HomeMy WebLinkAboutPermit Miscellaneous 1984-2-8
I INSPECTION LINE
726-3769 :
: .....
.
CITY UF SPRINGFIELO
COMBHIATION APPLlCATION/PERMtT
E!lERGY SOURCES:
Heat
Hater Heater
Range
~i""4l~ 'I 0
INFORlIATION LINe
726-3753
Sq, Ftg, I,'ain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Rep,
-Fence Oemo Change/Use
Other- -
Q
C)
o
:J-
'00
Job Address \S~?l ~ll
Legal Oescription '\I()~~ c; ~~()~U(X)
owner',Q)i\J_Vl-.~,.1. 0-1 ri~#ol,,-~rl'1- ~.~
Address 1 S, <., -:z., ~ /~ I 1 . 'i-i, P'\,l\ne
Address
Uc>lGrl I cAli
(name)
Phone
(address J
va1l~f4.o3:ro
Buildina Permlt Info: Describe Work(i.e., Build Single
Familv Residence With Attached Garaael
<!-~1~ r )1.U.0J.-,
R './Y>A.JH ~, X j':JA ''''' J f d--4/ ,; R~!t~lM b
lM:.j A J f'AlA,JJoy" P ,;Jo 0 .JJd..iJJ,
(lies. no.) (exoires1 I, vr {ohane no.l
~~
,~
P' -
Construction lender
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name)
General f.Rll\~ ~I\-l~! - ~1
Plumbino ~ U \\
(address 1
kX./L ~
r1frA'f
7 <{~-?':'7/
/3'22.
(li~ no.) ~nirp~)
N <,Q /lnlM (oO()'Z,
, )
(nhnnp no, \
Electrical
Hechanical
PLUIIBING
ELECTRICAL
MECHANICAL
SQ, FT,
furnace/burner to
BTU's
I='~r rI-lAQ~~ ~
NO,
FEF CHARr,F NO
~~~ rI-lAR~~ NO
Each single fixture
Residence of
,
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Sewer
ITemporary Construction
IChange in existing
rp~ i rlJ'~nrp .
Imultifamily. comm. or
TnrllJd.riill
IOf
ICOn1,/INO, FEEOERS
IInstall/alter/relocate
rlidrih. fpprlprc:.
IOf
I
I
I
amps.
Appliance vent
!;.eoa ratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnrl ~nd duC':t
~Iater service
Storm Sewer
Wood stove/heater
amps.
ISSUANCE OF PFRltlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
, WHERE STATE L,\\~ REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINEO tile completed application for permit, and do hereby 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 Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7n1.055 will be used on this project.
1lAf.1E(please print)"A1 bJ~ R, J<. ; "" SIGIIATURE~ d).....~JP , ~P-rV
J.( .A.-... OATE .).
v FOn OFFICE USE OJILY ~ ~
Zone Type/Const, Units Sq. Ftg, ria;n x Value
Fi re Zone Bedrooms Occy load Sq, Ftg, Access x Value
Flood Plain Stories Occy Group Sq, Ftg, Other x Value
TOTAL VALUATION
BUILOING PERHlT
Charges and
Surcharges
/If). 60
---4~-~<g---
Plan Ck, Comm/Ind
65%/Bldo PH Fpp
Plan Ck, Res
30%/Bldo Per Fee
Fence
Systems Development
Charqe tl,5~) "
PLUI~BING PERMIT
Charges and
Surcha rges
O~o
ELECTRICAL PERI:IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
A/C Pa vi ng
I Curb Cut
------------1
Total Comb. rerm;t
I
I TOTAL
rl \ (P ,c.f~
"
.'
;-
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Oescription
I, example- Tax Lot 100. Lane County Map Reference
1/ 03 43
2, example- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, examele- 1250 sq, foot house. 500 sq, foot garage
2. example- if new project. check new - if addition.
check add, etc,
F. Building pennit information:
1. example - construct Single family house with an
attached garage
2. examEle - remodel existing garage into family room
3. examole - convert single family residence into
restaurant (change of use) ".
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, OESIGN TEAM ANO 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.
II, Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No, Boxes adjacent
to the appropriate item(s) to be installed '
6, Full Plumbing. Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit "form the schedules
have been abbreviated
,2, If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C, BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
0, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to..sign the electrical label. -
Applicant to Sign 'and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
Signature.
IV, Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the penmit is issued.
,
III.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
-
PERMIT VALIDATION
jJ:.
J~5~D
~6~84
~
o
Permit Cler
Permit applicant exempt from registration with the Builder's Board because':
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date