HomeMy WebLinkAboutPermit Building 1984-08-07I IiSPEC
726-37 . CTTYTF SPRTNGFTELi-
COHBI IIATION APPL I CATION/PERI.IIT 7?6-3
Job Address
Legal Description oq\o\
Ranqe
l,Jater Heater
EIIERGY SOURCES
Hea t
Owner Cer."H-SdB-
Sq. Ftg. Access._
Sq. Ftg. 0ther
-llewJdd-AlG;-l[ep. -
_Fence_Demo Change/Use
0ther
nSq. Ftq
Addres \)S,\ Phonu,r,(rq\\\BuiIr.inq Permit Info: Desaribe l^lorkIFamily llesidence l,lith Attached Garaoe
:e., Build Single
E t rc^.exrc Oae Q\ucrr.I I
Addre s s Phone L
"0tcu
LrI
qtl name address exDt res ohone no.
q
Mechan i ca I
El ectr i ca I
Structura I
Pri
PI
El ectri cal ?
ftechanicat \J \
PLUI4B I NG ELECTRI CAL MECHAN ICAL
FEE CHARGF NO FFF CHAAGF NO FFF CHARGF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU' s
Relocated buildinq
(new fix. additioial)New circuits alts.or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERVICES Recessed wal I
Soace heater and vent
Duplex (I bath) each
Additional bath Temporary Constructi on Apol iance vent
seDa ra te
l.later servi ce Change in existing
resi dence
Stationary evap.
coo l er
Sewer multifamily, comm
Industrial
0r Vent fan with
sinqle duct
Storm Sewer 0f amps.apart from
,. c.
Vent system
heatinq or A
COMI.1./IND. FEEDERS Mechan'icai exhaust
hood and duct
Instal I /ai ter/rel ocatedist-rih- feeders l/ood stove/heater
0f
ISSUANCE OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAt,l REQUIRES that the Electrical work be done byshall not be vali,J until the label has been signed by an Electri
an Electrica'l Contractor, the electrical portion of this pernit
ca1 Supervisor and returned to the Building Division
llAl'lE(please print)IGNATURE DATE
any
of Ci ty
made
L EXAM EDN the e tica foon r t andc0mpDerm l here certi ttha ab.y onti reonhe s ruetfy
nda rrectco and rfue cert hatrth t ap !')
and a oerfowork shrmed afy be nedo n cca wlordance th t Ordihe ncena ofs theofpr'ls fi e anddng Lthe oaws Stathe te rta n to kDCtherwo desc r herebed n0relron andg th at NC PAr.rcOCCU wl betSructaofnyuretwluthothesrmlsonpeofhetBudiv1DisonfucertrtherathtsttraonthVJIButhe sfyreqderBoardsfuforcendefafects
ng
701 0 55 tha fredORS ba fS o+erequby t 0n noteds reonhe thaand tonsu bcontr ac to rs and awho re n aempoyeesc0mc nce thwl 70Rs 0 055 sedu on s toroj ec
fzD
Flood Plain- Stories \ 0ccy Group Sq. FtS
TOTAL VALUAT
x
Other \t\
Va 'I ueBedrooms - 0ccy Load Sq. Ftg. Acce
zo nC\\.R__rvp./ con' N:\}_u ni ts
Fire Zo
VaI
FtQ. l,lain i, x Val
Plan Ck. Corm,/Ind
65%/81do Per Fee \t- ($p trs\Svsteris Deve
charqe (1.52 opmeot 4r.6()BUILDING PERI'IIT
Charges and
Surcha rges .q(2
@
PIan Ck. Res
30%/81do Per Fee
I
FencePLUiIBING PERMIT
Charges and
Surc ha rges Dgmo
Sidewai kELECTRICP,L PERI1IT
Charges and
5u rcha rges Total Comb. PermitA/C Paving
Curb CutCharge
Surc ha
IIECHANICAL PERMIT
s and
rqes TOTAL rlil (16I I'-
Construction Lender nr
COMBINATION APPLICATION/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, ?nd Addition to
SE'FTn-ETield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1. examp l e-?, exampl e-
Square foota
air gas
E l. example- 1250 sq. foot house, 500 sq. foot garage
?. example- 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 room3. example - convert singie family residence into
iEs-taurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. 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.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are. not qovered on
the abbreviated schedules you should consult thefull schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.
