HomeMy WebLinkAboutPermit Building 1988-5-7
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. INSPECTION LlNE
. i 726-3769
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Legal Description /10 Ol... 3 { ({;) 00 {( 2-
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Construction Lende' -70/'7- 5'3:S-3'
CITY Of SPRINGfIELD
COMBIIIATION APPLlCATION/PERMIT
E1IERGY SOORCES:
Meat
I~ater Heater
Ranqe
ValuE of l'lork~ DOg
BUllriinQ Permit Info: Describe Work(;~e.. Build Single
Famil v Res; dence IH th At tached Garaae)
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Job Address
Owne r
Address
Address
Ut~lliN IE:.JU1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~fechan; ca 1
Inamel
Phone
(address 1
(name) J
(i~ ;Jf_~ 0
INfOR/lATIDr! lltlt
726-375l
Sq. Ftq. 1,Iain
~Q. Ftg. Access.
Sq. Ftg. Other
New Add Alter pep.
--Fence Demo Change/Use
-Other- --
flies. no. )j\
--1l-,
~
(exoi res 1
(ohane no
(address) 11ir:<:.. no.)
/" ~/ I'i '1 ~//Y2/)~.-o'y~
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PLUIIB I NG
ELECTRICAL
NO,I
Each single fixture
I FFF I r.HARGE
Nn I
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Iater service
Sewer
Storm Sewer
SERVICES
(pxnirpc;,)
<-')S- L( (; 7
I ." I r"..o.l NO
MECHANICAL
I ~H' I r~ARr.~
SQ. FT.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~n~~p n~~tpr ~nrl vpnt
amps.
Appliance vent
~poaratp
Stationary evap.
cooler
Vent fan wi th
~inole duct
Vent system apart from
heat;no or A.C.
Mechanical exhaust
hood nnd dlJ~t
Temporary Construction
Change in existing
rp'S i dencp
multifamily, comm. or
Tnoustria1
I ag/&:.A'~~~ ~""., 70.0
Of
cor~'1. IIND. FEEDERS
Install/alter/relocate
.nidrih fj:>j:>(iI;.rc:
Of
Wood stove/heater
amps.
I SSUANCf OF PFRI1IT
TOTAL CHARGES M/-1" /5'". - TOTAL CHARGES TOTAL CHARGES
WHEnE STATE L~W REQUInES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this perQit
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 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 Ore(]on pertaining to the work described herein, and that 110 OCCUPAllCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HAI,IE(please print)
Zone ~
Fi re Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLur~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
;
SIGll^TUR~J 0 ;:;4~ DATIJJv-#-8'\
fO~ OffICE USE om; /
So. Ftg. f1ain ;?E~~.c x Value 2C>&>t:r>.--
Sq. Ft~. Access x Value
Sq. Ftg. OtherMy....~ x~9" Value;:
TOT ^L V ALUA 11 ON
F/lf-L
.s TUL 7S
Type/Const. ~-f1I'
Bedrooms
Units
Occy Load
Occy Group
7f'- "2...
Stories
-:2
__Z~::~__
/~3
__-L~_~___
. 7;)~
Plan Ck.
65%1Bl do
Plan Ck.
lOX/BIde
Fence
ConmlInd
Ppr Fj:>j:>
R-es
Per Fee
Demo
S1dewalk
------------
I A/C PaYing
___________J Curb Cut Z. 9'e>'
I
.....
.
5-((-ft
::2/ . r /I(t,..- Sys teQS Deye 1 opment
,/3 1 I'r.:> Charee (1.5~)
4~
3'"4 -.5<tJ
~<_&>e>
Total Comb. rermit
11~.38
I II,/.~g
,
TOTAL
~.
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 43
2. exa~le- Lot I. Block 3. 2nd Addition to
>prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air QdS
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house. 500 sq. foot garage
2. exa~le- if new project. check-nfw - if addition.
enee Ie add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - 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. 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 oJ 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
fu 11 schedu 1 es
C. BUILDING OIVISION 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 b~ 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:
.~
PERMIT VALIDATION
.
i Permit Clerk cl CK. J,JJ,J.......-
: ----Qn " .~o-t ,p: 1153-/
Permi t appl i cant exempt from regi strati on with the Buil der I s Board because:
Additional Project Information:
PLANS REVIEWED' BY:
name_'L.&??~A- ~~
signature ~ -
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date 5:-1/- 8~