HomeMy WebLinkAboutPermit Building 1984-11-16
CITY UF SPRINGFIElD
COMBIIIATlON APPliCATION/PERMIT
EiIERGY SOURCES:
Heat
Ha ter Hea ter
I INSPECTION 1I11E
726-3769
.
Job Address S?'()-:<' ~ .'}flVa.
legal Description f?1C/'VVLOL ('~ G~~
/7.~2~/, "73~:f'
Owner., C\.-,..LJ. I))~
Address ,'2.1<.<; ~ l.CjlJOI.( /~P.dt Phonell(/"f?~??
'1/, ~ j rri;,~.J b,e rzJ1.
Construction lender
Address
DESIGN TEAI~
(name)
Phone
(addre5" )
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addres~ )
Genera 1
-~-
Plumbina
Electrical
-~-
~1echanical
PlUIIB I NG
NO.
FEF I cHARGE
.
INFORlIATlON liNe
726-3753
Sq. Ftq. i'lain-L2~~
~q. Ftg. Access.
Sq, Ftq. Other
flew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
~
~
00
~
\X)
I
Range
JIUE of Hork:
Bu~-Bi~~penllit Info: Describe Work(i.e.. Build Single
Familv nesidence With Attached Garaae)
16"L<'-(Y/ ~
'if 'X IS I
(l;es. nn 1
(exoir~~)
(nnnnp no
*
f1 ;r:<;._ nn,)
{~yn;res' (ohon~ no. 1
?Y7r lJjl~"
ElECTRICAl
MECHANICAl
.Nn I
I'Residence of
SQ. FT.
1New circu~ts alts.
or extenslons
I SERVICES
I
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bathl
Duplex (1 bath) each
Additional bath
"L U;IJARIiE. NO
.I.H.L J:llARIiE
furnace/burner to I
BTU's
Floor furnace I
and vent
Recessed wall I
SO<ll'P hP<ltpr <Inri vpnt '
It?-
rIa ter servi ce
!Temporary Construction
IChange in existing
rp~ i dJi~nrp
Imultifamily, comm. or
Inriuc;trlal
COMM,/IND, FEEDERS
"Install/alter/relocate
did.rih. fpprlprc:.
IOf
I
I
I
Sewer
Storm Sewer
Of
TOTAl CHARGES TOTAl CHARGES
WHERE STATE LW REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
amps.!
Appliance vent
C:f>O<lr.:tte
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hnnrl and duct
Wood stove/heater
amps.
I
I
It'. p.
ISSUANCf OF PFR'1lT
TOTAl CHARGES
'Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 rw OCCUPAfKY will be made
of ,any structure without the permission of the [3uilding 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 7nl.055 will be used on this project.
SIGIlATURE
FO~ OFFICE USE miL Y
Sq. Ftg. t1ain
Sq. Ft9. Access
Sq. Ftg, Other
(j.,u~-,-"..., 1'. 15 (. 3S Z. <{
'Ii 9 ..-' n(} Systems Development
.1., rOt CharQe (1.5~) ,
rAx. Po.!.O (J795f(
IlAI.IE(please print)
Zone C. ,c:.
Fire Zone
Flood Plain
Tyoe/Const. ~-)tf
Bedrooms
Occy load
Occy Group~'~
Units
Stories
I
BUIlDING PERflIT
Charges and
Surcharges
J~ cC'" Plan Ck, COl1lll!lnd
__4...;...l.L_____ 65%/Rldo PJ'r F="pe
",-, Plan Ck. Res
. ~ 30%/Bldo Per Fee
____________, Fence
I D~R1o
___Lt;?.!~_JSldewalk
. Y&> I A/C Pavi ng
!"Curb Cut
I
PlUI1BING PERMIT
Charges and
Surcha rges
ElECTRICAl PERIHT
Charges and
Surcharges
/lECHAN I CAl PERMIT
Charges and
Surcharges
DATE
17CJI"
x
Value---.L5"~. 00
Value
Value
x
x
TOTAl VAlUATION
:z 2.S~
..2f)
!Tota1 Comb. Permit
I
I, ''ZtD. dO
,-- TOTAl
..11.'10
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
11 03 43
2, exam~le- Lot 1. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air QdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition.
check add, etc.
F. Building pennit infonnation:
1. example - construct single family house with an
attached garage
2. example - 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 TEAM 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 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. ---
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.
V. FOR OFFICE USE ONLY
.
PERMIT VALIDATION
,
.
Permit Clerk
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ 10
v)
D
L
.I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name .L4~~~~~
-V;;. '9It"~
\'j \,;, II
Signatur~
, .
.,
~
.
date.H:~/~.a'Sl