HomeMy WebLinkAboutPermit Building 1988-4-4
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I INSPECTION LINE
726-3769 .
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CITY Uf SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat p~
Ha ter Hea ter
t
INfOR/IATJON llNL
726-3753
Sq. Ftq. 1,Iain 'f/'t>
~q. Ftg. Access,
Sq. Ftg. O~h r
Ilew Add lter Pep,
Range__._=_.___ . -Fence D mo Change/Use
ValuE ef Werk: I Other- -
OwnerL.~ss.t:..:/J.".J_t:".I1u AiZN.../I"..Q"~UP':"M ,~n.r '1t!>~_-
Address "'.0.' A / I I I Phene7 Buildino Pennit Infe: Describe Werk(i.e., Build Single
5,;,#" "~Pt...,~~, ,J 11....".,~,.. .;bt.-iti' Jt,.:,'; Family Residence Hith Atta.ched Garaeel
2./). &x C-?7,?,?;"' ,f4./J:. &A.!lFj2q.JZ~'>. ~",.t.j ,4/'/"/tt:,h,u.! /J1".k,Nf:J;; 1Je,.,.';
Jeb Address '7".2.2 7 A MAl/.! S7
Legal Description /10 d..., 5' ::;,),;2
o (t:{ 0 0
Construction lender
>hu/l~J"';
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C'N.kJt,
Address
Ut~ 1 tiN TI::.Ar~
Phone
(address)
lnameJ
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flies. no.)
(exn;res)
(ohone no.
/'....,<k......'/';"; C",
P.6. f2,~ >f
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS Inamel
General 4vt!:Jt...t',,""J~"c/';"
(address)
(1 ics. no.)
fnhnnp on ^
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/) D. /Jox 73'11 E'-)L#f!! 012 q.1!:&1 ~ <{ 117_7
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Plumbina
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DCV -i).-
eO&::
7'17-0.&'1/
Electrical
L.II. I'Y/0.4.JUS
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.:{M;....t:';~ i1n..
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~lechanical
PLUI.IBING
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
FEE
rHARr,F
Nn ~FF
rH~ Nn
Residence of
furnace/burner to
STU's
SQ. FT.
Relocated building
(new fix. additienal)
~ New circu!ts alts.
or extenslons
":2~J#l/~~
SERVICES
?2-~
Floor furnace
and vent
S.F. Residence
{] bath\
Duplex (1 bath) each
Additienal bath
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rp" i Qr.nr.p
multifamily, COITl!l. or
Industri;d
Appliance vent
goaratp
Stationary evap.
cooler
Vent fan with
I sinale duct
'I Vent system apart from
heatinq or A.C.
!Mechanical exhaust
, hood and dul"'.t.
Wood stove/heater
~Iater service
Sewer.\ ...-.
Storm Sewer
Of amps,
I COMI'!. /IND. FEEDERS
I Install/alter/relocate
rlic::t.rih_ fppl'tF.rc:
IOf amp~
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ISSUANCE OF PFRIIIT
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1..cJJARG.E
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TOTAL CHARGES TOTAL CHARGES -::z ':l.5"P TOTAL CHARGES
WHERE STATE L\IJ REQUIRES that tile Electrical work be dene by an' Electrical Contracter. the electrical pertien ef this permit
shall not be val;~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 rm OCCUPAUCY 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 exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IW1E(please print) dw,.. 6Lr,"".~~ aa'4 Ji~IGrMTURE~L ~
FOr. llP'F1 CE USE DIlLY d"
Sq. Ftg. 11ain 960 <fI1
Sq. Ft~. Access
Sq. Ftg. Other
DATE '7'- Y-6'tJ
Zene-<::::,/"_
Fi re Zone
Flood Plain
TYDe/Censt:~~
Bedrooms
x
Value
Value
Value
x
Y~.""'"
'5 -c{-H TOTAL VALUATION
:?A.~~ /H!iio Shstems Development /Y'-A .
C arqe (I.5~) .
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I .ITeta', G9mb.' ,Permi t~,. -
-"1, I" 7~36
I I TOTAL
.
Units
Occy Load
Occy Group
/
s.;z
Stories
x
BUILDING PERIIIT
Charges and
Surcharges
//d ~ Plan Ck, Cenrn/lnd
__ _Z2'.:.q~____ ~/Blda Ps>r F~~
"2 Plan Ck. Res
.~.2-" 30X/Blde Per Fee
Fence
PLur~BING PERMIT
Charges and
Surcharges
O~RIO
-::i?:<'-S;~ I'Sidewalk
_ _n--;.Ii--~I ~/C Pa~;ng
'Curb Cut
ELECTRICAL PERlm
Charges and
SurCharges ''';
MECHANICAL PERMIT
Charges and
Surcharges
:
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COMBINATION APPLICATION/PERMIT (CAP)
'.1:. ..:_
~
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Let 100. Lane County Map Reference
Il 03 43
2. exam~le- Lot I. Bleck 3, 2nd Addition te
sprlngfield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilin~/or forced air oas
2. exa~le- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foet heuse, 500 sq. feet garage
2. example- if new project, check new - if addition,
checK add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G. Value ef werk as defined in Sectien 303 (aJ ef the
Structural Specialty Cede
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 enly the No. Bexes adjacent
to the apprepriate 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 net cevered en
the abbreviated schedules' you should censult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted en 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. ---
Ill, Applicant te 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
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appli~ant exempt from ~egistration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
~,
name k:R/Y€ ?~~
Signatur~..-.c-r~'.
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