HomeMy WebLinkAboutPermit Building 1984-1-3
I INSPECTION LINE
726-3769
~ CITY Uf SPRINGfiELD
COMBINATION APPLICATIONfPERMIT
EilERGY SOURCES:
Meat
Hater Heater
Range
Job Address J7 </7 ~ ..J.t
YudJ..d.tJ ~
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Owner l' f.U.I-L(tJ Y ~
Address /7 f/7 hlt!~..lJ f,
Legal De5cription
Construction lender
Address
Ut~lt:iN rEAH
Valu, Jf ):?~&oO
BuilriinQ Permit Info: Describe Work(i~e., Build Single
Familv nesidence ''lith Attil.r:hpd Gi'lrilopl ./
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(ohane no.)
Phone
Primary
C'"1.. U~e. ~
(name)
Phone
(address)
(name)
Ro 4., V\...' .A Ll \...1>..1
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Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
~1echanical
NO.
q
Each single fixture
U:.ELJ..QJARG.E _.n
Residence of I
SQ, FT.
INew circuits alts. I '
\ or extensions \ ~ t,;)~
2. [SERVICES \("{')tw..." 1\~CIl ~
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I I I SSUANCf nF PFRllIT
I-.\. 'i 00 TOTAL CHARGES 1...\::" OJ I TOTAL CHARGES \ ~. CC
that the Electrical work be done by an"Electrical Contractor, the electrical portion 'of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
(addr~ss1
PLUI1B lNG
ELECTRICAL
FEF
rHAPr,F
Nn~
s.ctl L..\ ~OO
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
IAdditional bath
I ~Ia ter servi ce
I Sewer
I Storm Sewer
!Temporary Construction
IChange in existing
, rp~ i ciPJll":p .
Imultifamily, camm.
Indlle;.trial
IOf
ICOMfl./INO, FEEOERS
I Install/alter/relocate
rlic;.trih_ fPPrlprc;.
Of amps.!
amps,
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
.
(lies. no.1
(lice;.. nn.l
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INFORlIATION UNt
726-3753
Sq. Ftg, 1.lain
~q. Ft!). Access.
Sq. Ft9, Other
Ilew Add A Iter Rep,
--Fence Demo Change/Use
Other- -
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3
(exoiresl
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(pxoi res' ~ (ohnnp
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MECHANICAL
<<<
r"~
furnace/burner to
BTU's
/
Floor furnace
and vent
Recessed wall
C;l)ill":P np;ltpl" ;Inn ~P'11-_
'L
I Appl iance vent
e;.eoarat.p
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart from I
heatina or A.C.
I Mechanical exhaust
hnod <Ind durt
I ~Jood stove/heater
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~ro Co~
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I HAVE CAREFUllY EXAMINED the completed application far 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 describ~d herein, and that UO OCCUPAIICY 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 compl iance with OP.S 781.055/7 on this project.
1lAJ.1E(please print) D4u0 !t/; ~<l-J775'-'J SIr.IIATUR~A".;>~~~ DAT~/h,?/o/-
FOR OfFICE USE~ V 'I,
ZoneJr - Tyee/Const, ':".~\...\ Units.f)O~. Sq. Ftg, Ilain x. Value
Fire Zone - Bedrooms Occy Load Sq. Ft!J. Access x Value
Flood Plain - Stories \ Occy r.roup9- ~ Sq, Ftg, Other x Value
BUILDING PERMIT
Charges anc
Surcharges
PLU!1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI:IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
\.'rlr ~ ~
"000 Plan Ck, COl1l11flnd
____~__.,____~/Rldo P.f1r FfIfI
n 40 Plan Ck. Res
c.. 30%fBldo Per Fee
~ ~ CO Fence
----- \~eP-- Demo
----~~,-~~--
\. 'a:)
----\~-'~---
(J::>
n.oo-=.~'\
"t:Jo.... CO
I'Sidewalk
I AIC Paving
I Curb Cut
I
TOTAL VALUATION
Systems Development
Cha rqe (1. 5~) ,
I
~~\\
ITotal Comb. Permit
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I TOTAL
2. '0, reO
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
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
sprlngtield Estates
C. Name. etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceilinojor forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, examole, 1250 sq, foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
cneck add. ete.
F. Building permit information:
1. example - construct single family house with an
attached garllge
2. exarnele - remodel existing garage into family room
3. example - conver~ single family resjdenc~ into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM4 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 Electr;cal 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
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. ---
Ill, 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.
:
1~3-B4
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V. FOR OFFICE USE ONLY
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Permi t
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's~Board because':
Additional Project Information:
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PLANS REVIEWED BY:
nam~\.t:"'ls.~~~
SignatuDC'lA.A. ~-=<\e.... X-'
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