HomeMy WebLinkAboutPermit Building 1982-12-3
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CITY OF SPRINGFIELD
CDr1BliIATlON APPllCATION/PERMlT
E!lERGY SOURCES:
Heat
Hater Heater
I IrISPECTIOII lllIE.
726-3769
Job Address &JS' 3 1 1Y1 J4 i /II
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I.egal De<<ription 17.()2.~:J.'1t?
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; Owner kw
Address 3:'{'Z. q
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Phone-;"::.~'5"
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Construction lender !YJe /CUvZ 1< W/'{ F ~C/VfUr~
Address ;S;!.I(J() th M1,tJ , 5Pf~/~
DES I GN TEAr.' (name)
Phone
(address J
Primary
Structura 1
Electrical
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Mechanical
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CUNIt(,u,L.IUt<~
Inamel
laddress\
( OWNLfi..\
Genera 1
J(;. Ai {; Tn IV,! 61t.
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ellq I?}~
,X(N "cJmNC;ut..
yer
Lj50
~ Plumbina
, ~ Electrical
'1 ~le;chanical
eND.
: ...) 2'1 Each single fixture
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ai:(.(JL1G
( t'I (., I/JCIlI
PLUIIBIrIG
Relocated building
(new fix. additional)
-,
S.F. Residence
(] bath)
Duplex (1 bath) each
IAdditional bath
1~later service I
/ I Sewer Ib."'Y/4J t..F. I
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Ranqe
INFORlIATlON LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Fence_Demo _Change/Use
_Other
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'!Plu. of Hork:
~ 71()OO
BuilciinQ Permit Info: Describe l~ork{Le.,
Familv P-esidence With Attached Garaoe)
Build Single
//11 ~71'IL-L. LI1t1/V}!2(;M )1-1
,) f)12l4 (' /.- tS/h'Vf!.4U;
IN <;;iJ-!
COMM./IND. FEEDERS
amps.1
I
Install/alter/relocate I
rli~trih. fpprlpr~
,
ELECTRICAL
FEE CHARGE >j(l
S" Residence of
/ '2i?- SQ. FT.
.,/ New circuits alts.
or extensions ;r~
'2. ...~~
SERVICES
Temporary Construction
Change in existing
res.; d_ence
I~- multifamily, comm. or
Jndu~trial
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!/.?... 1'1
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I ISSUANCE OF PFRlIIT It::>. ~
TOTAL CHARGES I~~ao , TOTAL CHARGES ~~. TOTAL CHARGES ~y.".
WHEfiE STATE L,'14 REQUIRES that ti,e Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the l~bel has been 5igned by an Electrical Supervisor and returned to the BUilding Division
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V-
Of
Storm Sewer
I
Of
I/PC>
amps.l
flies. no.)
(exnires)
(phone no.
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. C1ic~. no.)
(exoires)iY (nhonP no.)
3Lj.J. 7 788
MECHANICAL
,Fe
rlJARGE. "0
r"ARliE.
,Fe
furnace/burner to
BTU's
~-:-
Floor furnace
and vent
I
7
Recessed wall
~~~IJ vpnt
710/~L€.1i
Appliance vent
~eoarat.e
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust "
hood and duct.
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1.S'fJ 7.-
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',J.- ~/.-'
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1"-3.-
Wood stove/heater
$", Ovn€~
AIR Cit:.Jrc.e7S
I HAVE CAREFULLY EXA~1INED 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 \'iork 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 OCCUPAfKY'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 ORS 7~1.055 will be used on this project.
SIG;I^TURE~p7}g..z::l!u..'t-<'1;A ~.
FO~ OFFICE USE OIILY / V
Sq. Ftg. riain x Value
Sq. FtrJ. Access x Value.
Sq. Ft~. Other I.4~G :SM.:~ 3~'Value
TOTAL VALUATION
liAI,IE(please print) J.( t:tV
or-n,',/ <f fAT.,.
Zone ~C
Fire Zone' IIA-
Flood Plain i\I~
TVDelConst. S"N:9R. !Jnits
BedroDms /1.4 Occy Load
Stories I Occy Group~.~
BUILDING PERI.IIT !/P -- Plan Ck. Co","/I nd
Charges an':: ---- --'----- 65%/Blrln Ppr Fp~
Surcharges I.~<> Plan Ck. Res
30t/Rl on p~r F~p
PLur'lBING PERMIT ae::>.- Fence
Charges and --- -------
Surcharges 5""~ D~mo
ELECTRICAL PERI~lT 31> ""''''' Sidewalk
Charges and --- --~-----
Surcharges /. <() AIC Paving
11ECHA"ICAL PERMIT -----~'(._~-- Curb Cut
Charges and
Surcharges 2. ./~
I
DAT~~2h/,fZ
7.~"-
. -
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':2~ .
Systems .Development
Charqe (1.5~l
-
ITotal Comb. rermit
"Z ~<f.l~
:Z9().16
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIOATION
:,
1. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100. Lane County Map Reference
II uj 43
2. example- Lot 1..Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air Qas
2. examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house. 500 sq. foot garage
2. examole- if new project. check new - if addition,
Check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - 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 TEM1 ANO 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
O. 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
signa ture.
IV. Fees and Charges
~lan 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:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY: ~
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