HomeMy WebLinkAboutPermit Building 1986-07-050/
INSPECTION LINE
7?6-37 69
CITY OF SPRINGFIELD
COHBI TIATI ON RPPI- I CNTIOIIIPERMIT
m
725-3753
Job Address / 47o l,/ctr/twk ,bl/2
Legal Descri ption
Hea
Ranqe
EIIERGY SOURCES
llater Heater
0wner E / ,Y0/ /V 4 ?r7 etlorkuatue j!
Sq. Fta. l.lain_
Sq. Ftg. Access._
Sq. Ftg. 0ther_
_l'lew_AddJl ter_Pep.
_Fence_Demo Change,/Use
0ther
Address '6V/ E?hEHl/1/f L|'/TY Pho""7472tt rni t
l,lith Attached Ga
I re.r Build Single
9 %Nkrt ELD q74 7 7 TE+ft OtF ,*l/y ,//Elro,r i/rfir{
Construction Lender A/1,,// 9o//ft1 EF_C,T/D/y9 , D/uE/U9 CAt/UhW
?zo Lt//L/ clt*gq 'tA" AmfAddressPhone
,()6'Oqq
DESIGN TEAI.,I name addre s s ICS- nO-exot res
Pri mary
Structura l
E I ectri ca I
Hechani cal
address lics- no-)PXnr rPq )CONTRACTORS name
EL,M/UE CXPl umbi nq
4rt+aZEl ectri ca l
I'techani cal
ELECTR I CAL MECHAN I CALPLUt{B I NG
FFF l.HA AGF NO FFF CHARGFFEEC HARGE NO
Residence of
FTsQ
furnace/burner to
BTU' S
Each single fixture
Relocated building
(new fix. addit'ionaI)
New circuits alts.
or extensions
Floor furnace
and vent
SERV I CES
Recessed wal I
Soace heatpr and vpnt
S.F. Residence
( I bath)
Duplex (l bath) each
Temporary Construction Apol iance vent
s eDa ra teAdditional bath
Change i n exi sti ng
rps i dpncp
Stationary evap
cool ertlater servi ce
Tndrr<triel
multifamily, comrn. or Vent fan with
sinole ductSewer
Vent systern apart from
heatino or A.C.0fStorm Sewer
Mechanical exhaust
hood and ductcoMr.!./IND. FEEDERS
Instal I /al ter/rel ocate
di slri h. fceders l'Jood stove/heater
0f amps
ISSUANCI OF PFRI1IT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
l.lHERE STATE l-l\li REQUIRES that the Electrical work be done by an
shalI not be valiC untiI the label has been signed by an Electrica1
S IGiIATUI'lAtlE(please print)
Uni ts x
x
. Other x
. Ftg . Access
'IFtq. l'lainConst.
Group Sq. Ftg
Electrical Contractor, the electrical portion of this permit
Sufrervisor and returned to the Building Division
gon
Bui
0r?s
t tha 'Ia 'I'I forman 'It heon reontcafoonrtdoandcerteted'ItheD Derm i hereb.ycompapr)ofIdanctwltheh0rdnancesndIawoIrksharformedIIdonebeacc0rdanfu rtherI 'Icert tha at a DEandfynycorrect
w1 'II'Ir here ibed n nda ath NOt CYOCCUPAI'In'I I thto wor dek scngorlfIdItandLawshetheofteSta0reofDe rtaSong theh Buif1thtas'I ttra on'I tvtl'I f th d 'I ID 1 'IS onI erfurth ert regfrest ructu tw1 utho the s on o es ng v m.ypermi
ba 'Is fors ti 1on noteds hereonfexempthe'I ORS 07 051 5 hat t 'IBoa
any
rd exemptIn,l Ifu forceI nda fectef sa redrequ by
n thi tsL tusedIbe'It/l550707'II ncea thwl projnItorsandIawhoIrensubcontracemp0yeesc0mDv
Val ue
Stori esFlood Plain
Load
Zone
Fire Zone Bedrooms OccY
l Value
ToTAL VALUATIoII_
i s true
the City
be made
'l der' s
and that
opmeotPlan Ck. Comn/Ind
65%/Bldo Per Fee
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERNIT
Charges and
Surcha rges a.o aS,O
Fence
Demo
PLUtlBING PERMIT
Charges and
Surcha rges
Sidewal k
Tota'l Comb. ['ermitA/C Pavi ng
ELECTRICAL PERIlIT
Charges and
Surcha rges
Curb Cut 5a:€2.-TOTAL
IlECHANICAL PERMIT
Charges and
Surcharges
(r
(n
Svstems ueve
Charqe (1.5r,
CoMBTNATI0N AppLTCATIoN/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. example- l?50 sO. foot house, 500 sq. foot garagez. example- if new project, check new - if addition,
EEecI-E-dd, etc.F. Building permit information:1. exampie - construct single family house with anattached garage
?. example - remodel existing garage .into family roomJ. example - convert single family residence into
- restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Spec.ialty CodeH. DESIGN TEAI,I AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepers0ns-regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. txcept where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaient
_ to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedu.lesare available at the Building Division1. To conserve space on the-permit form the schedu.leshave been abbrev.iated2. If the item(s) to be instal led are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUI ALL FEES AND
CHARGES ON THE SCHEOULESD. As noted on the CAp, the label must be delivered to theelectrical contractor for signature by his electricai -
supervisor. The general coniractor is not authorizedto sign the electrical labelApplicant to sign and date
I'lhenever possible, the.in.i tial application will be used asa.worksheet only. Hhere possible, Building Division Siaiiwill.prepare a type !.rritten copy ino returi it to theapplicant at the time the actuai permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and.no plans wiil- be procesied until theserees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
II
III
IV
v
a ceiIi
e or valuat on, etc.E
wa e
forced air gas
or solar
hea t/ el1. exampl e-2. examilE-
Square footag
6u', Y tre
N-7 -Y 6
PERMIT VALIDATION
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
'lPerm at 'lI ac tn ex tpp from 'lemp S rat 'tt no 'tW treg h the u I1 erd S rdBoa cbe ua es
Additional Project Information :
PLANS REVIEWED BY:
name dates1gnature