HomeMy WebLinkAboutPermit Miscellaneous 1986-2-7
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I INSPECTION LINE
/26-3769 .
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Job Address
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CITY Uf SPRINGfiElD
COMBlIIATlON APPLICATlON/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
legal
410"-
Description J 7'()Z'~7. ~Z .
I
INFORllATlON L1Nl
726,3753
Sq. Ftg, 1.lain
~q. Ftg. Access.
Sq, Ftg. Other
flew Add Alter Pep.
-Fence Demo Change/Use
Other - -
Owner
Range
ValuE of Hark:
$'5"'(I./'l ~
Builriinq Pennit Info: Describe Wor~:.(;..eq
Familv nesidence I-lith Attached (iaraae)
Fi?A\'1L. M LIG-t\T
~2- \ M ~ I ...\
c;. 11 F 1")
5~11==-
Address
Phone71f'~'ilZ
PA\Jt::
Construction lender
Address
Ut~ J liN i tAf1
(namel
Phone
(address)
Primary
Structural
Electrical
. 11echan;cal
CONTRACTORS (namel (address)
'General E,(')&'GIY€ -?~t'P/Gk' S/MS)
,
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Plumbino
Electrical
~'echani ca 1
PLUIIBING
ELECTRICAl
NO.
FEE CHARGE Nn
Each single fixture
Residence of
SQ. FT.
Relocated building
(new Fix. additional)
I'S.F. Residence
(1 bath)
IDuPlex (1 bath) each
IAdditional bath
I~I; t;-~---~ervi-ce
I Sewer
Istorm Sewer
I'New circuits alts.
or extensions
I SERVICES
I
ITempOrary Construction
IChange in existing
rp<;, i qftnr:p
Imultifamily, comm. or
Inrlustr;al
IOf amps.1
ICOffi1./IND. FEEDERS I
IInstall/alter/relocate I
di<;,trio. fppdpr<;,
lof amps.1
Build Single
P AlZlllt-)(~
L O>t-
-..
(l ics. no.)
(OhOM no.'
(exnires)
~
(lic~. no.) ,r, (exo;rpd
(ohnnp nn_ )
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MECHANICAL
I ... IJ:.I!ARG.E. "0
~~~ r~.iAR.G..E..
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~nacp hp~tpr ~nrl vpnt
, I
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I
Appliance vent
seoaratp
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatino or A.C. .
I Mechanical exhaust
hond and duct
Wood stove/heater
ISSUANCF OF PFR!HT
TOTAL CHARGES TOTAL CHARGES TOTAl CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication fo~ permit. and do hereby certify that all information 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 Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n. and that UO OCCUPAI~CY wi 11 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 ~~r701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and e~Yees who are in c~ ce with ORS 701.055 will be used on this project.
IWIE(pleaseprint) .-dt..n.......~ 'tn - 2r- SIGllATURE _tlAI-.lK. }.i\' U&...Hi OATE :J../7/9h
. 1\ FOR OFF I CE USE OIll Y j
Units Sq. Ftg. Hain x Value
Occy load Sq. Ft!J. Access x Va 1 ue
Occy Groun Sq. Ftg. Other ~ V/h'?-o. x value..5"1~ 06
TOTAL VALUATION
Zone ~ ~
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
BUILDING PERfllT Plan Ck. Corrm/lnd
Charges and '------------ 65%1B1 do Ppr Fpp
Surcharges Plan Ck. Res
30%lBldo Per Fee
PlU!1BING PERMIT Fence
Charges and ------------
SurCharges Demo
ELECTRICAl PERIHT Sidewalk
Charges and ------------
Surcharges A/C Paving
MECHANICAl PERMIT Curb Cut
Charges and ------------
Surcharges
. '3~ 73
5G,S~
Systems Development
Charoe (1.5%)
Total Comb. Permit
I
I
I
If 9'3. '23
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT ;VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description .'
1. example- Tax Lot lOa. Lane County Map Reference
11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
fP.r1ngtield Estates .'
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air qas
2. exa~le- waterheater/electrlcal/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 permit information:
1. .examole - construct single family house with an
attached garage
2. example. remodel existing garage into family foom
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. DESIGN TEN4 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 OOT 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: kP/8t!>//?)'n.T/'/7 ~..c..h'EE~E;"-;/7<; #....vp
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PLANS REVIEWED BY:
name ~RdE"' hcz:r8"?
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date -:Z-7'6b'