HomeMy WebLinkAboutPermit Building 1988-2-23
I ItlSPECTlON LINE
726-3769
.
CITY OF SPRINGFIELD
COMBIIIATlON APPLICATlON/PERMlT
E!IERGY SOURCES,
Heat,
Hater Heater
Ranqe
.
INFDR/lATlON LINt
726-3753
Sq, Ftq, 1,la;n
~q. Ftg. Access.
Sq, Ftq, Other
New Add Alter Rep,
-Fence Deroo Change/Use
Other- -
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Job Address ~112 I 3114 T~du.6.tJU.al. AIIP
Legal Description ThIN 17 Ro: 2 See.: 30
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Owner FIITlIllF I or,(;r Nr. ro
Address 3112-3114 T~r1Lu\.tJU.al.
~~h~no~ip1d, Oh 97478
Construction Lender FuJwr.P Laooino Ca
Ave
Phone 747-23
ValUE Qf,~ork:
./~ ..pe:::>r-> _ en;J
Builtiinb Permit Info: Describe Work(i.e., Build Single
1Familv nesidence With Attached Garaoe)
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?;; flE;pC#-.-?e- GfU'//#z:=-. ~T
h't:".:::>F
flies. no.) (exnires)
(OhOM no. J
Address
UI:.~ll;N ftAf"
(name)
Phone
(address)
Primary
Structural c;eoR.6E L. qR/;ril-/. fJ=:
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('2. - 31 -e,g '(4(,,- '2. "). So
Electrical
Mechanical
CONTRACTORS
Genera 1
(name)
/];-1/( e...
A'/Jl;J.d
,M;A~L:d~;;tk"r>:'rrl h'l;~r<2n~~ 9 / (PX;;~!<6<t,
fohnnp r'ln, 1
?2?f?6'9L
Plumbina
Electrical
Mechanical
PLUflBItlG
ELECTRICAL
MECHANICAL
--1JQ..,,1
Each single fixture
I FEF I (HARr,F Nn I I 1:.E.L'Jd!AB.G.E....lJlI I
Res i dence of furnace/burner to
SQ, FT, BTU's
1J:'~LI.t.llARUE..
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
II bat,h \
Duplex (1 bath) each
SERVICES
Recessed wall
So~cp hp~tpr ~nn~t
Storm Sewer
Of
amps.
Appliance vent
5~oaratp
Stationary evap.
cool@r
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd and nlJr't
Additional bath
Sewer
Temporary Construction
Change in existing
rp'ljnJ'Jlr'p
multifamily, comm. or
Tnnuc;;trial
Water service
CO~1,/IND, FEEDERS
Install/alter/relocate
rHc.trih_ fppnprc:
Wood stove/heater
Of
amps.
ISSUANCE OF PFRlm
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an, Electrical Contractor. the electrical portion of this pen:1it
shall not. be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAt1INED 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 Ore!:!on pertaining to the work described herein, and that UO OCCUPAr~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 exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
SIGflATURE 1<.,1" -1n~)
FOr. OFFICE USE DlllV, -
Zone_LJW/ Tyoe/Const.:5=-# I'nits Sq, Ftq, llain x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories / Occy Group;5'-2 Sq, Ftg, Other~ ~.,... Value /0,""'&e:>
Ch"/~/.ij~<:: llC7.#CY->EC ~5/=, 0,," /~ -?./ crY TOTAL VALUATION 7
-;z.L~...v .(//-3.""p~.f --)C"~p.;? ~r: 731q/c...qr- ;i~w..:5cZ>. :n() '1\ "-
BUILDING PERlIIT II/'-o Plan Ck, ConmlInd ('I C1 -r.? ({OOO Systems Development
Charges and __JL~:..2____ 65%/Bldo P.l'r Fe. ,M7./, -4 Charoe (J,5~)
Surcharges C-- ry? Plan n. Res
,j C:>~ 30%/Bldo Per Fee
IWIE(please print)
'T'M
I).,,-Clhti? ISTI4!),1
OATE
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PLUl1BING PERMIT Fence
Charges and ------------
Surcharges D~R1o I
ELECTRICAL PERlHT Sidewalk I
Charges and ------------
Surcharges AIC Pavi ng ITotal Comb, Permi t
MECHANICAL PERMIT I Curb Cut I .
Charges and ------------ I I TOTAL /2'<,33
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J. Appl icant to furnish
A, Job Address
B. lega 1 Descrl pt i on
1. example- Tax Lot 100. Lane County Map Reference
II uj 43
2, exa~le- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation. etc. ------
I, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - 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 TEAM ANO 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
fu 11 schedu 1 es
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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
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.
If ~5)-
~/5/~~
V, FOR OFFICE USE ONLY
Permit Clerk
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:
PLANS REVIEWED BY:
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name .L::>?5 $c /2 ~~~
signature/2--",~~;)
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date Y-S-e&