HomeMy WebLinkAboutPermit Building 1986-4-1
. ..~,.-,;.......\..:.... '~."--
I INSPECTION LINE
726-3769
,
.
.
CITY u, SPRINGrIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat G A- ~
S9~ Water Heater
Ran~e
ValuE of Hork:
"'1'6:'oo.(1Q
BuilriinQ Permit Info: Describe Work(i.e.,
Farnilv nesidence With Attached Garaael
IHfDRlIATlON LINt
726-3753
Sq. Ftq. r,lain....L;k>n
~q. Ftg. Access.
Sq. Ftq. Other
2tROw__Add__Alter--:qep.
Fence Oemo Change/Use
Other - --
Job Address~6S'Z MA/N ~7
Legal Description 1;UJPS7I:s~L~t6
/7~Z-'3~-<lJ ,,~
Owner '/i"" '5Pg......s e:-
Address '!..1.-'~ >_ o;-c:-TY PL
<;1"-'0 n ~ II-'
,
Construction Lender ~4=-
Address
Ut~ll.:iN {tAli
"""'P-'
,fJ)3,:en I.. 9'
Build Single
~
~
OJ
~
'---1
l..E..Jz..tl.1../ 1Ai.\ADr F-,fA^t/tIV A
1017- _D(, I:1kC-rR.utl ~
-'
(name)
Phone
(address)
(lies. no.)
(exoires)
.I
(oh'one no. l
Primary
-:r4r Ir I"tun ""014 11/
2 <:;'S"HoiL.."/P:-L..J' J;-l..A 2.(...1. ~9'
, ,.-
,6...,>../~ ,'"
I. Fe- 8'-Irl fJ ?
Structural
Mechanical
CONTRACTORS {namel
\
General .T~" IAl"n""fJ*fIL
(address l
(1 ic:s. no. \
.
~
(pxni rpc;.) .. "-(~I'lnnp no. )
~/'0-."I r8'f"--H1) ~
Electrical
P1umbino
Electrical I.le:L'~ J::Yr",",('
).f;;'C-J.'l.oU",uIIIW kL.f
, (T
21..10'>"
~'echanical
PLUllBI NG
ELECTRICAL
MECHANICAL
NO.1
I FFF I nIARr.F Nn I
CE.L' ..C1IAllliC NO
SQ. FT.
furnace/burner to
BTUI s
I...E.EL I !1JAI!liE.
Each single fixture
Residence of
Relocated building
(new fix. additional)
/'New circu~ts alts.,.../
or extenslons 0
~
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
I
I
I
I
I
I I
Y&?/rY ~j;h<: ~r~
,RE avNeals~
Appliance vent
c;eoaratp
S-tationary evap.
cooler
Vent fan with
5inole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and dut"t
Sewer
Temporary Construction
Change in existing
rpS j dJl'nrp
multifamily, comm. or
Tnrtll<:.triil.l
Water servi ce
I
I
I
I
I
I I
TOTAL CHARGES TOTAL CHARGES :z'Z.:S"c::> TOTAL CHARGES . '. ~
WHERE STATE L'H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be va1i~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
CO~1./INO. FEEDERS
Install/alter/relocate
r!i<:.tr;n fpprlprc;.
Wood stove/heater
Of
amps. I
ISSUANCE OF PFRr1lT
I HAVE CAREFULLY EXAMINED 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 cerformed 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 rm 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 ORS 7Ql.055 will b~ used on this project.
/
Units
Occy Load
Occy Group...8" '2
SIGrlATURE
fOn OffiCE USE DillY
So. Ftg. 'lain /2Cht> f!I
Sq. Ft9. Access
Sq. Ftg. Other
tJ~ 1V~
DATE ~/df--t.
IW1E(please printl----2Al"-k "-'to If...... j),It}lL
Zone -.C.J:;;
Fire Zone
Flood Plain
Type/Const.~
Bedrooms
Stories
x
Va I ue ...L8t:t!!).
Value
Value
-
x
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
'? 0 ~c> Plan Ck. ConrnlInd
___-!i_<.!...~~__ 65%/Rlda PJ'r Fpp
I I fIl2 Plan Ck. Res
. ~ 30%/Blda Per F~p.
Fence
/"7. /8
Systems Development
Charqe (1.5~l '
'27.-
PLU!~BING PERMIT
Charges and
Surcharges
------------
I Demo
:Z~. :;'e> I Sidewalk
-------:9c:;~1 A/C Paving
- I Curb C~t
---------::-;,--1,
I
I
I
ITotal Comb. Permit
I
I TOTAL
, '"If, 08 I
r--,
It:'~ ~
ELECTRICAL PERlnT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I
.......
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot lOO~ Lane County Map Reference
II OJ 43
2. examole- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example' 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new.- if addition,
check. add. etc.
F. Building permit information: '.
1. example - construct singlel family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~le - 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 penmit 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 ele~trical label. ---
111. 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 permit is issued.
, ,
V/O{&i
JJr qo'
1 G0'J /~~
if 6/ 1 .
",
'.
~
V. FOR OFFICE USE'DNLY
Permit Cl erk
GC
.
. PRDJECT CONDITIDNS TO BE SATISFIED BEFDRE OCCUPANCY:
,. .
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
" ,