HomeMy WebLinkAboutPermit Sewer Connection Record 1983-3-18
jINSPECTION LINE.
726-3769
CITY UF SPRINoFIELD
COIlBIilATION APPLICATION/PERMIT
Job Address ~~14lh~~ IIotef 17/0 ~ ~~~~GY SOURCES:
legal Description \i() ~ ,_I.0~\L)\~CX:P~::::Heater
.
Owner (TIM\) ~M l='
Address ':J:>()~-.t.
construction~
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/()'<, (0 C;
Phon<<l€?&~
INFOR/1ATlON lint
726-3753
Sq. Ftg. 1.lain
~CJ. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
-Fence Demo Change/Use
ValuE of I-IOrk~ JA Other--
BU11riinQ Permit Info: Describe Work{i.e., Build Single
Familv nesidence With Attached Garaae'
{le\l?Q.i.n Dt/ 'tJ.D.Yf' q-.-- less /b~
<:''''JIo('.Ir(A~ hQ.hll~rP MJ"
"
~
VI
B
Address Phone
DESJoN TEAf~ {name} {address I (lics. no.) (exoiresl (ohone no.
Primary A
Structural .~
Electrical ,~
I~echanical
CONTRACTORS (name I (address\ (1 it"f;,_ nn.' (plrnirpc;l (I'\h,~"np nn. \
"""","",,~y/ l )OYTIIwf<!:T l=KG4-IJA'TJlJh Po&t:n;;.:J. fUQeM 5ss/7 dlAlJ 83 ,H 7387
t ,
Plumbina
Electrical
~lechani ca 1
PLUIIBING ELECTRICAL MECHANICAL
Each single fixture
I FH I fHJ\lu::r t:Jn I I ~~r 'fl-l'1RGI. Nn I
Res i dence of furnace/burner to
SQ. FT. BTU's
I HI=' Irl-lARG..E..
J~.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp kp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
<;.eoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood nnd duct
Sewer i<e.PI/-IIL.. to'
/0.00
Temporary Construction
IChange in existing
re.s) d~nce
multifamily, comm. or
Indu(,trial
Water servi ce
COMM./IND. FEEDERS
Install/alter/relocate
rl;~tr;h fppdpr~
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valij until the
/0.00 TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRtlIT
TOTAL CHARGES
"Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM11NED 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 UO OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OPOS 7nl.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Tyoe/Const,
Bedrooms
Stories
Units
Occy Load
Occy Group
SIG;I~~
FOR OFFICE USE OIll Y
'p. Ftg. 11ain
Sq. Ft!J. Access
Sq. Ftg. Other
A,Lv.,
OATE 5-18 -83
IW1E(please
print)~.c<<=;
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfl1T Plan Ck, CommlI nd
Charges an~ ------------ 6S%lBlde Ppr Fee
Surcharges Plan Ck, R"es
30%/Blde Per Fee
PLUI1BING PERMIT _nn_ JPJ}fL Fence
Charges and
Surcharges . '10 Demo
ELECTRICAL PERil IT 'Sidewalk
Charges and ------------
Surcharges A/C Paving
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
CharQe (1.S~) .
Total.Comb. Permit
TOTAL
/C). yO
~
I
~
.
"III
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
l. Appl icant to furnish
A. Job Add ress
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II oj 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction'lender
., . D. Energy Sources
1. "exame 1 e- hea tle 1 ectr; ca 1 ceil; nq/or forced air qas
2. examole- waterheaterielectr;cal/or solar
E. Square footage or valuation, etc. ------
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add, etc,
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. examj)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 TEAl.! 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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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.
fo05f)
3-,/([--/3
V. FOR OFFICE USE ONLY
Permit Cl erk
(l~
./
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
b,c:;;,) {1(~A<~:# Y?'i/7
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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