Applicant to sign and date
Hhenever possible, the initial application will be used as
a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
s i g nature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these
fees are paid. Ail other fees and charges are due and
payable when the permit is issued.
FOR OFFICE USE ONLY
j L't \
h-$6 &
II
III
IV
V Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :FE s.*rr \su € LEcrB\c(\\-\) oPK\\\
NSSr-(\c)rs \\Yr \\S\€.S \ur OQC\\L\CrI- ?E({\fr\
I
PLANS REVIEWED BY:
n Si gnature date \-ttt\
\
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Addre sr
ol Description
ro
Fo
Ro
Work:
Qoooo
rng
Phone
Fence- Demo-Chonge/ Use
Address
&
ched Go
Sq. Ftg. Access.
Sq. Ft9. Moin
INSPECTION IINE
72fF3769
INFORMATION TINE
72837s3
-Other
........=-........=-----
Sq. Ftg.
CITY OF SPRINGTIETD
COMBINATION APPITCAIIONi PERMIT
ENERGY SOURCES:
Heol
-
With
Permit lnfo: Describe Work (i.e., Build Single
Consfruction lender // /l
,4-tr
"0(-cr
w-s
/VftAddress Phone
(nome)(odd ress)(lics. no.)(expire s)(phone no.)DESIGN TEAM
primory fa(D 6ett Zrzr///rAtfuLdl DenzrttrunT /6809 lfacfBon; /Ot/€. /aur^.e'.Otrf O4)?9'-65AQ
!'rr uciurcl
iiectri rol
/viechonical
!3!134ci
iis-:ei-q]---
f !unL
(oddresri (iics. no.)iexpires)!r:_
PiilM5iNG EI-[CTRICAt MECH/.NICAt
NC FEF f,!a :FEi CHAF{:.I.
iixture
--BTLI'S
{urnoce/burner lo
A,pplionce vent
Stolionary evop.
cooler
Vent fsn w'!th
duc*
FEE CHARGE HC"CHARGE
Iiesidence oi
aL
r5;\\a?
SERVTCES
Nev circuits, olterotions
or exlensions
Temporcry Conslruction
Amps.
Reloqoted building
{new {ix. odditionol)
S.F. Residence
--LL!g:!f- -
Duplex (l bolh) eoch
Additionol both
Yent Jyslem oport from
hecting or A.C.
ilechonicol exhoust
hcod ond ductWoier service
Wood stovel/heoterSewer
FEEDERSStorm Sewer
Ampr.
Heot Purnp
Air hondler lo
10,000 cFM
Air hondler over
't0,000 cFM
Nrrs \L\FP\\oL)
\Dco( \111-Qq2p15\
a
\o.oD
ISSUANCE OF PER,I$.IT
TOTAI. CHARGESTO]AL CHARGES \\N
WHERE STAIE tAW REQ|IIRES rhor rhe Electrical work be tione by the Elactriccl eonlrdctor, the electricul portion of this permit, shal! not bo vq{id unlil c
label hos been :igned by on Eleclriso! Conttq€tar ond ottoched to the aleelricol poael.
TOTAT CHARGES
oo\
I HAVE CAREFULLY EXAMINED the comple?ed opplicction for permit, ond do trereby certify thot ol! informstion hereon is lrue ond correct, ond I further
ceriify ihot ony ond oll work performed sholl be done in ocordonce with the Ordinorrces of the City of Springfield ond the Lows of the Sfote of Oregon
pertoining to the work described herin, cnd thqt NO OCCUP,AN,CY will be mode of ony struclure without lhe permission of. lhe Building Division. I further
ertlfy thot my reglsfrcrion with the Builder's Boqrd is in full force ond effect os required by ORS 701.055, thot if exempt the bo:is for exemption is note'f
heron, ond thot only subcontroctors ond employees who ore in omplione wifh ORS 701.055 will be used on lhis proiect.
