HomeMy WebLinkAboutPermit Miscellaneous 1985-7-26
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Owner <;:',) J.eN.f"
Address 3''7.5'"6
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CITY OF SPRINGFIElD
COMBINATION APPlICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
RanQe
ValuE of'Wor'~ ~
r{;;C1t70' c-
7~/ BullciinQ Permit Info: Describe Work(Le., Build Single
Phone - q~ Familv nesidence IHtlLllttached Garaoe)
;4, c, ~~rf/ to G:, !-o i-
ifP,77/1~)/ ~ Dc0t9 ~C) ^PA
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INFORlIATlON liNe
726-3753
Sq. Ftq. i,lain
~q. ~tg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Fence_Demo _Change/Use
_Other
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f)
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j'lilSPECTlON lINE
726-3769
Job Address 57~cO 11/t)/f/ 51-,
legal Description /?~8c.~ $'/--(/2- 'IF-1.:?Z!O
Construction lender
Address
Ut~HjN 1 cAr~
{namel
Phone
(address)
(1 ics. no.)
(exnires)
.
(ohane no.)
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Primary
Structura 1
Electrical
Mechanical
CONTRACTORS I name I
h~ //-tJdo
(addre5S)
(lis::s. no.) (pxnirpc;)
7;7/2 31))/;f?(.(~''f:(. 'J/(f.?a
(ohonp nn )
Z.~/tj~;;6
7~t; '-.5.5'"5f
Genera 1
~.IC~
r
/"uc~ ,
Plumbino
Electrical
~'echanical
\
PlUim I NG
ElECTRICAl
MECHANICAl
NO,[
Each single fixture
FFE CHARr" tl(l IOcC rH'JliiE. fin
Residence of furnace/burner to
SQ. FT. BTU's
l~r!:' r~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
{tJ' Storm Sewer
2$.""
Of
amps.
Appl iance vent
seoarate
Stationary evap.
cooler
I Vent fan wi th
sinale duct
I Vent system apart
heatino or A.C.
Mechanical exhaust
hnod and durt
Wood stove/heater
from
Additional bath
~Iater service
Temporary Construction
Change in existing
rps.irlf'\nrp
multifamily, camm. or
Tnnuc;t.r;;11
Sewer
COMi,l./l NO. FEEDERS
Install/alter/relocate
ni<:trih_ fppdprc;
Of
amps.
TOTAl CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ ~ntil the
ISSUANCE nF PFRrllT
25:- TOTAl CHARGES TOTAl CHARGES
that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this permit
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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore(]on pertaining to the work described herein, and that fW 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 exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 701.055 will be used on th::7ct. /;;/'
ilAf.1E(p1ease printrx-15;/...oPN'.P 4..x...~-R'-I SIr,ilATURE ~~A2
/-FOR OFFICE USE mil Y ./ I
'Tyoe/Const. ~..., Units Sq. Ftg. I(.in .x I Value
Bedrooms Occy Load Sq. Ft9. Access x Value
Occy Group Sq. Ftg. Other~"~x Value, ~
/riJ /!d; t:-- ~t030 TOTAl VAlUATION
Plan Ck. Commifnd ...,... -f3.!Z Systems Development
65%/Blda Ppr ~",e "'-'";J . CharQe 0.51:)
------------ Plan Ck. Res
30%/Bldo Per Fee
_ _ _ _ _"?$. ..,. I Fence
1.~IDemo
I Sidewalk
------------
..1 AIC Pavin~
I Curb 'Cut"
------------1
<::.:::.
DATE7~2~~1,,..
Zone
Fi re Zone
Flood Plain
Stories
.-
BUIlDING PERIIIT
Charges and
Surcharges
~~.-
PlUI~BING PERMIT
Charges and
Surcharges
I
I
ElECTRICAl PERI~IT
Cha rges and
Surcharges
-=?I{;. -
ITotal Comb. rermit
&2.-'
~/SZ~-
11ECHANICAl PERMIT
Charges and
Surcharges
1
T
.J
I
I TOTAl
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference' ,
17 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examDle~ heat/electrical ceilinqjor forced air Qa5
2. example~ waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -----
'1. example- 1250 sq. foot house, SOD sq. foot garage
2. exa~le- if new project, check-new - if addition,
check. add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - 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 TEAfI 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 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:
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PERMIT VALIDATION
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Pennit Cl erk
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Pennit applicant exempt from registration with the'Builder's Board oecause:
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....A'ddi ti ona 1 Project'Infonnati on:
PLANS REVIEWED BY:
name
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s';gria'ture ~~::l.,
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date '7-7ra.~