HomeMy WebLinkAboutPermit Building 1984-7-10
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II1ISPECTIOII LIIIE
726-3769
CITY Of SPRlllGFIELD
CDrIBIiIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat ~-IJlt! I
!"ater Heater 6'.Ja.
Ranqe fnl.s
ValuE of Hork:
Job Address ~qq5_ fllQIIU fT. ~pl'l~K'2! (JIL-
LegalOmriPtion\ IUe-3 \41 ?fD
INFOR/IATlON LINE
726-3753
Sq. Ftg, ',lain
~q. Ftg. Access.
Sq, Ftg, Other
lIew Add Alter Rep,
Fence_Demo _Change/Use
_Other
l!~
J
(l', /-//nh'?U S
I'Rr. Phone7{1'7."3~
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BuilGina Permit Info: Oescribe Work{i.e.,
Familv nesidence With Attached Garaae)
,
(l ics. no. ) (exoires) (ohane no. )
A
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11 ir:c:_ no. , (pxnirf'C:) (ohnnp nn 1
Owner {I.ha.rl...es 6'." Atl!li> In
Address ::21 go /J'JI'II ru.onn"/
_:SPIe~'I.'~,/~id (dfF60N q.2!L??
Constructio~lender
l?,,<,raUN1U/Y,r
'..'~
Address
Ut~lI.jN It:.Ar1
(namel
Phone
(address)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(namel
(address)
Genera 1
Plumbina
Electrical
~1echanic'al ~(lt<
!,J1lt'do^\
1 l..3sl
PLUllB ltlG
ELECTRICAL
---.llih'
Build Single I
- ':;od=?<I P.A
MECHANICAL
Each single fixture
I FH: I r.HARr;r ~n I I HLI..cJ:lAR.G..E. Nn_ I
Residence of furnace/burner to
SQ, FT, BTU's
l ~~~ I r~~
/.'
S.F, Residence [SERVICES
(1 bath)
/DuPlex (1 bath) each I
IA~~~tional bath !TempOrary Construction
[Water service IChange in existing
rp')idyJ'lcP .
I Sewer ImU1tifamilY, COlTlTl. or
Induc:tritl;l
I IOf amps,l I
Storm Sewer
I ICOI-lf1,/lND, FEEDERS I
I I Install/alter/relocate I
d;~trih_ fppdpr<
I IOf amps.! I
I I I I
I I I I
I I I I I ISSUANCE OF PFRfm
TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES' /d/. ~
WHERE STATE 1.,\11 REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion 'of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Oivision
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
Recessed wall
Soa~~ hpatpr tl;nd vpnt
Appliance vent
SF'oarate
Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hood and dud
I \.Jood stove/heater
~ 7?nt.,C"'yc".
I ;
I
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I
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I HAVE CAREFULLY EXAlIINEO 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 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 ORS 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 7Ql.055 will be used on this project.
IWIE(please print;PQf~'~"'ij A- JuIJ1J?1ILS
SIr,rlATUR~/~_L:''''
FOR OfFICE USE OIlLY
Sq. Ftg. r1ain
Sq, Ftg. Access
Sq, Ftg. Other
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILOING PERI,1!T
Charges an~
Surcharges
Plan Ck, Comm/lnd
___________ 65% Blda P~H. Fpp
Plan Ck. lies
30%/Bldo Per Fee
I Fence
------------
I Oemo
I Sidewalk
------------
I AIC Paving
____/~.:~J Curb Cut
. '10 I
PLUI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
/1ECHANICAL PERMIT
Cha rges and
Surcharges
~d1/-/.<? .-/
DATE
7-/0-11
x
Value
Value
Value
x
x
TOTAL VALUATION
SystemsOevelopment
Charae (1,5~) ,
I
I
Total Comb. Permit
I
I TOTAL
/0. t.tU
,
COMBINATION APPLICATION/PERMIT (CAP)
~
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2, examole- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. exam~le~ heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq, foot house, 500 sq. foot garage
2. examole- if new project. check new - if addition,
check add. ete.
F. .Building permit information:
1. example - construct single family house with an
a ttached garage
2. exam~le - remodel existing garage into family room
3. examole - 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 TEN1 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design infonmation or job site
corrections, etc.
II, Abbreviated Plumbtng, Mechanic~l, &,Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedule's,
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
Z, If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
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. ---
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 wheQ. J:h~, p'.er'!l.it'~is issued.
111.
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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....,
I' "..
Permi t
Clerk'~
.
Permit applicant exempt from registration with the Builder's Board,because:
Additional Project Information:
PLANS REVIEWED 8Y:
name
signature
date
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