HomeMy WebLinkAboutPermit Building 1988-8-22
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IINsrECTION lINE~ ", . CITY Uf SPRINGFIELD
.726-3769 .- COMBIIIATlON APPLICATION/PERMIT
Job Address 0 ~. r/~/-"Of&!"D ~ T""'-~~"'" "'EIIERGY SOURCES:
/~ ~.m~"""',n__""'- ~IP Meat
Legal Description /7~'3:/? //.<?.<? Hater Heater
.. Range _____
ValuE of Hark: "
Owner POZ>Ly'A-X1/) P~~LcF5 1"1,:z,;:;p.---.
~_ _ /' _ Bui1oino Permit Info: Describe Work(i~e., Build Single
Address 3Y'::;:> ~L>Y ~ LA_~Phone Familv Residence IHth Attached Garaoel
~/H.z::; ~~LD~. ~? /5L.t!.. ~,t::' .#7PA'.e>v <\~~ /0 ~
"",*,,:.~:_.. ~-,,~:,.?.,~...._';Bc~. 7<V~~q LJA/ ~nEI/~/oz:;>~ ~-'='l~T.Y.
Address .;?~ ~~~;--<S~ Phone
DESIGN (EAt~ . rname) (addressl (lies. no.) (exn;res) (ohone no.)
.
INfORltATlON liNt
726-37S3
Sq. Ftg. 1,lain
'q. Ftg, Access.
Sq. Ftg, Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Primary /f.RA;j~~.",,::,.,k"'"~!':~~_~ ?t? r:> ~ c(";;::>"c:", n nR.
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Structural
El ectri ca 1
Mechanical
CONTRACTORS lnamel (address)
General ~,.e s::.w."" ~ .&::~V"~ c::&... 9"'~
f1 ;r-c: nn.)
(pxnirpc;,l
(ohnnp nn )
ij ~/'>/-<;"'
Plumbino
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Electrical
~'echanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
..J!!h
HE' r.HARfir NO
~~~ I r~ NO
J=~L-..c.HAB.G.E..
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTUI s
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bathl
Duplex (1 bath) each
[Additional bath
I ~Iater servi ce
I Sewer
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
s~oaratp
Stationary evap.
cooler
Vent fan with
<i.inole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd i'!:nd durt
Temporary Construction
Change in existing
rp'}jrlYJ1rp
multifamily, conm. or
Indu<i.trial
COffi~./IND. FEEDERS
Install/alter/relocate
nic::trih fppnpr<i.
Wood stove/heater
Of
amps.
UI
I
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TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali~ until the
TOTAL CHARGES
ISSUANCf OF PFRIIIT
TOTAL CHARGES
that the Electrical work be done by an'"Electrical Contractor, the electrical portion of this pemit
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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that flO OCCUPAIKY wil be made
of any structure without the permission of the Building Division. I further certify that my registra . n with th lder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption i ted he . and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this p~
NAf.lE(please print) /~C" r ~d ZJ SlGIIA~~-~
/ FO~ OFFICE USE om. y .-?'
Sq. Ftg. 11ain
Sq. Ftl]. Access
Sq.'Ftg. Other~~
DATE&fiJ8
/
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Units
BUILDING PWllT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Rldo Ppr Fpp
------------ Plan Ck, Res
." 30%lBl do Per Fee
Fence
CD
4"a <>~
x Value
x Value
L:lf/t. ic'~ Value/.l?:2~.-
TOTAL VALUATION
Stories
Occy load
Occy Group
Systems Development
Charoe (I.5~) ,
PLDr1BING PERMIT
Charges and_.....P.
Surcha rges .
D~mo
I Sidewalk
I A/C Paving
-I'curb Cut " ~<"
------------i~;p~ ~.".I-
Total Comb. Permit
'.
ELECTRICAL PERmT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
:::? 7"y.....b
z.:, 0/. MJ
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COMBINATION APPLICATION/PERMIT (CAP)
. 'PERMIT,VALIDATION
'j
I. Applicant to furnish
A. Job Address
B. Legal Description ,
1. example- Tax Lot 100, Lane County Map Reference
11 U3 43
2. exam~le- Lot I. Block 3, 2nd Addition to
Spnngtield Estates' .
'C.~ Name. etc. of owner' and' construction lender
D. Energy Sources
1. example; heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- 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. example - remodel existing garage into family foom
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 TEAM 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.
I!. 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. I f the item( s) to be i nsta 11 ed 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. ---
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
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
C~
PROJECT ,CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
.name~r/-? ~~~
Signature/?,::-/~<"~~
// I' ~
,
date .B.~-=<'-BF;
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