Bosis for Builder,s Boord exemprio n.,l/rr 4eo,tnaT Faa 4atu*tc77c4r< qdea( Aofl'/'cfrE
SIGNATURE
q
D^TE 2 -/ l'NAlv{E (pleqse print)
FOR OFFICE UsE
Plon Ck. Comm/lndBUII.DING PERMIT __iz3 oooo
%
-So.
Ftg. A,ccess
Flood PIoin
Yolue
Sysiems Development
Zone
Group-Sq. Ftg. Other
Per
Plqn €k. Res
Per
Const.
Chorges ond
Surcho rges
x
-Yolue
x
---VqlueTOT/.[ YAtUATiOi.{ .
nils -.=-Sq. Ftg. Moin
Fire Zone
-
Bedrooms
-_
occy Lood
Totol Comb. Permit
PTUMBING PERMIT N
Demo
Chorges ond
Surchorges
__\ag_C&
Sidewolk
PERMIT
Chorges ond
Surchorges
TOTAT \3\ 2<
MECHANICAL PERMIT
Chorges ond
S urcho rg e r
Curb Cut
co
r\o_-\
J /v/aftau(/E
Woler Heoler --.--_-
owner rtlgZzv l-tsruarr
,(.4.
Fanca
A/C Povino
coMBINATTON AppLtcATtON/pERA._ _.p)
l. Applicont tg furnish
A. Job Address
B. Legol DescriptionI. exomple-lox lot.1 00, Lone County Mop Reference I7 03 432. exomple-Lot l. Block 3,2nd Addition ro Springfield Estores
C. Nome, etc. of owner ond construction lender
D. Energy Sources
1. exomple-heot/'electricol ceiling i 6l. forced oir gos2. exo m p le-wo terTeoteilelEctri co l . o r- solE?--
E. Squore footoge or voluotion, etc.I. exo e-l 250 sq. foot house,500 sq. foot goroge
nE-w-if odd ition, check2. eE new project,check
o , elc.
F. Building permit informoiion:
I. exomple-conslruct single fomily house with on otloched
goroge
2. exompie-remodel existing goroge into fomitv room
3. Jiarnp=Ie-convert single fomily residence inio
reiicuront (chcnge of use)
G. Vqlue of work os defined in Section 303 {o) of the
Strucrurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Stoff must be oble to contocf oppropriote persons regording
design informoiion or iob site correetions, etc.
ll. ,A,bbrevioted Plumbing, Mechonicol & Electricol S.:l';edules
A. Except where blonk spoces occur in the description poriion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electri*al Schedules
ore ovoiloble ot the Building Divisior,
'I . To ionserve spoce on the permit fornr the schedules
hove been obbreviored
2. lf the item(s) ro be instolled ore not cove'red on the obbrevi-' oted schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL TILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dqte
Whenever possible, the initiol opplicotion will be used os o
worksheet only. Where possible, Suilding Division StCIff will
prepore o typewritten copy ond relurn i? to the oppliconl ot
the time the octuol permit is issued for his signoture,
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicction,
ond no plons will be processed until lhese fees ore poid. All
other fees ond chorges ore due ond poyoble when the permif
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Cm.qf,-\\"u\t\\ g tI)c-GN \crx-\ O\ T\DgAdditionol Proiect lnformotion:
EIC(r,rrCat\ \s\\tTQ- Lr-) r SQLu-\c^L \6r f\ T r D e HNvs,rrs.ru
r 2 c-- a-1i.1
t
T
PLANS REVIEWED BY
signoturenom dote
:MIT VALIDATION
+ ('7 a'{'uq
prL 4'/'
Permit Clerk
\*\r,-*
726-
ECTION LINE
37 69 COMBI TI APPL I CATI ERI.t I T . 7?6
Job Address SO EIIERGY SOURCES
Hea
l.later Heater
Fto. l.lain_
Sq. Ftg. Access._
Sq. Fto. 0ther_
_l{ew_Add A'lter_Rep.
