe
Owner \---\ <>\ ,1<.. , ~~0 \C.J
Address cQQn ~ C' f)~ )\("1 ~O\ Phone
f l ,(\Ql'\Q . ~ \':, . C{l=:\()\
Construction-len~r \
Address
Ut:.~lliN IE.AH
Primary
Structural
Electrical
INFORlIATION liNt
726-3753
Sq. Ftg, '.Iain
~q. Ftg. Access.
Sq, Ftg. Other
--1lew__AddJ<tnter-"~ep,
Fence Demo Change/Use
va~r I-IrtL((().CO, Other-- --
BuilriinJ Pennit Info: Describe Work(;..e.. Build Single
Familv nesidence With Attached Garaae)
:-'i\..)J\O\.Y\.. -t\ ~ ,~
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flies. no.) {exnires} (Dhorll~ no. I
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lname)
Phone
(address)
Meehan; ca 1
CONTRACTORS (name) (address)
General ",~D\ 1 :r\f\~'~ \[\~ ~cl-{" \\<7_ X\
Plumbino \~ ~ "i:"\J
Electrical ~a.. ~ r~ ~ .~~
"echanical .('~~ -C\ ~\.\
PLUIIBHIG \)
-1!Q.,.
Each single fixture
(lic~\no.)
!J.A ~ ~\-
~ Q f) 't\ {\e'\J
ELECTRICAL (j
FEE CHARGE Nn
... r~ NO,
Residence of
Relocated building
(new fix, additional)
/ D.Cf. SQ, FT,
New circuits alts.
or extensions
I!emporary Construction
IChange in existing
r~s_i d~nce .
Imultifamily. comm. or I
industrial
I -.SIOf r9tJ<j:r.- amps{..OS'I7S/
I ICOMI-I./IND, FEEOERS I I I
I I.~~~;~~~~a~;:~~~~locate I I I
I IOf amp~1 I I
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I I I J ISSUANCE OF PFRlm
/0,00 TOTAL CHARGES fl. '5 ~ TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pemit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
IS,F. Residence
(1 bath 1
louplex (1 bath)
IAdditional bath
Iwater service
I Sewer
IStorm Sewer
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TOTAL CHARGES
SERVICES
each
?R
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) t~ilO~ ~ (-)4"~I()ro\
"'-"\lJ "
MECHANICAL
furnace/burner to
BTU's
m,...JQiAIlliE.
\(\~
Floor furnace
and vent
Recessed wa 11
Sn~cp hp~tpr And vpnt
Appliance vent
S~P!H.ate
Stationary evap.
c.Qo 1 er
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C. ,
I Mechanical exhaust I
hood and duct
I Hood stove/heater I
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I(),CC
I HAVE CAREFUllY EXAMINED 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 do~e 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 NO OCCUPAI~CY 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 exe t the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OPOS 7Ql.0 wi ~p ~on this project.
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IlAl-IE(please print)Ci&-lN f(~~j,.(,(A.flfj
L\...-
Zone
Fire Zone
Flood Plain
BUILOING PERl-IlT
Charges an~
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Tyoe/Cons t.
Bedrooms
Stories
SIGfI 'RE
FOn OfFICE OSE OIILIY,' /
Sq~ !lain
Sq. Ft~. Access
Sq, FIg, Other
Units
Occy Load
Occy Group~~
__\jCQ~_ ~~~~Ri~~
~ Plan Ck.
, 30%/Bldo
...__LO_.~_ Fence
,4'D Demo
___~-S~- Sidewalk
~ ,c--r: A/C Paving
-___\O_,_~I Curb Cut
"N .
Conrn/l nd
Ppr F'PP
R-es
Per Fee
OATE.;l~~\f'~ .
,
.x
x
Value
Value
Value
x
TOTAL V ALUA TI 011
Systems Development
Charqe (1.5%) .
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I
ITotal Comb. Permit
1 TOTAL ~rA ,0
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COMBINATION APPLICATION/PE~~IT (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, examole- Lot I. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Q3S
2. examDle- waterheater/electrlcal/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,
cneck add. etc.
F. .Building permit information:
1. "example - construct single family house with an
attached garllge
2. exam~le - remodel existing garage into family room
3. examole - 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
8. 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
0, 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 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.
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V. FOR OFFICE USE ONLY
Pennit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
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PLANS REVIEWED BY:
name
signature
date