HomeMy WebLinkAboutPermit Building 1986-2-14
1.
I
,j
~
0\
:8
-.hI
~
Construction lender
Address
Ut~IGrl TEAI1
(namel
Phone
(address)
Primary
Plumbino
PIa If
I
'address} (lics. no.)
.P 1./ ;' h: -n,/. ~ 1/
~
x,......
II . ~
- -. ~'
--'f
(pxoirpd ' (ohnnj:> nn.1_
Structural
, Electrical
Mechanical
CONTRACTORS (namel
General '""t\r '').1/7
'7 y6 - ;>, ;;.. "Jt')
Electrical
~1echantcal
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FFF r"~ ~n
Each single fixture
Residence of
I="~~ rl-laB.G.E.I_tlQ..a...J
SQ. FT.
furnace/burner to
BTU's
ILEL' ..cHAB.G.E.
Relocated building
(new fix. additional)
,
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
I
Recessed wall
~n~rp np~tpr ~nrl vp~
ITempOrary Construction
'Change in existing
r~~j<<jp.J1r:P
Imultifamily, camm. or
TnA"c:trio'll
IOf .
I COMl.I./lND. FEEDERS I
"Install/alter/relocate I I
rl;~trih fpprlprc:
1M ~p~ I
, I
I I
i I ISSUANC, OF PFRllIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L.\l/ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pe..,it
shall not be valtJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I Stann Sewer
amps.1
Appliance vent
, 'ifl'o!,!rM.p
I Stationary evap.
r::ooler
I Vent fan with
~inole dUc:':t
I Vent system apart from
heatino or A.C. .
'Mechanical exhaust
hnnc1 ilnd r1ur-t
Additional bath
Water service
Sewer
Wood stove/heater
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 110 OCCUPAIICY 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 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 7D1.0?5 will b~ used on this project.
Zone ~ c:::
Fire Zone
Flood Plain
rlAllE(~lease print),M.1"" /? R r--:TfJ 1I&tt/tl r(/SIGIIATU-(jj-d~H.#fJl~~ATE:?-
"C . Fan OFFICE usE" Or/L'Y -. /"
Type/Const. 5-/V Units Sq. Ftg. 11ain x Value
Bedrooms Occy Load Sq. Ftg; Acces,uloeli/' 1~~, l~ ./) ......l ue
Stories Occy Group'''~ Sq. Ftg. Other )t Value
-/~ ,};~
/":2#0
TOTAL VALUATlml
BUILDING PERfllT
Charges an~
Surcharges
...,.........0 Plan Ck. Conm!lnd
____~!::"'"...!~~___ 65%(Rldo P.rr FFI~
~ Plan Ck. Res
. 04 3D%/Blda Per Fee
Fence
ELECTRICAL PERlm
Charges and
SurCharges
HECHANICAL PERMIT
Charges and
SurCharges
.Sidewal k
l--.-ft. ~~
I
i
I
,
I
,
I
Systems Development
Charae tI.5%) ,
PLUljBING PERMIT
Charges and
Surcharges
---.....--------
I DfIIIlO
I
I
A/C PaYing
I Curb Cut
I
Total Comb. Permit
~ (. 3:l
P f{.6$"
I
I TOTAL
. .' '.' '-" -. - ~
. ...~- ,"'
,
.-i r
I,
,~. . ~ ~ ~ 'I. .,
.........:-:'.
'..
l,l '. ~ .~.~.
:\,;.
,"~'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II OJ 4J
2. examEle- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinqjor forced air Qas
2. examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation, etc. ------
I. example- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check new.- if addition.
cneck add, etc.
F. Building pennit information: .
1. examole - construct single family house with an
. attaChed garage ,
2. example - remodel existing garage into family room
3. example - 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design infonnation 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 ;'tem(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. 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
..
,
'TV OF SPRINGFIELD
City Hili
'Sprlngftlld, Oregon
.' ~"'" ~;, ..... -..I~'~~', ~ Department at Public Warkl., :.:.:,
OFFICIAL RECEIPT
~
J
..\'~~' .
~"
~
,~. ~I'.' ;'"
65972
(, p. C.
-g:p.
(IJ~
(t
;1;"~
3~_ t,S-
(I
(I
~5'"~:?~
o
Amount ReCejlled~ P "f.
cs-
o _
~
(. ".
"I
...
~
,r:tz,~UTHORlZEO SlQf.M,TURE
.
Pennit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
Pennit applicant exempt from registration with the Builder's Board because:
, ...
Additional Project Infonnation:
PLANS REVIEWED BY:
,.,
I
name LC>B~ .J?:.~~
signature ~~- -:.. ?L_~~
-'," -(' ~
date ':2"""~-l?~
:.