_Fence_Demo Change/Use
0ther
o\
lo
Ys+
Oe
l-ega1 Description
Owner
Value of l,lork
Address Phone Buildin
Farni ly
q Pernrit Info: Describe l,lork(
Residence l,lith Attached Garaqe 'e.; Build Single
Construction Lender
Addre s s Phone
DES I GN TEAI4 name address I CS. nO exot res ohone no.
Pri mary
Structura I
EI ectri cal
Hechan i ca l
ACTORS n ame addres s I i cs. no.exDt res ohone no.
Genera I
Pl umbi nq
'/ (,e (-6 2y'7a&/EI I I o
PLUI,{B I NG ELECTRICAL MECHAN I CAL
FEE CHARGE NO-FFF CHAPGF NO FFF CHARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extensions
Floor furnace
and vent
S. F. Residence(l bath)SERV I CES
Recessed wal I
Soace heater and vent
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
seoa ra t-e
talater servi ce C han
res i
ge in existing
dence
Stati onar,v evap
cool er
Sewer multifamily, comm. or
I ndus t-ri a l
Vent fan with
sinole duct
Storm Sewer 0f amps.Vent systern apart from
heatinq or A.C.
cOr.il'1./IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
distrib- feeders l'lood stove/heater
0f amps
.? o'e ./ro4a /tl,u)
-st)1J /J-o4
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES o*Y TOTAL CHARGES
WHERE STATE LAl,l REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electr
shall not be vali:l until the label has been signed by an Electrical Supervisor and returned to the Bu
ical portion of this permit
ilding Division
completed apnlication for oermit, a hereb.v 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 City
of Springfield and the Laws of the State of Oreqon oertaining to the work described herein, and that NC OCCUPAI{CY will be made
of any siructure without the permission of the Building Division. I further certify that m.y registration v,ith the Builder's
Board is in full force and effect as recluired by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees r.rho are in comoliance with 0l?S 701.055 wilI be used on this Droject.
IlAl.lE(please print)E S IGiJATURE TE o\
Zone Const.its Ftg
Ftg
Ftg
. l'lain
. Acce
X Val ue
Fire Zone Bedrooms Load lq x Val ue
Flood Plain S 0c c.y Group Sq.x Val Ip
ToTAL VALUATI0N_
tori es . 0ther
BUILDING PERI'IIT
Charges and
Surcharges
Plan Ck. Corm/Ind
55%/Bldo Pcr Fee
teris ve
5'/"
opment
1
PIan Ck. Res
30%/81dq Per Fee
PLUI4BING PERHIT
Charges and
Surcha rges
Fence
Demo
ELECTRICAL PERI1IT
Charges and
S u.rcharges
1s od
6o
Sidewal k
A/C Paving
Curb Cut
Total Cornb. Permit
14ECHANICAL PERMIT
Charges and
Surc harges
$oToTAL /J-,/s 6:
COMBINATION APPLICATION/PERMIT ( CAP)
Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, Znd Addition to
Springfield Estates
C. Name, etc. of owner and construction lenderD. Energy Sources
1. exampl e-2. exampl e-
E. Square footag
hea t/cal ceiIin or forced air gas
wa e or solar
e or valuation, e
1. example- 1250 sq. foot house, 500 sq. foot garage
?. example- 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 room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Bui!din9
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.II. Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description
portion 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 Electrical Schedules
are avai lable at the Building Division1, To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrical
supervisor. The general contractoris not authorizedto sign the electrical label.III. Applicant to sign and date
lrlhenever possibie, the initial application will be, used as
a worksheet on1y. l,lhere possibie, Building Division Staffwill prepare a type written copy and return it to the
applicant at the time the actuai permit'is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wi1 I be processed untiI these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
N* bzqbZ
t1",/*,/
Perm'it Cl erk oA/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because
Additional Project Information
PLANS REVIEWED BY:
name S1 g nature date
I iISPECT I OI,I L iNE
726-37 69 COHB I CAT I ON RJ{IT 726-3753
Job Address
Legal Description \\ct5zs 3q oq\o\
EIIERGY SOURCES:
Hea t
l,later Heater
Ranqe
ou'n'" \\c-\cN \:rlgtrne\)a. co.
