HomeMy WebLinkAboutPermit Building 1988-01-25CITY OF SPRINGFIELD
COHBI NATION APPLICATION/PERMIT 7?6
Job Address iqS{) Iv\.c\k],,arl r \ rc,
Lesal Description Zl)ONr> N,UARII {\).2, I tVfr l,later Heater
Range
ETIERGY SOURCES
Heat
owner Ef) tJ Ct.t__lr.A
Value of l,lork: 6 t t-l 5 .-
Sq. Ftg. I'lain_
Sq. Ftg. Access._
Sq. Ftg. 0ther_
_l{ew_Ad d_A l te r_Re p.
_Fence_Demo_C ha n ge/ U s e
0ther
Address G3\ 8Or-€ \1nr.)1- trrs,ur errone r,r.r.{f q
Re
BuiIci in
Fami'ly
Permit Info: Describe t,lork(
sidence tlith Attached Garaqe
Build Singlel:€
I
I
S,F}eruc-<'el u;\ D 9r L{ rl ']"C,6r.rc>l't etJ'pY " 115AlQ-, <F€ EOOsg'ft'
Construction Lender
J R-t\A-\:Dp -/Ourg; ros -eD(eio1.l.)(r,.{ S*^{,
c{ep s/}\flsr.carsrseer-ass) 5l hr.e,.Addre s s Phone
DE5IGN TEAI.I name addre s s 'I ics. no.exDr res phone no.
Pri mary
t )q , StbaStructura l
El ectri cal
Mechanical
name a ddres s ( pxnlics- no.')res,)(nhonp no- )
(6en"rut) (? rG n rY\E-r LJ/-I ?().1u e-p fiLl rer\ & tqo3 llrq I RR -B}-}q-o1-bq
Pl umbi nq GrJG-{g NE
q relOl-El ectri cal
l.lechanicaI
PLUHB I NG ELECTR I CAL },IECHAN I CAL
FEE CHARGE NO-FFF CHARGF NO FFF CHARGF
Each single fixture Res idence of
SQ. FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New circuits alts
or extensions
Floor furnace
and vent
S.F. Residence(l bath)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Construct i on Apol iance vent
seDa rate
l^later servi ce ge in existing
dencp
Chan
res i
Stationary evap.
cool er
Tnductria l
multifamily, comm. orSewer Vent fan with
sinole duct
Storm Sewer 0f S
Vent system apart from
heatino or A.C.
c0Mr'1./IND. FEEDERS
Mechanical exhaust
hood and duct
I nsta I I /a I ter/ rel ocate
di ctri h fppdprc ['lood stove/heater
7 0f s.
q)
ISSUANCF OF PFRI{IT
TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES
WHERE STATE Llltl REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAHINED the completed application for oermit, and do hereb.y 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 0rdinances of the Cityof Springfield and the Laws of the State of Oreqon pertaining to the work described herein, and that N0 OCCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that m.y registration vrith the Builder's
Board 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 ORS 7n1.055 wi"ll be used on this nroject.
I'lAt'lE ( p1 ease pri nt )S IGNATURE\M" R-|)SS
F0t1 0r
Ftg
Ftg
Ftg
Uni ts Value
Value
ToTAL VALUATI0N_
x
Load
x
s q
Flood Plain Stori es
xr Val
l4ain
Group Sq
Zone Const
Fire Zo Bedrooms Access
0ther
Plan Ck. Conrn/Ind
65%/Bldo Per Fee rqe (i.szSvs
Cha
tems Deve'opmentBUILDING PERI'IIT
Charges and \Surcharges J I
3 t_oo
Fee
Plan Ck. Res
30%/Bldo Per
FencePLUi4BING PERMIT
Charges and
Surcha rges DEmo
Sldewal kELECTRICAL PERIIIT
Charges and
Surcha rges A/C Paving Tota'l Comb. Permit
Curb CutI4ECHANICAL PERMIT
Charges and
Surcharges 3a,5sTOTAL
J
,I(IRS
\
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Hap Reference
17 03 43?. e;arnple- Lot 1. Block 3, Znd Addition toSFIIfsField EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. exampl e-2. exampl e-E. Squa re -ffi6:tag
hea t/e I iti or forced air gas
wa te ea or solar
e or va]uati on, etc
II.
l. example- 1250 sq. foot house, 500 sq. foot garage2. exailile- r'f new project, cheik-new - it adOitioi,
check add, etc.F. Building permit information:1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert single family residence inlorestaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structura l Specia l ty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriite
persons regarding design information or job sitecorrections, etc.
Abbreviated P)umbing, Mechanica'1, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Eiectrical Schedules
are available at the Building Div.ision1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF hIILL FILL OUT ALL FEES AND
(ar
l-t5
tu
-r(
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label mustelectrical contractor for signaturesupervisor. The general contractorto sign the electrical label.
be delivered to the
by his electricalis not authorized
III Applicant to sign and date
Whenever possible, the initial application will be used asa.worksheet only. Where possibie, Building Div.ision Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
IV
V Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration w'ith the Builder's Board because:
Additional Project Information :
PLANS REViEWED BY:
name s'l g nature date
G