HomeMy WebLinkAboutPermit Building 1984-2-8
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I INSPECTION 1I1IE
726-3769
Job Address 5'8 ,-/(p
Legal Oe5cription"7"~t
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
INF0R11ATION UNt
726-3753
Sq. Ftg. l-1ain_ "2..o'L-
~q. Ftg. Access.
Sq. Ftg. Other
~lewXAdd_Alter_p.ep.
FerlCe Demo Change/Use
Val u},ot.t."og6 (). cSt) Other - - .
Buildino ~ennit Info: Describe Work{ Le., Build Single
Familv nesidence With Attached Garaqel
..
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CD
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Owner TOM. LAR(;,E"
Address/7'19 MAli''; ST:
~,.~,tJC;rltl- D
Construction Lender AJOAJ~
7L/~-gZ1 '5 Phone
z.oq III ADD/TJiJ,.}-rf) e;:jusnoJtI. "':t:l~e:
R.P. "Z.aalF
Address
Dt~IGN TEAr!
lname)
Phone
(address)
(lies. no.)
(exniresl
(ohone no.
Primary
f)" hJ FE'R.
.
Mechan;cal
CONTRACTORS lname)
General 10M. /.....A1?r..€. c3Mlr!f:R
Plumbina /JI'J,j E:
Electrical Ii L f!RT-
(address)
llk<;..no.)
~
)~
y-~
(exnirps) (ohone no.
Structural
Electrical
nt./CJ MAIN s:r
-, L//-- ~2.13
Mechanical
-,
PLUIIBI riG
ELECTRICAL
I CCC I rHWiE.l NO.
MECHANICAL
NO.1
I FEE I CHARGE NO t
SQ. FT.
furnace/burner to
BTU's
1'=.~1=' Irl-l~
./
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Soac~ h~atpr and vpnt
Storm Sewer
Of
amps.
Appliance vent
<;.~o!lrate
Stationary evap.
cooler
Vent fan with
sinol~ duct
Vent system apart from
h~atina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
residence
mul'tffamily, COtml. or
Indac;.trial
~Iater service
CO~1./IND. FEEDERS
Install/alter/relocate
dic;.trib. feeders
Of
amps.
ISSUANCE OF pmrHT
TOTAL CHARGES
. WHERE STATE L'W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion -of -this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAr1INED 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 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 OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderts
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 employees who are in compliance with ORS 7nl.055 will be used on this project.
SIGIlATURE ~ ~L!-
FO~ OfFICE USE miL Y I
Sq. Ftg. Hain
Sq. Ftg. Access
Sq. Ftg. Other'
IlAI-1E(please print)_-rO M !d1~t.; r:
Zone
Fi re Zone
Tyoe/Const.
Bedrooms
Units
D~.TE Z. -'IV6&{
x Value
x Value
x Value
Flood Plain
Stories
Occy Load
Occy Group
TOTAL VALUATION
BUILDING PWlIT Plan Ck. Conm/Ind
Charges anC: ------------ 6511Bldo Ppr Fpe
Surcharges Plan Ck. Res
301lBl da Per Fee
PLUt~BING PERMIT Fence
Charges and ------------
Surcha rges D~mo
ELECTRICAL PERI~IT 'Sidewalk
Charges and ------------
Surcharges A/C Paving
liECHAN I CAL PERMIT Curb Cut
Charges and ------------
Surcharges
IU~"'O""\l yl'tl\;)
\?I.M 7...~- N
Systems Development
Charqe (J.5~) .
Total Comb. Permit
TOTAL
I
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.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
II oj 43
2. example- Lot I. Block 3. 2nd Addition to
~prlngtield Estates t.
'C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinqfor forced air QdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
1. exame1e- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached gar~ge
2. exam~le - remodel existing garage into family room
3. examyle - 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 TEN4 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.
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 penmit fonm 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 OUT 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. ---
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 penmit 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.
. .
,
V. FOR OFFICE USE ONLY
Permit Clerk
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's cBoard because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date