HomeMy WebLinkAboutPermit Building 1985-5-1
I INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD INFORllATION uNc II
COMBINATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftq. I'[ain
Heat ~q. Ftg. Access. ()n
Ilater Heater Sq, Ftg. Other
Ilew Add Alter ~ep, ( 11
RanQe --Fence Demo Change/Use ~\
ValuE of l'lork: Other- - a
fu:l~n<;' ?~:!~fO: Describe Work(Le.. Build Single Lv
Familv l'1.esidence Hith A.ttached Garaoe) ~
Drl"k.e OA/~V, TI3J!/i "rF M&3TI9"- "'~OF/A/61\)'
/;/I"iTALL ?A" T,*~ />L VIIJOOI7, IlEAnnP _
Job Address 4/, 7'7 M It / ;1/
Legal Description 11{)~~~4 ~ ("j \~
Owner SifrFF .:rEi/A/IA/&-5
Address JJ.O, It-v. thh ,';;Zl:;,,/P q71t;lhone4~5:2555
Construction Lender
Address
DESIGN TEAI~
(name)
Phone
(address)
WITH DU/6,v<;-CtJAJ//,{/tf' <;PIY; ~ZO Wflf
c-J.lt5$ JJ- /troT' ~CX3#))/'( 1/:ZSI.9Qt5t)
(lies. no.) (exo;res) - (ohane no, J
Primary
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.)
(PXP; rpd
~/9/;
NoA'/(I.~ IdeLrY CIl.A/l7/k1~)
-<<
r (ohone nn )
Structural ~EA)e /tcJMj!JJi - ,9C#/If}JJr;'!;T5#J1 '# WILl:! ;PC,
Electrical
EA/,p-/#cE,I{>
Genera 1 !If) E AccPF/ A/&. / Pc. ;;Z B:O 74 CA'IJJI! Ab
r;(/G~pc o/te
9',~1~~
Electrical (i#/f){ ,,~p AA/)J IA/:;T,fj.,j.,krft741' Or 'pLYWood
d-r...L.o/ (/ 3
-:?A40:z.t'f
Plumbino
~y
~lechan; ca 1
PLUt1BING
ELECTRICAL
>>> 'r"'IB.liJ NO,
MECHANICAL
.....t!Q"
Each single fixture
Residence of
SQ. F1. I
I
I
I
furnace/burner to
BTO's
ILELI..cJJAilliE.'
I
I
I
I
I
FEE
rHARr,F
NO
IRelocated building
(new fix. additional)
IS.F. Resldence
(] bath1
IDuplex (1 bath) each
IAdditional bath
1~later service
I Sewer
IStorm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
Recessed wall
Snarl" h~ntpr and vpnt
ITemporary Construction
IChange in existing
rps; df'ncp
multifamlly. camm. or
Tnrluc;tr;al
Of
amps.1
Apoliance vent
spnari11:e
Stationary evap.
cooler
Vent fan with
sinnl/'! duct
Vent system apart from
heatinq or A.C.
IMeChanical exhaust
hood and duct
I ~'Jood stove/heater
I
CDMM,/IND, FEEDERS
IInstall/alter/relocate
dic;trih. fppdprc;,
IOf amp~1
ISSUANCf OF PFRI1lT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'U4 REQUIRES that tile Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED 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 Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore<]on oertaining to the work described herein, and that NO OCCUPAr~CY 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 ons 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 7~1.055 will be used on this project.
IlAI,1E(please print) /{(/C-IfJft3L AlOE SIGIlAT~~~ DATES// /8'~
FOr. OFFICE'1lSE 0111. Y r
Zone Type/Const, Units Sq, Ftg. t1ain x Value
Fire Zone Bedrooms Occy load Sq, Ft9. Access x Value
Flood Plain Stories Occ.v Group Sq. Ftg, Other x Value
TOTAL VALUATION
BUILDING PERfIlT
Charges and
Surcharges
-j", 00 Pl an Ck. COIrmlInd
ex O. 65%/Rldo PPI" Fpp
---7,-'a.--u- ~6~~B~~~ ~:~ Fee
Fence
Isystems .Development
Charoe (L5~)
I
PLU'~BING PERMIT
Charges and
Surcharges
D~mo
ELECTRICP,L PERI~IT
Cha rges and
Surcharges
Sidewalk
/1ECHANICAL PERMIT
Charges and
Surcharges
A/C Pavi ng
I Curb Cut
------------
I
jTotal Comb. rermit
I
I TOTAL
.
;?tFl:2..
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
17 03 43
2, examEle- Lot 1, Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. . example- heat/electrical ceilin...Q/or forced air Qas
2. examole- 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 pennit,~inform.at;on:
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 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 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 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. ---
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
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. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
. PERMIT VA~IDATION
V ~\ n'Y-:
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I (AM7
S~d-2S-
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P,noit Cl"k~~'~~
Permit applicant exempt from registration with the Builder's Board' because:
Additional Project Infonnation: \.."5:\\1\ L\~, \"
\ ~~~--\r" \\ -r) '- roc\ \- ,Q
~
PLANS REVIEWED BY:
name
signature
~~,Q~~
date
1