HomeMy WebLinkAboutPermit Building 1984-6-27
I HiSPECTIQ;1 LlIIE
726- 37 69
Job Address
Legal De5cr;ption
Owner
Ranqe
va~' of Hark: H~
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Builtilna Permit Info: Describe Work(i.e.,
Familv n~~id~nce With Attach~d Garaoe)
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Address
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Construction lender
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Address
Ut~ lliN I l:Ar.'
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS
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{name)
Phone
(address)
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(namel
(address)
(1 ics. no.)
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General M A-'l'r R I ..,- ~Qa..(.I., s=
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Plumbi'1o, .
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Electrical: )
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~lechanical
PLUilBIrIG
ELECTRICAL
6
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Each Single fixture
Residence of
, fFf 'CHARGf yo
5~ '2S~~
, ~~I=' 'rl:iARGI. NO_
furnace/burner to
SQ. fT. BTU's
. HI=' 'fJ.1JlB.G.E.
Relocated building
(new fix. additional)
S,F. Residence
11 bath 1
Ouplex (1 bath) each
Additional bath
~t)'
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~!ater service
Sewer
Storm Sewer
New circuits alts.
or extensions
SERVICES
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Temporary Construction
Change in existing
rp')irlpncp
multifamily, comm, or
Industrial
Of
amps,
CO~1./IND, fEEDERS
Install/alter/relocate
rli~trih fpprlpr,
Of
amps.
-., --....;-
INfORlIATION liNE II
726-3753
Sq, ftg, 1,Iain
!:q, Ftg. Access.
Sq, ftg, Other
--1lew "':"Add If.A 1 ter x:~ep,
Fence Demo Change/Use
-Other- -
Build Single
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MECHANICAL
Floor furnace
and vent
Recessed wa 11
So~cP hp~tpr ~nrl vpnt
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1:<.- I to
,.. (n.
Appliance vent
c;eoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust '
hood and dur:t
Wood stove/heater
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TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
ISSUANCE OF PfR!lIT
,...,'j ,,;: TOTAL CHARGES :....\ t::.. .~ TOTAL CHARGES
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that the Electrical work be done by an Electrical Contractor, the electrical portion of nits pernit
label has been signed by an Electrical Supervisor and returned to the Building Division .
I HAVE CAREFULLY EXM1INEO 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 work nerformed 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 OCCUPAr~CY will be made
of any structure without the permission of the Building Division, I f1 ~L., ~;tt:mt ~ i~i..~\"C.o,:.:"" ,:.~' " :.~
0.' ~~:~. .,~-';..~~ .::-.:.___ :::..~A ,&fec. ~~ ---,.~..:... '\' Q~[ :'81.~. 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 be used on this project,
1lAf.IE(please print)
Zone ,-,C_
Fire Zone -..
flood Plain .~
BUILDING PWIlT
Charges and
Surcharges
PLU'~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Charges and
SlJrcharges
/1fCHANICAL PfRMIT
Charges and
Surcharges
N\ pt-T-r ~ I 'T'''2.:C7'' f!...("'- SIr,II^TUR[~~~ ~
fO~ OffICE USE or~L Y I 1/ 1'/
So, Ftg. liain'!"!,"'>/) x "
Sq, Ftg, Access x
.~~Sq. ftg, Other x
Tyoe/Const. V.i\)
Bedrooms .-
Stories \
Units
Occy Load
Occy Grou.B\
_____:1~, 00
"3, ca<"{
Plan Ck,
65t/Rldo
Plan Ck,
30UBlda
( "':;
_____>1Q'~___1 fence
.J '~Q Demo
"--,
\...).5,'.J,.:) I Sidewalk
------l~80---1 A/C Paving
____\.OJ~_J Curb Cut
40 I
Conroll nd
P~l'" Fpp
Res
Per Fee
f\q, ~O
\0,5<;'
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I \ '2., 60
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OATE
,,J:L 7 fgy-.
Value
Value
Value
TOTAL VALUATION
Systems Development I .....,,....,,..,, o:e...
Charae (1.51,) , ;)\... )
Irotal Comb, rermit
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Appl icant to furnish
A, Job Address
B. Legal Description
1, example- Tax Lot 100. lane County Map Reference
II 03 43
2, example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources . ,'.
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electrlCa(/or solar
E. Square footage or valuation, etc, ------
I, examole- 1250 sq, foot house, 500 sq, foot garage
2. example- if new proj~ct'l checkli'ew - if addition, \ "
check add, etc. . . , - l_j .,-
F, Building pennit information:
1. exam~le - construct single family house with an
attached garage
2, exam~le - 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 (aJ 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 blant 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, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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. ---
Applicant to Sign and date
Whenever possible, the initial application will be used as
a worksheet only, Where possible, Building ~ivision Staff
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
Permit Clerk
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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 Information:
PLANS REVIEWED BY:
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