HomeMy WebLinkAboutPermit Building 1992-12-15 830513INSPECTION LINE
7?6-37 69
CI-TY OF SPRINGFIELD
COMBI NATI OI'I APPL I CATI ON/ PERMIT
I NFORI,IATION Li NL
726-3753
N$3o
G)
Job Address
r-esa1 Descriptlon I Z.A7 -3 O. Z q. t t] %
EIIERGY SOURCES
Heat
llater Heater
Ranq e
Sq. Ftq. l'lain /&Ot
Sq. Ftg. Access.-_--
Value of llork: - ooEst 65, ooa\a"i,/es l)* p *t
Addres s S,nqA Phone Bu 'I erntit Info ..e., Bui1d Single
Aurl/an aF r'sp<€3 ,A Aa>
Construction Lender {6s ct €.r7s2r-^ B.so*
Addre s s Phone ficrrr-jr7a: .
DES I GN TEAI.I name addre s s 1CS. nO-exD I res . phone no
Pri mar 72( --
Structura I
El ectri cal
l''lec han i ca I
CONTRACTORS name add res s I i cs. no.exD I res ohone no-
'al E gr.r- v>8 /
El ectrical 272 14 &fq
nt o
PLUIlBI NG ELECTR I CAL MECHAN I CAL
FFF CHARGF NO FFF rHA PGF NO FFF l.HA PGF
Residence of
SO. FT
furnace/burner to
BTU' s
Rel ocated bu i l ding
(new fix. additional)
New ci rcui ts al ts.
or extens ionsZ aZ ,b)o?€E.FIoor furnace
and vent
S.F. Residence
( l bath)SERV I CES
Recessed wal I
Soace heater and vent
Ouplex (l bath) each /,yl< oil rT ./ cr.e,
Additional bath Temporary Construction Apol iance vent
seDa rate
l,later servi ce Chang
rcsid
e in existing
pn ce
Stati onar,v evap
cool er
Sewer multifamily, comm or
Tndrrstrial
Vent fan with
s'inole duct-
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
,(/a.to COMI.I./IND. FEEDERS
Mechanical exhaust
hood and duct
D,,?nt Ttzroz Instal l /al ter/rel ocatedistrih- feeders l'Jood stove/heater
0f amp s.
ISSUANCE OF PFRIlIT /a,o'
TOTAL CHARGES /a.o'TOTAL CHARGES /f"TOTAL CHARGES /6.n
I.JHERE STATE LAI.I REQU
shall not be valid unti I
IRES that the Electrica] work be done by an Electrical Contractor, the electrica'l portion of this permit
the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication 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 0regon pertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my registration vtith 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 ernployees who are in comcliance with OPS 70i.055 will be used on this Droject.
I'lAl'lE ( pl ease pri nt )J E. /3ec/<S I GIIA :3 &-<,onrc >l kl ?3
Tone___1_4__Tyoe/const. 5-/ l/E un;t q. Fts. 111in /OAt*.Fl.x.-----Value 14,*,os
Fi re Zone Bedrooms Occy Loa d Sq.Ftg.Access x Value_
Flood Plain Stori es Group Zr-2 s x Val ue
TOTAL VALUAT TOTI 1 E qN.g.
q. Fts .0ther
BUILDING PERI.lIT
Charges and
Su rcharges
? /?.'-g,6A
Plan Ck. Comm/Ind
65"/./Bldo Per Fee
;vsterns Deveiooment
lbarqe (1.51)
P'lan Ck. Res
30%/81dq Per Fee
PLUI'4BING PERMIT
Charges and
Surcha rges
CrD
/a
Fence
Domo
ELECTRICAL PERIlIT
Charges and
Surcha rges
6-
6,0
Sidewal k
A/C Pavi nq
Curb Cut
Tota'l Cornb. Permi t 269,72
IIECHANICAL PERMIT
Charqes and
Surc harge s
-o
.6rl TOTAL { zea.z<
0ther
0wner
)e
I
lt'lo rk
Ga raor
1,,*e-< /,-hn.1n/
Each single fixture
COMBINATION APPLICATION/PERMIT (CAP)
L Applicant to furnishA. Job AddressB. Legal Description
I. 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
r forced air ga!
sol ar
sq. foot garage- if addition,
F. Bui)ding permit information:1. exampie - construct singie fami)y house with an
attached garage2. 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 theStructural Specia lty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated P)umbing, Mechanical, & 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 Plumb'in9, Mechanical, and Electrical Schedules
are available at the Building Divisioni. To conserve space on the permit form the schedules
have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF l^llLL 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 genera) contractor is not authorizedto sign the electrical labelIII. Applicant to sign and date
II
IV
l. example- heat/eiectrical ceiling/o2. example- waterheater/elEETiJtaTorE. Sguare footage or valuationl-ETEl--l. example- 1250 sq. foot house, 5002. example- if new project, check-iEw
check add, etc.
Whenever possibie, 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 actuai permit is.issued for h.issignature.
Fees and Charges
Plan check fees are due and payabte at the t.ime 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 ONLYV
PERMIT VALIDATiON
Permit Cler
*)
PROJECT CONDITIONS TO BE SATISFIED BEFORI OCCUPANCY
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name Lofrtre 7<eqgR sisnature date 2-t>-8 3
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