HomeMy WebLinkAboutPermit Building 1982-12-17
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JObAddress~I:;l.'J- MaLn St. I
.. 17'O~q~.~3~~A,,06l01 , ~l
Legal De'C"ptlon 7/, ul7lsl,; p 17. .~~~.2 ,""""f".rn~
''/4 3 - 'In..., Oared Ohh?/
Owner Wm J. -j (l/Jy'{))un d~Yl""/'?' k
A ;- vi '74b-
Address q IS- ;-" 4 7 -th Phone .s<'A-<' I
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Ranfle
tNFORlIATlON UNt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Demo ChangelUse
-Other- -
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IINSPECTIOfl L1IIE,
726-3769
Constructioh lender "
Val!l.' of Hork: 00
'fiX 1'f'.8 an.
Bul1GlnQ'Permit info: Describe Work(i.e., Build Single
Far.lil.1 I'!.esidence IHth JI..ttached Garaoe)
~/) I ctQL bl;\l Vrlln,rAf
f1 0 Xt- (j.hl ('i1n.JlO ftli,R)
Address
Ut~ llitl r tAil
(name) I' J I }--')rlP_ Y
Phone
(address)
flies. no.)
(exoires) (ohane no.
..~
YI c-~
Primary
II
, I
I {
Structural
Electrical
Mechanical
CONTRACTORS
(namel
( )'~rv1"'/V'
(addre~s)
l1ies. no.)
(f:\xn;res)
(ohone no.
Plumbina
I'
II
II
1/
Genera 1
Electrical
~1echan;ca'
PLUllB IrIG
ELECTRICAL
. MECHANICAL
NO.
FFE CHARGF Ij(L
FFF rH~ NO.
FFF rH~
SQ, FT.
furnace/burner to
BTU' 5
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
F1 oor fu rnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Soace heatpr and vpnt
Sewer
Temporary Construction
Change in existing
rp..jqrJ'IC'p'
multifamily, comm. or
TndlJo:;trial
IOf amps.
ICOMfI./IND. FEEDERS
I Install/alter/relocate
distrib. fpf!ders
IOf amps.
I
I
I
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hond rind duct
Wood stove/heater
~Ia ter serv; ce
Storm Sewer
ISSUANCE OF PFRlllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I; REQUIRES that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of 'this permit
shall not be va1ij until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed aprlication 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 OCCUPAHCY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IWIE(please print)
Type/Const.
Bedrooms
SIGrlATURE
FOR OFFICE USE OilL Y
Sq. Ftg. rl3in ,x 'Value
Sq. Ftn.~~_e_ss /S()() x 7.78 Value 1't~<5c
8-/ Sq. Ft~:~z.1..r~ <~C>O x' 7.!"'-value I~ 2'-==>0
: . IrL TOTAL VALUATlOrl4.a~
,jk'1/..CD ['" r,JI? Systems Development ... 3 ""'......
40\\l/ iHl,-..:- Charoe (1.5~)' ~ '"
I
I
Demo I
I Sidewalk I
lAIC Paving I, Bt:().- i
~___________: Curb Cut
DATE
I.
Zone C. ~
Fire Zone
Flood Plain
_'r"-N
Units
Occy Load
Occy Group
Stories
/
BUILDING PERI.IIT
Charges an~
Surcharges
G a.. 40
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2.72.
Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldo
Coam/! nd
Ppr Fp~
R-es
Per Fee
PLU/1BING PERI1IT
Charges and
Surcharges
Fence
I I
~:-- "#C:-"""
~t~r
r
Ig. <4
ELECTRIC;,L PERI~IT
Charges and
Surcha rges
I~.-
Total Comb. rermit
I1ECHANICAL PERI~IT
Charges and
Surcharges
'--
I TOTAL
,$343.q2J
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y
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2. example- Lpt I. Blpck 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 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. DESIGN TEM1 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 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. ---
Ill. 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.
(p 0/2-0
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V. FOR OFFICE USE ONLY
Permit Cl erk
0~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
\
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY: ~ ~ ,_'
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