HomeMy WebLinkAboutPermit Building 1983-1-12
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I IrISPECTlOIl L111E.
726- 37 69
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CIn OF SPRWGFIELO
COIIBItIATlON APPLICATION/PERMIT
. E!IERGY SOURCES:
Heat
Hater Heater
Ranqe
INFORt1ATION LJJ'~t .1
726-3753
So. Ftg. 1,Iain
~q. !='tg. Access.
Sq. Ftg. Other
Ilew Add A Her Pep.
--Fence Demo Change/Use
Other - -
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Legal
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De<cription /'?d";J,.32.D4f>
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Job Address
Owner ('7ec: /
Address.;L ,y 3 7
Construction Lender
Address
DESIGN TENI
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbino
Electrical
~lechanical
NO.
S;-A X d)../
~<0 '.?'~..",_t"-/p
Valu~ l'lork:
p~_o
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Phone:;?// ,. .lluj!~inQ Permit Info: Describe Work(Le.. Build Single
7Y<" ~ '.5.a'b1lv ~esidence I~ith JI..ttached Garaael
/~rcR/~flj J?~..z,r.z. - ~D
&A'- /h7: Im~,-, -1 &':4'.
c:>e.>Tc. FT$ .
(lies. no.)
(name)
Phone
(address)
(ohane no.
(exnires)
,
~
V
(name)
(address)
(ohane no. )
(lies. no. 1 (exo;re~)
gl?e5o~v
ZJORV
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4c/e;.k~~_
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PLUIIBING
ELECTRICAL
MECHANICAL.
FFE CH~ jj(l
FFL..J:HAB.liE. NO,
~FE fHIlRlil
.).'- lS;iH
Residence of
,/
Each Single fixture
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Ouplex (1 bath) each
Additional bath
3
~Ia ter servi ce
Sewer
v
New circuits a1t5.
or extensiQr:ls_~ ~
2'R,~C'"
SERVICES
Recessed wall
~n~~p hp~tpr ~nrl vpnt
6:"#
Floor furnace
and vent
Temporary Construction
Change in existing
rpSo.irlJ'j1l":p
multifamily, camm. or
Industrial
Appliance vent
Spoari'ltf:>
Stationary evap.
r:nnlpr
Vent-fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and dud
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TOTAL CHARGES 1S:.so TOTAL CHARGES IS. - TOTAL CHARGES
, WHERE STATE L\H REQUIRES that tile Electrical work be done by an"Electrical Contractor, the electrical portion of
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
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SMl~ST ~.Gy.J'/~8'he>~
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"thi s permit
I HAVE CAREFULLY EXN11NED 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 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 rw OCCUPAIKY 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 th basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 wi l/'~ us~ on~~s project.
1lAJ.IE(please print) SIGtlATU ,~.d~.i- DATE
FO~ OFFICE USE- miL Y
Sq. Ftg.
Sg. Ft9.
Sq. Ftg.
Storm Sewer
Zone ---1:!1 '*'
Fire Zone
Flood Plain
BUILOING PERmT
Charges an~
Surcharges
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICft.L PERI~IT
Cha rges and
Surcharges
IIECHAN I CAL PERMIT
Cha rges and
Surcharges
~
Of
amps
CO~1./IND. FEEDERS
Install/alter/relocate
rl;~tr;h_ fpprlpr~
Wood stove/heater
Of
amps.!
ISSUANCf OF PFRllIT
Tyoe/Const..%7T". N
Bedrooms
Units
Occy Load
Occy Group.L1- 3
t1ain
Access
Other ,4(17'
x
Value
Value
Value
x
?1c-.~
TOTAL VALUATION
S<>A.:>: --
G'-.-
Stories
.2
-:;7-;> _ Plan Ck,
___.-;t_~,,=-____ 65%/Blda
I ~ 8' Plan Ck.
. - 30%/Blda
Is-. - Fence
------------
. (;;t> Demo
./..S". - I Sidewalk
- --- --':-~~-I AIC Paving
/t:. "'..,. I Curb Cut
-------.-6-i-1
Conm/lnd
Ppr Fpp
Res
Per Fee
~P,$.r:>
Syste~s Development
Charqe (1. sn
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ITotal Comb. rermit
81./~
1(>/. ~~
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I TOTAL
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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
II oj 4j
2. examole- lot 1. Block 3. 2nd Addition to
~pringfield Estates
C. Name. etc. of owner and construction lender
. D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electricaf/or solar
E. Square footage or valuation. etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check new - if addition,
check add. etc.
F. Building permit information:
1. example - construct single family house with an
a ttached 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 TEM~ 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. 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. ---
III. 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.
V.' FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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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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name L~;;>NE;"" ~E~ E19signature /~~~.. .,. date 1'Y'::<-fii?'3
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