HomeMy WebLinkAboutPermit Building 1982-3-10
Job Address I ~ /J 4 A A <.
"'-/AIU ~.
Legal Dmription /7-03 -;5(,;, -4:2 TL, '700 .
v
I INSPECTION LINE
726,3769
Owner.. 3A "" '"'''
Address
PL:t)/ R /
P,:n I.A~-
~.
3(,,4.1"1
S-,onn ('))1(.
Construction Lender PJ.. tV..
Address
Ut>! uN I tAl-!
(name)
SIl..,J!:-
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
SA"'~
Genera 1
Plumbino
Electrical
~1echanical
PLUllBlNG
NO, FEF CHARGF Nn
Each single fixture /
Relocated building /
(new fix. additional) I
S.F. Residence /
(] bath)
Duplex (l bath) each /
Additional bath /
Wa ter service /
Sewer /
,
Storm Sewer
II
I
I
I
I
I
. t...fJ/.I/? p:>E(o<{9/
CITY UF SPRINGFIELD
COl1BIIIATI ON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range
.
INFORllATION LINt
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg. O~~er 700 l?r
..Jlew ~dd lS{\ 1 ter -Yep.
Fence Demo Change/Use
-Other- -
I.tr
[!l
(
(.,
I)
ValuE of HoJl\<:
'/'fOD
J Builciino Permit Info:
Phone7'f/lJ-I'f{ Familv Residence l~ith
CC"'MIZ',e,c..(~L
f?"'_C>b"'- L..
~J
i
~
\'...l
Q
~,:t
(ohane no. )
Descr,be Work(i,e., Build Single
Attached Garaoel
Phone
(address)
{lies. no.l
(exniresl
(address 1
~-
. (PXnir'T!nnnnp nn
(lies. no.l
ELECTRICAL
MECHANICAL
Residence of
HI=' rl-lllB.G.E. NO. !=,j:'L..cHARG.E..
furnace/burner to I
BTU's l/
Floor furnace /
and vent
Recessed wall f
Snarp hPAtpr nnd vpnt
SQ. FT.
New circuits alts.
or extensions
SERVICES
Temporary Construction
Change in existing
res i q~.nce
multifamily, camm. or
Industrial
Of amps.1
C0I1I,I,flND. FEEDERS I
IInstall/alter/relocate I
rihtrih. fpprlpr<
10f amp~1
I
I
I
/
/
1/
A
Appliance vent
~~oaratp
Stationary evap.
cooler
V"ent fan wi th
sinole duct
Vent system apart from I
heatino or A.C- .'
Mechanical exhaust
hond and duC':t
Hood stove/heater
i'
ISSUANCE OF PFRl11T
"
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,'lJ REQUIRES that the Electrical work be done by an,'E1ectdcal,Contractor, the electdcal portion of this permit
shall not be valiJ 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 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 OCCUPAnCY 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.
1lAl-IE(p1ease print)l<..>J ~Ry>... SIGII^TURE"R",^-,~
Far. OFFICE USE O~LY
Sq. Ftg. Ilain
Sq. Ftg. Access
Sq. Ftg. Other
OATE JtO/"ff).-
/
Zone l..!.- 41_Tyqe/Const. 1Z- j-)li2Units
Fire Zone Bedrooms Occy load
Flood Plain Stories Occy Group_;q--~
BUILDING PERmT
Charges and
Surcharges
Plan Ck.
_______l..o$!2;2, ...ill!Bldo
Plan Ck.
; bo 301/B1 do
Fence
PLQr1B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
,
Value
Value
Value
VALUATION
'/~(XJ-
x
.
Conm/l nd
P,.E'r Fpp
Res
Per Fee
. 71' TOJ,l\L
I\...Lc ~ a?,f - ( ") ~ 1..'1 q
-.$0 7'''"' 'Ii Systems D.evelopment
7. J POI(. Charoe O.5~) .
D~mo
I
I
'S1dewalk
A/C Paving
I Curb Cut
I
ITotal Comb. rermit
I
I TOTAL
/~S'~~
"',
.
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. exa~le- Lot I. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceilinq/or forced air QdS
2. examDle- waterneater/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.
check add. ete.
F. Building permit information:
1. example - construct single family house with an
a ttach~d gar~ge
2. examole - remodel existing garage into family room
3. examjile - 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 constru~tion 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 availa~le 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. ---
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.
'V. FOR OFFICE USE ONLY
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,
PERMIT VALIDATION
~~ '5'f:J\?:D
.~ ~\\\~~
"
'\~,OO
.&20
~
\ 'S.lo 0 CfjJ
,
Permit
Cler;{U:n
j
Permit applicant exempt from registration with the Builder's Board because:
/fU
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date ?-/#/l[ L