HomeMy WebLinkAboutPermit Building 1982-3-8
IIIISPECTlON LINE
726-3769
Job Address \n~~ ( f'\'O...l,.f\ ~,.
Le9al Description J7-{) 3 ~ ~- t/2
. CITY OF SPRINGFIELO
CDMBIIIATlON APPLICATION/PERMIT
EilERr,y SOURCES:
Heat
\~ater Heater
TX '-0-07 r){)
INFORllATlON UNt
726-3753
Sq. Ftg. ',lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
Range \_"ince_Deiiio_Change/Use
ValuE of~ c:t:) ,)(:ther
'-:-~. . /
BuilGlnQ perniit info: Descr'be Work(Le.. Build Single
Familv Residence With Attached Garaae)
.
Address
Ut.~lliN IE.AH
(name)
Phone
(address)
_\O~C'Q
. I
~ t'AU
u
I~
o
-
..D
~
Owne~ \ t< () MD
Address~~\ ~ ~ .'J~ __ Phone
const~l~l II V ~i)!1 J 0141'1
fl ics. no.)
(exnires)
(ohane no. 1
Primary
~A
.~
'4
Structural
Electrical
Mechanical
CONTRACTORS Inamel
t II t ')MJ-..J
(address)
(1 ics. no.'
(plCnirpc:,l
fohnnp nn )
Genera 1
Plumbina
Electrical
'Iechanical
. PLUllBI NG
ELECTRICAL
MECHANICAL
NO,
HF fHARr.F NO.-
"r" rlJARliE..lJll
HI=' rl-l4RG.E ~ .
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
./
Relocated building
(new fix. additional)
S.F. Residence
n bath l
Ouplex (1 bath) each
Additional bath
lwater service
I Sewer
I Storm Sewer
I
I
I
I
I
I
INew circu~ts alts.
or extenSlons
!SERVICES
I
Floor furnace
and vent
Recessed wall
~~~rp hp~tpr ~n~ vpnt
j
ITempOrary Construction
IChange in existing
r~s i ~.nc:e
Imultifamily, comm. or
Industrial
IOf amps.!
!CO~1./IND, FEEDERS 1
IInstall/alter/relocate I
di~trih. fppdpr~
IOf amps.1
I
I
I
I Appl fance vent
s_~oaratp
I Stationary evap.
cooler
I Vent fan with
sinal~ duct
I Vent system apart from I
heatina ar A.C.
I Mechanical exhaust
hood And dud
I tiood stove/heater
I
I
I
ISSUANC, OF PFRlUT
"
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vall1 until the
TOTAL CHARGES TOTAL CHARGES
that ti,e Electrical work be done by an .Electrical Contractor, the electrical portion of this pem1t
label has been signed by an Electrical Supervisor and returned to the Building Division
Zone
Fire Zon€'
Flood Plain
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 Derformed 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 DCCUPAIICY 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 7~1.055 will be used on this project.
15 Ftsl,i " SIGOMTU , ~ ~ ~II...'.
FOP. OFFICE ~
Sg. Ftg.
Sq. Ftg.
Sq. Ftg.
Tyoe/Cons t.
Bedrooms
Units
Occy Load
Occy Group
riain
Access
Other
,x
DATE 3- g.8i.--'
I
~
IIAI-IE(please print)VA-MLS-.5
Stories
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERfllT
Charges anC'
Surcharges
c:::=:.. c;t::::) , Plan Ck.
_ J....J _ _ _ _ _ _ 65%/Bl do
-" r""'i Plan Ck,
. ~\..I 30%/Rldo
Fence
COnIDl! nd
P.rr Fpp
Res
Per Ff!e
Systems Development
Charqe tI.5%) "
PLU11BING PERMIT
Charges and
Surcha rges
I Demo
I.S1dewalk
I A/C Paving
I Curb Cut
------------1
I
I
I
ELECTRICAL PERmT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
ITotal Comb. Permit
I
I TOTAL
6~
,. :
"",
I. Appl icant to furnish
A. Job Address
B. Legal Description
I. example' Tax Lot 100. Lane County Map Refer,
1/ 03 43
2. example- Lot I. Block 3. 2nd Addition to
Spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced (
2. examyle- waterheater/electrlca (lor SOlar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house. 500 sq. foot \
2. examole- if new project. check new - if add;
check add. etc.
F. Building pennit information:
1. examele - construct single family house with
attached garage
2. examf:?le - remodel existing garage into famil. t..,
3. examOle - convert single family residence in
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of t,
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropria1
persons regarding design infonnation or jOb site C..
corrections. etc.
Abbreviated Plumbing, Mechanical, & Electrical Schedl
A. Except where blank spaces occur in the descriptic
portion of the Mechanical and Electrical Schedule I
the applicant need fill-in only the No. Boxes adj ~t
. to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical. and Electrical Schedul
are avatlable at the Building Division '
1. To conserve space on the permit form the sche ~~
have been abbreviated
2. If the item(s) to be installed are not covere,
the abbreviated schedules you should consult
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANI
CHARGES ON THE SCHEDULES
D. As noted on the CAP. the label must be delivered 1 (
electrical contractor for signature by his electr', ." Amount
supervisor. The general contractor is.not authori
to sign the electrical label. -
Applicant to sign and date .,
Whenever possible, the initial application will be use G BY
a worksheet only. Where possible, Building~Division S ---t.,',..
will prepare 'a type written copy and return- ft to the "-
applicant at the time the. actual permit is issued for r
signature. C,
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.
. .'~.r ~.,. ,__. ,_
.
COMBINATION APPLICATION/PERMIT (CAP)
II.
111.
V. FOR OFFICE USE ONLY
.
PERMIT VALIDATION
.
,r
CITY
OF
SPRINGFIELQ
f
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
DO~ ,~ 19~~B, 58166.
'ocd ,..~()h. ~~ '
Address 3..0 i)..,\ Cf ~
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Received For:
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U Olltl'lIED SICNATURE
.HI~TON.TU'''.'U~~ """'TI'" ' IUGINI, Oil '7.00' ...,,-.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWEO BY:
name
signature
date
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