HomeMy WebLinkAboutPermit Miscellaneous 1983-5-26
CITY OF SPRlIIGFIELD
CmlBIlIATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
~ eS-Z-b-D
I IrISPECTlOII L1IIE
716-3769
Job Address S3 '1'1 J.1A/N Sm(fF~
Legal Dmription /'l-c'g-33."3/, 6S't:'1i. tl6S'd?
.
Owner V~7'~A"y~ ~r r~~6N h?,H>S{/$~
>
Address "'::;A-/"e- ?/)'J'>"7..::o'l
Construction lender
Address
OE51011 fEAr'
(namel
Phone
(address)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS Inamel
General ~t.~ t;;;..4&J!:> 9'~v~_
. . .
(addr~55)
~~ ~~N.. ~<Eh~
6S8.::2<~
Plumbino
Electdcal
~lechanical
PLUIIB IIiG
ELECTRICAL
---1!!h
I Each single fixture
q.~~.
I Relocated building
(new fix. additional)
I'S.F. Residence
(J bathl
!DuPlex (1 bath) each
Additional bath
-.
Ranqe
ValuE. of Hark:
~~,...c
BUilGino Permit Info:
Familv nesidence With
INFORlIATlON LIN'
726-3753
Sq. Ftg. 1.lain
~q. F'tg. Access.
Sq. Ftg. Other~;'~C)
Ilew Add A Iter Rep.
--Fence Demo Change/Use
Other~-'".,.c::.. .
\)()
W
.......
~
ill}
I
Describe Work(i.eo,
Attached Garaoel
Build Single
A-$?J!? 19:r B~ '.t /8 X ;'S-~ I :S'"d;;o:.7/e",
?.;;. €~~ 0';::- ~/S7A1:J"c-., &y/~
~,.~~ ~ :2 "-f.tC.. M//'#~p,M.
(lies. no.) (exoiresl (ohane no.
~
~f
~
(li~<;._ nn.1
(pxoirec;.)
Cohnn" nn \
. MECHAN I CAL
FU rH^Rr.F..IlO..- "LIJ:IlARIiE JJ(\
Residence of furnace/burner to
s:-- SQ. FT. BTU's
ITempOrary Construction
IChange in existing
rpsid~n('~
Imultifamily, camm. or
lndudrial
IOf amps.!
ICO~1./IND. FEEDERS I l
I Install/alter/relocate I I
rli~trih_ fppdpr~
IOf amp..1 I
I I
I I
I I ISSUANCE OF PFRllIT
.~ .~p I
? . . TOTAL CHARGES 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 EX~INED 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 perfonmed 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 OCCUPANCY 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 ons 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 7Ql.055 will be used on this project. .
1lA/'IE(p;:ase print},! SIr.iMTURE~-'V~~/ OAT~hJ..
FO~ OFFICE USE carl '" V / j.
Sq. Ftg. t1ain ,x Value
Sq. Ftg_ Access .J x Value
Sq. Ftg. OtherJI/Y",. mY.l~ Value Ij~_-
TOTAL VALUATION
New circuits alts.
or extensions
I SERVICES
I
Water service
I Sewer
I Storm Sewer
TOTAL CHARGES
WHERE STATE L~1l REQUIRES
shall not be valij until the
Zone
Tvpe/Const.
Bedrooms
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
Stories
BUILDlIlG PER~IIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
____________ 65%/Bldo P..er F'Pp
Plan Ck. Res
30%/Bldo Per Fee
r-: - I Fence
-----;>-:-~--I Oemo
I Sldewa lk
I A/e Paving
'PLU'iBING PERMIT
Charges and
Surcha rges
ELECTRIC;.L PERr:IT
Cha rges and
Surcha rges
HECHANICAL PERMIT
Charges and
Surcharges
~ I Curb Cut
-----------, .
':EL
<</
Floor furnace
and vent
Recessed wall
~n~~p hp~tp~ ~nrl upnt
Appliance vent
c;eoaratfll
Stationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart from I
heatino or A_C.
I'Mechanical exhaust I
hood and dUr'_t
I ~Iood stove/heater I
I I
I I
I I
I
I
I
I
I
I
I
Zt:>,$k>
Syste~s Development
Charoe (1.5%) .
'5":<. -
Total Comb. rermit
.?;:>. ::CO
S$. (;)~
I
I
I
I TOTAL
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
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
5prlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. examole- heat/electrical ceilino/or forced air Qas
2. examole- waterheater/electricalior solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check~w - if addition,
Checl<. add. ete.
F. Buflding permit information:
1. example - construct single family house with an
attached garlJge
2. examole - 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. PESIGN TEN1 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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
fu 11 schedu 1 es
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. ---
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 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 penmit is issued.
009 fj
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-. /
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v. FOR OFFICE USE ONLY
Permit Clerk
6.irru. J
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
.
PLANS REVIEWED BY:
name ?.o;z?~ 73~~Signature~Z_.
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