HomeMy WebLinkAboutPermit Miscellaneous 1980-9-18
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Description '"thUr5",,,^ ~\a..'2.0. ShOpS
lINSPECTIOII LIIIE
726,3769
Job Address
legal
Owner
Address
Construction lender
Address
Ut" till I tAI1
{namel
Primary
Structural
Electrical
f1echanical
CONTRACTORS
(namel
Genera 1
M e.'l \ i G:,(\ S-'<;C'.
~ ~o..se Ce.
Plum~ino
Electrical
'.lechanical
PlUI1BIIIG
110.
FEE
CHARGE
Each single fixture
Relocated building
(new fix. additional).
S.F. Residence
(I bath\
IDuPlex (1 bath)
each
Additional bath
~!atp.r service
Sewer
\
Storm Sewer I
~S\r \>I"(n,lf:o I/o~ I ~
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TOTAL CHARGES
WHERE STATE l'W REQUIRES
shall not be valiJ until the
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C ITV OF-. SPRI NGFI ElD
CDMBlIlATIDN APPLlCATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range
..
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INFOR/IATION LINt .1
726-37S3
Sq. Ftg. !'Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Her Rep.
-Fence Demo Change/Use
Other- -
cD
o
o
J'
../'
----
Value of Hark:
Phone
Builtjinq Pennit Info: Describe Hork(Le.. Bu;ld;Single
Family l'1.esidence Hith .A.ttached Garaoe) "
s~ -Y uJo..J:Q.y
{ LYLe-
Phone
(address)
\
flics.no.l
lexoiresl
(phone no.
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fp' hone no. j;
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'j/85~/l.\n ~
t7..2~-/~8 L:
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,
(address)
(lies. no.)
(exo; fes)
/6 V 0.(\ ~L.I('er'l
~D.'!>>oV' 554 q
ELECTRICAL
MECHANIC,\l
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III J:JJAlli} F.
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,
NO I
I' Res i.~ence of ,
SQ. FT.i
INew circu~ts alts.
or extenslons
ISERVICES
<<r
r'JARG.E. NO
furnace/burner to
BTU's
Floor furnace
and vent
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Recessed wall
So~cP hp~tpr rtnd vent'
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole du'ct'
Vent system apart
heatino or A.C.
I Mechanical exhaust
hood ilnd dud
I \'Iood stove/heater
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frof(l
Temporary Construction':
Change in existing
___._ U.ll'kn~__.
multifamib. conm. or.
Tndustri;Il'
amps.1
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10f
I COli!.!' II NO. FEEDERS
Ilnstall/alter/relocate
di~trih_ fppdpr~ .
10f amp~1
I SSUANCF OF PFRllIT
. TOTAL CHARGES . TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Divisi~n
this permit
I HAVE CAREFUllY EXArlINED tre 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 oerformed shall be done in accordance with the Ordinances 'of the City
of Springfield and the Laws of the State of Ore~on pertaining to the work described herein, and that UO OCCUPAUCY 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.
NA'IE(please print) C'~~ Cf.:,..- ('h.o..('\~nf' ~i~~!IG;IATURE ~ \)~
FOr:OFFICE USE Q;llY
Sq. Ftg. riain
Sq. Ft9. Access
Sq. Ftg. Other
. Plan Ck. COIl1l1/Ind
65%/Rlda PPr Fpp
------------ Plan Ck. Res
30%lBldo Per Fee
10 .00 Fence
------------
. 4D Demo
Zone
TyoelConst.
Bedrooms
Fire ZOnE'
Flood Plain
Stories
BUIlDHlG PERI.IIT
Charges an':
Surcharges
PLU!iBING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI:IT
Cha rges and
Surcharges
11ECHAIIICAl PERMIT
Charges and
Surcharges
~
DATJ'i:JS-M
Units
Oeey load
Occy Group
Value
Value
Value
x
x
,
TOTAL VALUATION
'Systems Development I
Charqe (1.5~)
Sidewalk
AIC Paving
Total Comb. rermit
Curb Cut
TOTAL
lo.6.()
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COMBINATION APPlICATION/PERMIT (CAP)
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I. Applicant to furnish
A. Job Add res;
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example' Lot I. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources "-
1. example- heat/electrical ceilin~q/or forced air Qas
2. examole- waterheaterjelectrical/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 information: 'j
l. examole - construct single family hou$e ~..ith an
attached garagp. _
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) Qf the
Structural Specialty Code ,'I
H. DESIGN TEAM AIID CONTRACTORS
To avoid design or construction'delays, BLdlCLng
Division. Staff must be able to contact appropriate
persons regarding" design information or job Site
corrections, etc. {
II. Abbreviated Plumbing, Mechanical, & Electrical S~hedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the appl.icant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed. .
B. Full Plumbing, Mechanical, and Electrical Sc~edules
are available at the Building Division .; .
1. To conserve space on the permit form the;schedules
have been abbreviated j
2. I~ the item(s) to be installed are not c6vered 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. --- I
Ill. Applicant to sign and dat,:,.. ... .
\Jh':~~'!~f pc:;:;!bl.::. Hit:! :n1',:::.;; ap~l'cJ.tlOn wIll be j:;ed as
a \.'Iorksheet only. Where possible, Building Division Staf1
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
. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature'
.
date
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