Val ue of l.lork:?.SCY)-
Sq. Ft9. I'lain_
Sq. Ftg. Access._
Use
Sq. Fta. 0ther
Address2-raaa Ct\\c!^otr\\)E\ Phons{s*c<r\\\tI Descri be
Fami I
n k .e., Build Single
Eug.gr.:e OQc- Q\um I ,
Construction Lender rl
Addre s s Phone )
"0tcI
0)I
IJL5IGN It.AI.l name addres s 'I ics. no.exo t rFs ohone no.
_9r,x-e\)E. Oa€ Q\qorPri ma q
structural \p.1.f.fe \\. \a.lfr Sr \-fq-F-(tcb\ \rr- t3ri
EI ectri ca l
l'lechani ca l
name address 'I ics- nn exD l res (ohonp no-
2SCnesrno\)'tr\\\r$t e \)c\F.\\F. L\t5qql\Gen I
Plumbinq \l.N?
Itectranical \l N.
PLUIlB I NG ELECTR I CAL HECHAN I CAL
N0.FFF NHARGF NO FFF rHAPN F NO FFF CHA RCF
Each single fixture Residence of
SQ. FT
furnace/burner to
BTU, s
Relocated buildinq
(new fix. additioial)New circuits alts
or extensions
Floor furnace
and vent
S, F. Residence(l bath)SERV I CES Recessed wal i
Soacp hcatpr and vpnf
Duplex (I uath) each
Additional bath Temporary Constructi on Apol iance vent
sepa rate
l.later service Change in existing
res i dence
Stationary evap
coo I er
Sewer multifamily, comm
Industrial
or Vent fan with
sinole duct
Storm Sewer 0f amps.Vent system apart from
heatino or A.C.
COMI'I./IND. FEEDERS Mechanical exhaust
hood and duct
Insta l I /a1 ter/rel ocate
di qfri h fppdprs l'lood stove/heater
0f s.
ISSUANCE OF PFRI{IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,1tl REQUIRES that the Electrical woshall not be vaiiC until the label has been signed
rk be
by an
done by an Electrical Contractor, the electrical portion of this pernit
Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apolication for oermit, and do herecomect, and I further certify that any and all work oerformed shall be Ci ty
madeof
of
Boa
b.y certify that all information hereon is true
and done in accordance with the Ordinances of theSoringfield and the Laws of the State of 0reoon oerta.inin g t0 the work described herein, and that NC 0CCUPAI,|CY wilI be
reqistration vlith the Builder'sssion of the Building Divi sion. I further certify thatany structure without the permi
rd is in full force and effect as required by ORS 701.055, that if basi s ion is noted hereon, and thatonly subcontractors and employees who are in comoliance with 0l?S 701.055 used on h i s oroject
fzDl{AllE(please print)S IGNA'
zonC\\.L
-ryoe/cors$)_units
- so. Fts. r,tai
Fire Zone - Bedrooms 1 Occy Load So. Ftn
Flood Plain- Stories \ Occy Group Sq
V
TOTAL
Access x Va'l
Ftg . 0ther lue
Val ue
Plan Ck. Conm,iInd
657"/8lrlo Ppr Fpp \t- (Hn.rrru\svsteris Deve
Charqe (1.51 opment 4I.50BUILDING PERI.IIT
Charges and
Surcharges
co
qb PIan Ck. Res
30%/Bldq Per Fee
,
FencePLUHBING PERHIT
Charges and
Surcha rges Dgmo
Sldewa l kELECTRICAL PERIIIT
Charges and
! l rcha rges A/C Pavi ng Tota l Cor,nb. Permi t
Curb Cut rlil (16I l'-
IlECHAN I CAL PEP.HIT
Charges and
Surc ha rges TOTAL
\CTORS
El ectri ca I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, 2nd Addition to
SETin'sTielO EstatesC. l{ame, etc. of owner and construction lender0. Energy Sources1. example- heat,/electrical ceilino/oZ. example- waterheater/ejectrical/or
Square fbotage or valuation,-etc. -l. example- 1250 sq. foot house, 5002. Exaffile- JT-i'ew project, check-new
check add, etc.F. Building permit information:1. example - construct single family house with anattached garage
?. example - remodei existing garage into fami ly room3. example - convert single family residence inlorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropr.iitepersons regarding design.information or job sitecoffecti ons , etc .
