HomeMy WebLinkAboutPermit Building 1985-8-20
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I IrISPECTI ON LI NE
726-3769
Job Address (0 'J,T 0 1Vla.h-....J
Legal Description /7 Od- 3L/30
CITY OF SPRINGFIELD
COMBINATION APPLlCATlON/PERMlT
EilERGY SOURCES:
Heat
!~ater Heater
RanQe
INFORlIATlON U~l
726-3753
Sq. Ftg. r.lain
~q. !='tg. Access.
Sq. Ftg. Other ~ /2-
....!lew_Add..!(AI ter _~eD.
Fence Demo Change/Use
-Other- -
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I
00 300
Owner Cr1rMhhAO (;(1 )JYJji,n !/A
Address pt) Rfl \C ./)
::J0M.strrYJ q 1ff;)..
Construction lender
Address
Ut~luN TEAr-'
Primary
Structura 1
Electrical
Hechanical
CONTRACTORS
Phone1l{{/1
)lf~ I
ValUE of Hork.'it
~"JsoO
Buil ril no Penn; t Info: Oeser; be \~ork. ( i -. e. .
Fami 1 v nes i dence "lith /l.t tached (la raoe)
fbmo~Q_
t9-1 j" i/ .P 0
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Yo
Build Single
~t't..Af
U I
nfl"l.
(name)
Phone
(address)
(exoires) (ohane no.
(1 ics. no.)
4
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(namel
(addre~<; )
(lics. nn.\
(pxnirp~' (ohnnp nn. \
Plumbina
iO<<.M; JlJ
PLWIBING
-.!!Q.." ,.
:3 Each single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
(J bathl
IOuplex (I bathl each
IAdditional bath
[water service
I Sewer
[Storm Sewer
COMi'I./IND. FEEDERS
IInstall/alter/r~locate
rlic:trih. fpprlprc:
IOf ,mps.1
I
I
I
TOTAL CHARGES ,,~~ TOTAL CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
I HAVE CAREFUllY EXArllNED the completed aprlication for permit, and do hereby certify that all infonnation 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 fW OCCUPArlCY will be made
of any structure without the permission of the Building Division. I further certify at registration with the Builder's
Board is in full force and effect as required by DRS 701.055, that if exempt the b f exemption is noted hereon, and that
only subcontractors and employees w:~ in comoliance with ORS 701.055 will be thij project.
IIAllE(please printlkw ;[~pJk) SImlATU J DATE!I"2ifA~
,- Fo~-6'"r"F I CE USE m~L Y --- t
Type/Const.---s~-~ Units Sq. Ftg. f1ain x Value
Bedrooms Occy load Sq. Ft9. Access x Value
Stories Occy Group;e'-/ Sq. Ftg. Other I[t!!:iI'AdZ>El:., Value~~-
t:l:ll D . r-" /~ TOTAL VALUATION
#oW/ofo /5/0' Systems Development ,( / A
,10 Charqe (J.5~) fY4r
Genera 1
Electrical
tlechanical
Zone if: HJ
Fire Zone
Flood Plain
BUILDING PERflIT
Charges and
Surcharges
PLur1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI:IT
Charges and
Surcharges
/1ECHAN I CAL PERMIT
Charges and
Surcharges
ELECTRICAL
I
I.H.L 'J:I!ARliE
I
MECHANICAL
I FFF I cHARr.F
NO I 1 ~~~
Residence of
I r"!lRGJ:'-1lQ...1
furnace/burner to
BTU's
r- IS-
SQ. FT.
V'
New circuits alts.
or extensions
2 -olllMI!>,.,E
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
IS-
Floor furnace
and vent
Temporary Construction
Change in existing
rec;.jrleprp
multifamily, comm. or
Industrial
Appl iance vent
seoaratp
Stationary evap.
conlFO'r
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
~-
/
Of
amp~.
Wood stove/heater
ISSUANCf OF PFR'1IT
I.)...... TOTAL CHARGES M/N . /~ -
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
,., U 00 Plan Ck. Conm/lnd
.tI; L _~ . 65%1Bldo Ppr Fpp
------ -96- Plan Ck. Res
~ 30%/Bldo Per Fee
I~ _0 I Fence
_n-r.,.)-~6<>- Demo
____ISc..":'_~_ Sidewalk
< bO AIC Paving
_n./Q~~J Curb Cut
< 'f~ I
I
Irotal Comb. rermit
~.5~
bb.-5'6
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. exampl~- Tax lot 100. Lane County Map Reference
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
I. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-nfw - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. example - 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. DESIGN TEM, 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 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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
Pennit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name--.L~RNE .~~-~signature4("...,.~ date-.-S-/~-8S-