HomeMy WebLinkAboutPermit Miscellaneous 1987-2-9
II':SPECTIOIl LINE
726-3H~. .
Job Address ~&/q ~ I ~ (), 1"(1(\\ n rr!l
legal Omription 11.01.- Z 0- DOt) .....D7()l)
Owner \V\~)dcJ \kD~ h,r C\~\\A .~ ~a~u, ofl~r~7')6 t
Address'-:z/5.t':lr-:-" "'I ....Ar..\/1 Phone Bu;ldinoP~hnitlnfo: OescribeWork(Le.,
~1-1~ '\I\..fl, L-\U l..A.....- Far.nly ~esldence I-11th Attached Garaoe)
CITY OF SPRINGFIELO
COMBIIIATION APPLlCATIONfPERMIT
EilERGY SOORCES:
Heat
t~ater Heater
Ranqe
~
,.f-.
.
1'210.1%5
Construction lender
"-
Address
UI:.~lliH ItAI.l
(namel
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
.
INFORlIATION LINE
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
So. Ftg. Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other- -
~.
~
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.~
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Build Single
0~sh'LL~*I~q ~\tl\1 t'.ollp-!l~
(~(\00f(7t1 ,\:,,t(h i (\"'06'. ~
iiics\ no. i \ (exoire51 fA. (ohone no.
W
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Genera 1
~~m~V\ \\JSL~~&clre440 C_~frr~e(\~nn~ql~X~rP~h'4~5n~SI~'
. U . " .
Plumbino
Electrical
~'echanical
PlUllB ING
-.!!!h.
ELECTRICAL
MECHANICAL
Each single fixture
FFF r:HARr,F tom H~ fHAR.G..E. NO_
Residence of furnace/burner to
SQ. FT. BTU's
I<r
IRelocated building
(new f,ix. additional)
Is.F. Residence
(] bath)
IOuplex (1 bath) each
lAdditional bath
~Iater service
INew circuits alts.
or extensions
!SERVICES
Floor furnace
and vent
Recessed wall
Snnrp hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing
rp~ j qe.n('~
ImultifamilY, comm. or
'ndlJ~tri..l
IOf amps.
ICOffi~.fINO. FEEOERS
Install/alter/relocate
rl;~trih^ fpprlpr~
Sewer
Storm Sewer
Of
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
Appl iance vent
seoarntp
Stationary evap.
coolpr
Vent fan with
sinolp duct
Vpnt system apart from
heatino or A.C.
Mechanical exhaust
hnnd and duct.
Wood stove/heater
amps.
ISSUANC, OF PFR!11T
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN11NED the 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining toUthe work described herein, and that rm OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further ce tify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exe ,~h basis for exemption is noted hereon, and that
only subcontractors and employees who are in comollance with OP.S 7l11.0 will use on this ject.
SIGIlATURE .
FOR OFFICE USE DillY
Sq. Ftg. f1ain
Sq. Ftn. Access
Sq. Ftg. Other
&i!..-:(l::~ l~t.A' ~\l-\Cl ,&:, TOTAL VALUATION
0--7 ,- -:2 . ~ Systems Development 2 ~~
n---, '::;>:J Charoe (1.5~) ~ ".
IIAl,IE(pleasc print)
S--rl.\lJLef
u ojjI-.J
L.
Zone~ ~
Fi re Zone
Flood Plain
f;-N
Units
TyoefConst.
Bedrooms
Stories
I
Occy load IB
Occy Group If. '2
BUIlOIllG PERHIT __L~,-S<> Plan Ck. COIlm/! nd
Charges and 65~/Blda PJ'r Fpe
Surcharges! ~/'I Plan Ck. Res
30%/Blda Per Fee
PlUt~BING PERMIT Fence
Charges an~ ------------
Surcharges: Demo
ELECTRICAL, PERIHT Sidewalk
Cha rges ant1 ------------
, AIC Pavi ng
Surcharges;
MECHANICAL! PERMIT Curb Cut
Charges an~ ------------
Surcharges :.
OATE~
/ I
f
I
/7'2R
x
Value
Value
Value
,x I~
1~2BO
x
"2.0
ITotal Comb. Permit
I
I TOTAL
3?Z.8'1
,
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.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100, lane County Map Reference
'J! 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilin~/or forced air OdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example. 1250 sq. foot house. 500 sq. foot garage
2. examole- 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. exam~le - 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 $pecial~y Code ,. J
H. DESIGN TEAI.I 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
B. 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. BUILDING DIVISION STAFF WILL FILL OOT ALL FEES AND
CHARGES ON THE SCHEDULES
D. 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. ---
III. 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 permit is issued.
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V. FOR OFFICE USE ONLY
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
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Permit applicant exempt from registration with the Bui.lder's Board because:
-,
- .
Additional Project Information:
. ~
.
PLANS, REVIEWED BY:
,
i
name~R.N~ ~':'j~=. y
signature ./? ~?':"'
:/,~~
date //-ZC::-:i'~