Abbreviated Plumbing, Mechanical, & Electrica't SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in only the No. Boxes adjaientt0 the appropriate item(s) to be installedB. Fu'll Plumbing, Mechanical, and Electrical Schedulesare availab'le 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 shouid consult theful l schedulesC. BUILDING DIVISION STAFF l.lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricaisupervisor. The general contractor is not authorizedto sign the eiectrical labei.Applicant to sign and date
lJhenever possible, the initial application will be used asa-worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual perm.it is issued for hissignature.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wil) be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
II.
III.
IV
V
r forced air qas
solar
sq. foot garage
- if addition,
E
PERMIT VALIDATION
Permit Clerk
\4
*(,
+
A6
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REViEWED BY:
oate\-3\-BqS1gnature
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
INSPECIION TINE
7263769 CIIY OF 9PRINGFIETD
COA{BINAIION APPTICAITON / PENA{IT
INFORMAIION TINE
7263753
Addre:r
Descripfion
Owner
ENERGY SOURCES:
Heot --.................'==-_EASq. ftg. ,Accesr
Sq. Ftg. O
-Alter-Rep.-
-New
Woter Heoler
5q. ftg. Moin
-Fence-Demo- Chonge/ Use
_nrLa,&
Vol
ooooo
Addre ss Phone Gqro
Building Permit lnfo: Describe Work (i.e., Build Single
dtr /</<Yrtr&
Addre rr Phone
.0sot\.\$.-s
(nome)(odd res:)(phone no.)DESIGN TEAM (lics. no.)
f3ettPrim 1
i-'.!!rsl
Liectri;cl
l-qechonical
coi.rTRAcI.f Is
L
I
F
It_
no m Fi)(otid nc.)(expires)(plr:r^ r c.)I
I
"F!-_L ,\/,4
'r!e:'ri:,:!
I
IL--
I
I
!
i
L,
7
retircnicol ?
Pi.U/Y'IJING EI.::CTRICAt MECHANiCAL
FEF CHARGE NG.FE
Re:irience o'I
fr
Reloroted buiiding
(new {ix. ociditionol)
S.F. Residence
(l both)
bolh) eoch
Additicnol both
I
I
FEE CHARGE hro.
Eosh sinqle fixlure
furnoce/burner to
--BTU'S
cr)\ i--Applionce veni
sepc rqle
Nerv circuits, olteiotions
Or ex?cnStOnS
SERVICES
Stotionory evop.
cooler
Vent fqn w'ith
sinqle ductTemporory Conslruction
Amps
Yent syslenr oport from
heoting or A.C.
Woler service
Mechonicoi exhousl
hcod ond ducf
Sewer Wood stove / heoter
Storm Sewer FEEDERS
Amps.
Heqt Pum
Air hondler to
I CF,!{
Air hondler over
I 0,000 cFA
RFrrr Nr\F.9tss\ott)
I \lrrr-r tur.\r\\Dco
TOTAL CHARGES \o.oD
ISSUANCE OF PERrrtlT
TOTAT CHARGESTOTAL CHARGES
I HAVE CAREFUttY EXAMINED the completed opplicotion for permit, ond do hereby certify thot ol! informotion hereon is lrue ond correct, ond I further
certify thot ony ond oll work performed sholl be done in ocordonce with the Ordinonces of the City of Springfield ond the Lows of the Stote oi Oregon
pertoining lo the work described herin, cnd thor NO OCCUPAN,CY will be mode of ony slructure without the permission of the Building Division. lfurther
ertlfy thot my registration with the Builder's Boord is in full fore ond effeci os required by ORS 701.055, lhoi if exempt the bosis for.exempiion is nobd
heron, ond thot only subcontroctors ond empioyees who ore in omplione w ith ORS 70I
Flood Ploin-E- Stories I Occy Group-Sq. Frg. Other
-./l-NA,lvlE (pleose print)DATE
Systems Development
q"
J
?{;.
