HomeMy WebLinkAboutPermit Building 1987-3-9
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I INSPECTION LINE
I 726-3769
CITY UF SPRINoFIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of Work:
1'1. ,. ..-
/-.......
BU11riino Permit Info: Describe Work{i~e,"
Familv nesidence With Attached Garaael
.
Job Address ,11,7{" ~/'h'S./ _Y/1I;'/,/JR'
Legal Description / 7-0 <.~ '31"- '7"-:/ /? 2~e::..-.o::::>
Owner, ~C/ c;{ /-2,,/ ./::-hlJr f/
Address 3;;'V~-~ y /'",.h/'pX/l,ij /Jp, ' fJ'!i; 5!' ~ :'
~"'/~d.lL.T ~'f A, .J? 7Y'1.-?03
Construction lender
Mechanical
-CUNTRACTURS I name I
General ~-'> <.. :>rr~T~""?.~
Plumbina
nectrical ~/T_ f//Fec.::> 7C~=?_ ~L/_~.c ....s~.
", - . /"
Address
Ut,loN TlAf~
Primary
Structural
Electrical
~1echani ca 1
NO.
4d~;. "
. /
t;1 -1'-1: ;.. R
(name)
Phone
(address)
(addr~ss 1
~;2?A...n_ ,,-::>7<"
/
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PLUflB I NG '
ELECTRICAL
F~F_ !:':l^J;lr.:~
"n
,
Each single fixture.
SQ, FT,
6
1.1174$\ ,
Residence of
Relocated building
(new fix, additional)
~ New circu~ts alts.
v- or extenSl0[lS __
"2-. ~ ~
SERVICES
S.F. Residence
(1 bat~\
Duplex (1 bat~)
Additional bath
Water servi ce
Sewer
Storm Sewer
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each
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- '1
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ITempOrary Construction
I'Change in existing
rps i d_p.ncp
Imultifamily, comm. or
Tnrllldriil;l
IOf
ICD~~./IND, FEEDERS
IInstall/alter/relocate ,.
rli~tr;h_ fppdpr~
IOf amp~1
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INFORJtATIDN LINt
726-3753
Sq, Ftg. '.Iain
~q. Ftg, Access,
Sq, Ftg. Other
New Add Alter Pep,
-Fence Demo Change/Use
Dther- -
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......
~
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1..cJiARIiE
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1
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amps.
Build Single
ltJc,f'pp
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TOTAL CHARGES ~- TOTAL CHARGES ::<-=? -;-S-C> TOTAL CHARGES /?;?/N -r:5"":"'''''
WHERE STATE L\H REQUIRES that the Electrical work be done by an<Electrical Contractor. the electrical portion of this pemit
shall not be valid 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 Oregon pertaining to the work described herein, and that NO OCCUPAIKY 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 ORS 7Ql.055 will be used on this project.
1lAf.IE(please print)~&.k.1" SIGN^TURE;.?'/..M '/-,,~J
. - FOr. OrnCE USE IlLY
Type/Canst, ~A/ Units Sq, Ftg. Ilain x Value
Bedrooms Occy Load Sq, Ftg, Access x Value
Stories Dccy Group B-2 Sq. Ftg. Othe~~_'l"~O~ Value/'7' ~,..e>
TDT^L VALUATION
ZonE'
/..C-:
Fire Zone
Flood Plain
BUILDING PER~1lT
Charges and
Surcharges
//~E L'=P~ &'< 7
I .~ <'") Plan Ck, Comm/Ind
__+<P-L:52~_ 65%/Blda PJ.r ~pE'
/1 /<:> Plan Ck, Res
, ~ ./,~ 30%/Blda Per Fee
Bb'7QIO
(,,7.9'5 -:>,-1 -'i(f)
ij -11-
PLU!~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
_____~_~__ .Fence
/ .80 DBfIlO
_ _ __ ~"?:::f5??.~ldewa 1 k
':' 70, 'A/C Paving
'J2; ~ 1 Cu~b Cut
---- ~-~-I
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;:;;VM4
./
(lies. no.)
(exoires) (ahOM no.')
__AI
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~r
~
f1 ic~_ nn.)
(pxoirec;,l
(ohnflP I'm. \
MECHANICAL
...
r IJAJlll -*'
furnace/burner to
BTU's
'2<$'
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Floor furnace
and vent
Recessed wall I
SnM~p "p~tf'r .:Inn vpnt '
W.A'-'t- ~#,.f"~
Appliance vent I
seoarate
Stationary evap. I'
cooler
Vent fan with I
sinole duct
I Vent system apart from I
heatinq or A.C.
I Mechanical exhaust I
hood and durt.
I ~Jood stove/heater I
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ISSUANCf OF PFRllIT
DAT~ rf/$J7,
Systems Development
Charqe tJ.5~l '
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ITotal Comb; Permit
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I TOTAL
J9Y rg,
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COMBINATION APPLICATION/PERMIT (CAP)
",PERMIT VALIDATION
I, Applicant to furnish
A. Job Address
B, Legal Description
1. examole- Tax Lot 100, Lane County Map Reference
17 oj 43
2. exa~le- Lot I, Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele~heat/electrical ce;l;nqlor forced air qas
2. example- waterheaterjelectrical/or solar
E. Square footage or valuation, etc.
1, examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc,
F. Building pennit infonnation:
1. examele - construct single family house with an
a ttached gar~ge
2. example - 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
Structura 1 Spec i a lty 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 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
0, 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
signa ture.
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.
&l1f3r
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V, FOR OFFICE USE ONLY
Permit Clerk
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,PROJECT CONDITIONS TO BE SATISFIE~ ~EFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Addi ti ona 1 Project, 'Infonnati on:
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PLANS REVI EWED 8Y:
t:..~~?~ ~Signatur,e--:::~~
I
name
date 3~2o-e:/
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