HomeMy WebLinkAboutPermit Building 1986-7-11
CITY U, SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
He.t
, t4ater Heater
Ranqe
-110..-1
I Residence of
SQ. FT.
.,r INew circu!ts alts.
or exte!lS)ons ,%Z..e-
,-:z. .:> it:: Melr.n:-
ISERVICES
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,
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I IrISPECTION LINE
726-3769 .
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le9.l Demiption j 7.tJZ "'j. '1,< C>Z 74!Jc:5
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Owner ~./L ~ ;jJU?~
Address jJb171!.a-d
Job Address
Phone
Constructi~n lender
Address
Ut~lliU IE-AU " (name)
,Prim.ry ( Ll/.Jl
Structural
Phone
(address)
Electrical
!1echanical
CONTRACTORS _ (n.me I (address)
Gener.l {/~(!Ib1AfPiJ~ 7:-;;4~o{)
Plumbina .~ UV/tc.s Pflltm~ . Z;.Iy~'~
E1ectrical~~ (C"c..~
'Iechanical ~';I _ 4b d
PLUllBIrC (;
IlU.
~ Each single-fixture
Relocated building
(new fix. .ddition.l)
1 FFF
Cl-HHU:;F
lS"~ (;7$0
S.F. Residence
(l bath)
Duplex (1 bath)
each
~~~ . .
e-- INFORlIATION LINt
726-3753
Sq. Ftg. 1.I.in
~q. Ftg. Access.
Sq. Ftg. Other
ilew Add Alter P.ep.
Fence_Demo _Change/Use
_Other
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E;'
CJ
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ValUE ~ork.:
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Builtilna'Permit Info: Describe l~ork(Le.,
FiJ;:;;;th;'che;;J~~
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()
Build Single
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"
fohane no.)
llics. no.}
lexrii r@sl
~'L
YEr"
r~
ni~~. no.'
(plCl);rp~ \
(ohnnp nn, \
1- /s--f6 3Lf5~ ,?,;;J:J / ,:;:;1;]'/ L./1-
8 r..(1'53fJf) %-210 -Y-b
ELECTRICAL
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1
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MECHANICAL
furnace/burner to
BTU's
2Z~
Floor furnace
and vent
Recessed wall
~~~~p hp~tp~ rnrl vpnt
(/".~/h~-r
Water service
ITemporary Construction
IChange in existing
r~c;jqP'J'l~P
multifamily. comm. or
Industrial
I HAVE CAREFULLY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Orel]on pertaining to the work described herein. and that flO OCCl!PAfKY will be made
of any structure without the permission of the Building Division. I further certify that my reqistration 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
:::::(:~::::t:::::~S27 ~/ compliance with :~:il:::~:55;~1~b::~ this;~~t~ LDATE t1~.1 \_~
'~ FOP. OFFICE USE QiILY
Tvpe/Const. <);-~ Units Sq. Ftg.
Bedrooms ~Occy Load Sq. Ftg.
Stor~es2<~~rccy Group../?- '2 Sq. Ftg.
.
Addition.l b.th
I Sewer
'Storm Sewer
Zone c..c:.
Fi re Zone
Flood Plain
BUILDING PER/lIT
Charges and
Surcharges
/. c/ ~ Plan Ck. Co","/Ind
. ___J5P-l:'~=_ ~/Rldo P.l'r Fee
i_I ~4Ic Pl.n Ck. Res
"7. ~ 30%/Blda Per Fee
. G"7.S0 I Fence
-n-nz~7~-1 Demo
'27:.'S"o I Sidewalk
_nnn~_cj';:;_1 A/C Paving
'?"9....... I Curb Cut
------./~56-1
PLU!iBING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
11ECMANICAL PERMIT
Charges and
Surcharges
amps.
tiain )( Value
Access x Value
Other 7fr~2?~ V.lue
TOTAL VALUATION
/y~
,
I.,'" ,C/o> 'D,ll "" Systems Development
.,." :::> C!d.do-,,,, Ch.rae (1.5~)
.N,~
'Total Comb. rermit
I
I TOTAL
'2'/2. BY
-:z '/<.87'
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,
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
Sprfngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole. heat/electrical ceiling/or forced air Qas
2. examole- waterheatertelectrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examyle- 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. examEle - remodel existing garage into family room
3. exam~le - 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. OESIGN TEAr~ ANO 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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.
6&0.11~
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V. FOR OFFICE USE ONLY
Permit Clerk
cu
II
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
PLANS REVIEWED BY:
name..L~RN'~ h~.Gi:?
Signature~'"1,_.'Io~. k' ~ ""l
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date 7-9-8&