HomeMy WebLinkAboutPermit Building 1983-9-20
I WSPECT 1011 L WE
726-3769
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Job Address
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CITY OF SPRI1IGFIELD
COMBWATlON APPLICATION/PERMIT
E,IERGY SOURCES:
Heat
t~a ter Hea ter
Ranqe
INFORlIATlON LWt
726-3753
Sq. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
--Fence Demo Change/Use
,I Other-- --
Legal De$Cription,\,\ -(')'(__ "?,~.I....\\
ValUE of Hork:
'.0 rj rnoo
BuilGlnQ Permit Info: Describe Work(i.e., Build Single
Fa~ilv nesidence With Attached Garaael
~ .ON"\ 02"Q,t (\ . " F A~ F / / (', L
~ ,; Ot4f J inn llli\ l,l,~ -. J\ ~
I ; J'ltt'-'10r'1 Lt :al(r(ll
(lies. no.) lexoires) lohoneno.\
Owner 'Th, \~~ J{ 0 l) J('\().J
Address fflCY") ~f'\ "",,*-- P
const~;n~~~; c<)eQ f'\~
Mechanical
CONTRACTORS (name)
General y. ql\~^-\._ (h~ b
Plumbino () t\
Electrical . ,
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TOTAL CHARGES '- 'D\ -e.. I TOTAL CHARGES \. '\'~le_ TOTAL CHARGES \ '('11. 'E'~
WHERE STATE L1W REQUIRES that the Electrical work be done by an, Electrical Contrac or, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Address
DES I GN TEAll
(namel
Primary
Structural
Electrical
~lechanical
PLOllS I1IG
NO.
Each single fixture
IRelocated building
(new fix. additional)
IS.F, P.esidence
11 bath \
IDuplex (1 bath) each
IAdditional bath
I ~la ter servi ce
I Sewer
IStorm Sewer
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Phone
Phone
(address)
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(addresc;.)
(1 ir:<:.' no. 1
(pxo;rps) (ohonp no,
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ELECTRICAL
ITL~l
NO,
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I HAVE CAREFUllY EXN1WED the completed ap[Jlication 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 NO OCCUPArKY will be made
of any structure without the nermission 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 emnloyees who are in compliance with OP.S 701.055 will be used on this project.
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MECHANICAL
<EF
nIARr.F"
110
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits aIts.
or extensions
Floor furnace
and vent
I SERVICES
Recessed wa 11
~o~rp np~tpr ~nrl vpnt
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Temporary Construction
"Change in ~xisting
rp~ i dJ'prp
Imultifamily. comm. or
Industrial
10f
ICOI1fI./IND. FEEOERS
Install/alter/relocate I
rl;~tr;h_ fpprlpr~
I App 1 i ance vent
seoaratp
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I' Vent system apart from I
heatino or A.C.
I Mechanical exhaust '
hood and durt
Il'JOOd stove/heater
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amps.1
Of
amps.
ISSUANCE OF PFRlnT
f1a/
1/Al-IE(please print)'/I/~
II\;. I '
Zone cr.:.. Tybe/Cons t:"',,\\ - \.. ~
Fire Zone Bedrooms
Flood Plain Stories \
SIGIIATUREjV'
FOr. OFFICE USE 01lL Y
Sn. Ftg.
Sq. Ftg.
Sq. Ftg.
x
x
x
Value \(). ~tCD. =--
Value
Value
OATEIt
Units
Occy Load
Occy Group
t1ain
Access
Other
TOTAL V ALUA Tl ON
BUILOIllG PERt,l!T
Charges an~
Surcharges
t::.( 0:::> Plan Ck.
___-.J~______ 65%/ijldo
. n "u Plan Ck,
<.... <., 30%/61 do
Fence
\~~,""",'<v--'''''
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I, ""
Sidewalk
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I A/C Paving
I Curb Cut
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PLU11BING PERMIT
Charges and
Surcharges
ELECTRICft,L PERI~IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Cha rges and
Surcharges
Conrn/lnd
Pp" ~pp
Res
Per Fee
Syste~s Development
CharQe t1.5~)
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II~. 2.~
("1'('\\,\') c......,~.; _
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Demo
Total Comb. Permit
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I/OTAL
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COMBINATIO~ APPLICATION/PE~~IT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. examole- Tax Lot 100. Lane County Map Reference
II OJ 4J
2. examole- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name~ etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinqlor forced air Qa5
2. examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. -
1. examole- 12S0 sq. foot house. SOO sq. foot garage
2. example- if new project. check new - if addition, ~.
ctleck add. etc.
F. 'Building permit information:
1. example. construct single family house with an
attached garage
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. OESIGN TEN1 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
'fu 11 schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES -
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. ---
111. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building Oivision Staff
will prepare a type written copy and return it to the
applicant at the time the ~ctual 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
paya~le when the permit is issued.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED ,BEFORE OCCUPANCY:
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PERMIT VALIDATION
LP!2?O\
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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signature'Uo.A r\ <:'I ,,-,~)r date o.,,?()-~~
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