Bosis for Builder's Boord exemption:llr tqeouna/t tsaz 4atr.ttezz'cttl< fiatg.tt
So Ftg. Access
Sa Ftg. Moin x Volue
7r)6s9Ll Per
.055 will be u*d on this proiect.
Plon Ck. Comm/lnd
Plon Ck. Res
Per30%
\
FOR OfFICE U5E
SIGNATURE
Zone TTpe/ Const,
BUITDING PERMIT
Chorges ond
Surchorges
x Volue
a
-Volue
TOTAT YAI.UATIOi.I .
Fire Zone
-
Eedrooms
-
occy Lood
< L.!,
<..1,
Totol Comb. Permit
PTUMBING PERMIT
Chorger ond
Surcho rges
Fe\'
Demo
EI.ECTRICAL PERMIT
SidewolkChorges ond
Surchorges
MECHANICAT PERMIT
Chorges ond
Surchorges
Curb Cut
TOTAT \3\ 2(
i
WHERE SIATE tAW REQUIRES ,hot ,he Electricol work be tione by tha Electricsl eontrqclor, the cleclricol .portion of this pe;mit' rhal! not ba volid until c
lobel hor been signod by on Electrico! Contrsctor snd ottoched to the electricol palel.
)(
\r-et o -r' \-r
,cl oo tal0(q.r I -5911
i
A/C Pavina
COMBINAIION APPLICATION/PERM,vTCAP)
l. Applicont t9 furnish
A. Job A,ddress
B. Legol Description
l. exomple-tox lot .l00, Lone County Mop Reference IZ 03 43
2. exomple-Lot I. Block 3, 2nd Addition to Springfield Esrores
C. Nome, etc. of owner ond construction lender
D. Energy Sources
1. exomple-heot/electricol ceiling,/or forced oir gos
2.exo;;E-woterTEEGiEEctrk-tricol,'o.-sqE,.:
E. Squore footoge or voluotion, etc.l. exomple-1250 sq. foot house, 500 sq. foot goroge
2. exomFlE-iT nEw proiect, check new-if oddition, check
odd, etc.
F. Building permit informotion:
'I . exomple-conslrucl single fomily house wilh on otloched
goroge
2. exompie-remodel existing goroge into fomity room
3. cianol-e-convert single fomily residence into
lls-tarrront (chonge of use)
G. Volue of work os defined in Seciion 303 (o) of the
Structurol Specio lty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or conslruclion deloys, Building Division
Stoff must be oble to contoci oppropriote persons regording
design informotion or iob site corrections, etc.
ll. Abbrevioted Piumbing, Mechonicol & Electricol Schedules
A. Except where blonk spcces occur in the description poriion
of the Mechonicol ond Electricol Schedules, the opplicunl
need fill-in only the No. Boxes odiocent to the oppropriole
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Divisior.
'I . To conserve spoce on the permit fornr the schedules
hove been oL;brevioted
2. lf the item(s) :,: be instolled ore not covered on the obbrevi-
' oted schedules you should consult the full schedules
C. BUITDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, lhe iniliol opplicotion will be used os o
worksheet only. Where possible, Suiiding Division Sroff will
prepore o typewrirten copy ond return it to the opplicont ot
the rime the octuol permit is issued for his signolure.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of lhe opplicolion,
ond no plons will be processed until lhese fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
-"JERMIT VATIDATION
+ (/1aaX.x."
0 4'/'
PP
Permit Clerk o
PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY:
CCf>tS)rr \f\\t= r r-\c ()S rcx\ c:\ T\D€Additional Proiect lnformotion:
C?fflr \Ca,\ \ \t\\EB - \ x\ r :Qflrt"\ta\'\e{ n :[ i Dtr HNtzsrtu.t-u
r 2G^a-1i=1
PLANS REVIEWED BY:
no signoture dote \ -\, --