HomeMy WebLinkAboutPermit Building 1985-05-07Ae\
INSPECTION LiNE
726-37 69
CITY OF SPRIN6FIELD
COHBI NATI ON APPLICATION/PERMIT -TNmRr,ATTmEsf7?6-3753
Job Address /3 05 7'H
Legal Descri ption 11.41 t
Hea tEIIERGY SOURCES
l,later Heater
Range
Owner
VnluE of l.lork:T6 yf,?o,-o
Sq. Fts. t'1ain1l6g1l2
So. Ftq, Access.:=tW,77Z-
l!'lew_AddJliarI[epl_
_Fence_Demo Change/Use
-other..-.---
7HAddress t In scrn
F I
.€., Build Single
llSa (-4 ,'rt--
Construction Lender a46'R /a-=
Addres s Phone 4
DOvlS
-l
O(
oO
I]15 ] GN EAI.I name addre s s I ics . no.)exD r rFq ohone no.
Prinary .' e E -, flx=r.-8?1aauru.,b.-Eoa*e.6*>am
Structura I
El ectri cal
Mechani ca l
CONTRACTORS name addres s iics- no- )ex0l res ohone no- )
a-ujvuu-a,Genera I
Pl umbinq
El ectri caI
I'techan i ca l
PLUI1BING \l ELECTR I CAL MECHAN I CAL
FFF CHARGE N0_FFF .HAAGF NO FFF CHARGF
€Each single fixture l'cta 60 Res.i dence of
SQ. FT
furnace/burner to
BTU, s
lfi*
Relocated buildinq
(new fix. additional)New circuits alts
or extensions2 aQ ,vro.A
Floor furnace
and vent
S. F. P.es i dence(1 bath)SERV I CES Recessed wal I
Snacp hcaipr ind vpnf
Duplex (1 bath) each
Additional bath Temporary Constructi on Apol iance vent
separate
llater servi ce Change in existing
res i dence
Stationar.v evap.
cool er
Sewer multifamily, comm. or
Tndrrstrial I Vent fan with
si nol e duct g.*
Storm Sewer 0f Vent systenr apart from
heatino or A-C.
c0Mr.1./rND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al ter/rel ocate
di stri b. feeders l'lood stove/heater
0f amps
ISSUANCE OF PFRI{IT
TOTAL CHARGES 25,n TOTAL CHARGES /s'>TorAL CHARGE} /v//y, /2.-o
WHERE STATE LAN REQUIRES that the Electrical work be done by an E'lectrical Contracshall not be vali'l unt'il the label has been signed by an Electrical Supervisor and ret
tor, the eiectrical portion of this permit
urned to the Building Division
oertaining to the work described herein, and that N0 OCCUPAI,ICY will be
and employees who are in compliance wi
KoeeKT 14, Rn u Ds4-t-S-rl{AtlE(please print)SI
any
of Ci ty
made
true
di
I HAVE CAREFULLY EXAI1INED the completed apo) ication and do hereb.y certify that all 'information hereon isfor oermit,
oerformedand correct, and I further certi fy that and al l work shall be done in accordance with the 0rdinances of theof Springfield and the Laws of the State
further certify that my registration vrith the Builder'sof any
Board i
structure without the permission of
0regon
the Bui I Divi s ion. Is in full force and effect as required by ORS
ng
701 055, that if exempt the basis for exemption is noted hereon, and thatonly subcontractors th 0l?S 701.055 wilI be used on this oroject.
F
Zonefi/rzltlf_1yoe/const. *tY units Sq. Fts
Fire Zone Bedrooms Occy Load Sq. Ftg
Flood Plain Stories 0ccy eroup,ty'-B sq. Ftg
luel4a'I n
x
Val u" /6&,o0
Val
*. E090ba
Acces
0ther
TOTAL VALUAT]
ue 4?O, oc
oN {f20.a'
Plan Ck. Conrn/Ind
65%/81do Ppr Fee 0r ld.oo rqe ( 1.52
Svs
Cha
tems Deve opmeot 2/.+BUILDING PERI'IIT
Clrarges and
Su rcha rges
___?_z=
Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcharges
-z ? 2,O3O.aa Dgmo al w;rrffi<_Y*al*v*T + ./.oa
Sidewal kELECTRICA,L PERI|IT
Charges and
Surcha rges 6o A/C Paving Total Comb, Permit I f,-zs
Curb Cut // 5 z6;
IIECHANiCAL PERMIT
Charges and
Surc harges .lo
a?
TOTAL
re Work (
I Garaop
___/_&_1:_
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources
PERMIT VALIDATION
1. exampie- he2. example- waE. Square footage
air gas
2
exampie- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check add, etc.
F Bui 1d ing perm
1. example -
a ttac hed
it information:
construct single family house with an
9ara ge
2. example - remodel existing garage into family room3. exempTe - convert single iaiily-residence inioiElTiuFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, I'lechanical, & 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. Ful l Plumbing, Mechanical, and Electrical Schedules
are available at the Building DivisionI. 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 thefull schedulesC. BUILDING DIVISION STAFF I^IILL 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 authorized
B bgcs+
g-1'gs
3 i0
to sign the electrical iabelIII. Applicant to sign and date
IV
l,lhenever possibie, the initial application will be used asa worksheet only. Where possible, Build.ing Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual 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 will be processed unt.il thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
I
v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
nane LdK^rA 7t€6< sisnature da te 8-4-.9f,