HomeMy WebLinkAboutPermit Building 1984-2-6
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INFORl1ATION liNt ~I
726-3753
Sq. Ftg. f.lain
~q. Ftg. Access.
Sq. Ftg. Other
Uew Add Alter Rep.
--Fence Demo Change/Use
-Other - -
IIISPECTIOII L1I1E
726-3769
Job Address
7'7~o .#At-,'...,
, CITY OF SPRIIIGFIELO
COtlBHIATION APPLlCATION/PERMIT
E!IERr,y SOURCES:
Heat
('later Heater
.'
Owner CPc_; I
Address 7'-7 c,/o
~ SA...x c.l......
.s;o,'-{.c
~A. ....
~luE of Hork: ().J
/000 , -
'.
Phone;r,r, oo~ ~~~1~~n~e~~~~~elnf~~ A~i~~h~~eG~~~~~~.e.,
Build Single
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Legal De,cription I? - cJ'L - 3 "2.. ~ (.) c:J 7.::>/
Address
Ul:.~I(iN ItN1
(name)Cr,::o '-~. I
~- S~'e.-r ~ tU#-V'!!>-~'"
<; ~-o/ ~"'- c.-I e...,. ~..J,,--;?'
Phone IB~_1 A c......,f'_v./.;.- ~".,.7.,\
'"-;;;.6:0..V ~ (address) ,',*",,,,~ _(lic5."00.) (exoires) (ohane no.
Construction lender
Primary
Mechanical
CONTRACTORS
(name)
~~F,
'address'
(lies. no.)
~
(exofres) (ohnnp nn )
Structural
Electrical
General
Plumbina
Electrical
~lechanfcal
PLUllBIrIG
ELECTRICAL
MECHANICAL
.....!!Q."I
Each single fixture
, FFF 'CHARr,F .1'n
Residence of
~J:'!:' . fl:iARG.E. Nn
SQ, FT.
furnace/burner to
BTU's
'=.J:'J:' ru~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
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TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L~W REQUIRES that the 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
S.F. Residence
(1 bath)
Duplex (l bath)
IAdditional bath
1~later service
I Sewer
I Storm Sewer
I
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each
I SERV ICES
I
amps.1
-,
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Recessed wall
'So~rp hp~t~~ ~nrl vpnt
!Temporary Construction
Change in existing
rPos. i dJ'nrp
multifamily, comm. or
Tnrluc:.trial
IOf
ICOffi1./INO. FEEDERS
I Install/alter/relocate
dic:.t.~ih fpprlprc:.
IOf amp~1
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatino or A.C.
" Mechanical exhaust
hood and durt
I \.Jood stove/heater
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ISSUANCE OF PFR!llT
I HAVE CAREFULLY EXNlINED the completed aprlication for permit, and do hereby certify that all infonnation 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 Oregon oertaining to the work described herein, and that NO OCCUPAHCY 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 exemp n is noted hereon. and that
only subcontractors and employees who are in, comol;ance with OPOS 7~1.05~d on this ect.
IIAI-IE(please pr;ntCeC i (~"')I..Oe..I SIr.IIATL~. ~::. DATut2 -6- "7
Fon OfF! CE USE QiIL Y
So. Ftg. rlain
Sq. Hg. Access
Sq, Ftg. Other
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occ'y Group
x
Value
Value
Value
Fi re Zone
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
__L~_~~___I ~~~~B~~~
, LJtt> Plan Ck.
. -, 30%/Bldo
ConmlI nd
Pe>r Fpp
Res
Per Fee
Systems Development
Charoe (1.5~)
#.4
PLUt1BING PERMIT .
Charges and
Surcha rges
Fence
------------1
Demo
I Sidewalk
I A/C Pav; n9
I Curb Cut
I
ITotal Comb. rermit
: TOTAL
lot/. ~CJ
ELECTRICAL PERI:IT
Cha rges and
Surcha rges
11ECHANICAL PERMIT
Charges and
Surcharges
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map ReferencE (
II 03 43
2. example- Lot 1. 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
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot gara
2. example- if new project, check-n€w - if additio
check add, etc.
F. Building permit information: , C'
1. examele - construct single family house with an
attached garage .
2. examt;lle -. remodel existing garage into family r
3. examDle - 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 infonmation or jOb site
correct ions, etc. ..
11. Abbreviated Plumbing, Mechanical, & Electrical Schedule: (
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the appl icant need fi 11-in only the No. Boxes adjacl (,
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedu' CO'
have been abbreviated
,2. If the item(s) to be installed are not covered (
the abbreviated schedules you should consult thf
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. ", -
Applicant to sign and date
Whenever possible, the initial application will b~ 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
paya~)e 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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"V OF SPRINGFIELD
City Hall
Sprlngllald, Oregon
Department 01 Public Works
OFFICIAL RECEIPT ,
No. B 62366
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Date .Fei$. L., 19
Rec'd From C Eel '-
Address ~g3';> ~L4-"'-e-,'''' ~.
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Received For. t)~
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, Amount Received
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VP Aulfi RIZEDSIGNATCF!E /- \..
.,noo. ~ftINTl:ft./LlTHOOIllA~Hl:ft.. I:UGI:NI:. OftI:OO"
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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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\ UNITS
_ STCnIES
LEGAL. DESCRlPTION
OCCUF'ANCY GROUP
OCCUPM-=CY UJ.e,O
TYPE COt.1ST.
_ AD;RESS_'1?&/t::> M#/U.-5T.
OWNER ~~~I'C .Zin'ffd!P;p..:---
THE cor.lTE~rr5 Hl:'RE 0.... Hl.VE SEJ:.:N REVIEV.:ED. \fIltH
ALTERAT10tJS INO!CA,EO IN COLORED PEI..CIL. CH,\NSES
OR ALTER.J:..:-,OflS M..CE A'FT'~R DAT;;: ei:::LCW SHALL BE
APPROVED BY THE 8tJILD1N~ OFFICIAL.
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CITY OF SPRiNGFiELD. OREGON
~~:ROV_ED ,BY #~.__,~:' DATE.~:~~_'
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