HomeMy WebLinkAboutPermit Building 1985-10-21
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I ItISptCT ION LlIIE
726-3769
Job Address I It()1/ M.4..J ST".
legal Dmription /7~03-::<.IJ'J- Uj) - '1tYO
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CITY UF SPRINGFIELD
COMB illATION APPllCATION/PERMlT
EilERGY SOURCES,
Heat
Ijater Heater
Ranqe
INFORlIATION LINt
726-3753
Sq. Ftg. ','ain_ ~2~
~q. Ftg. Access.
Sq. Ftg. Other
..Jlew _ AddX Alter -,~ep.
_Fence_Ifelio_Change/Use
_Other
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ValUE oflJ'lork:
" 1)')'00. .,
BUllrilnQ Permit Info: Describe Work(i.e.,
Familv nesidence With Attached Garaoel
Owner C_tlLLI""c. t:n'trtLPRI~E'...5
AddresstkY-I ':J .H411.1 ~l' Phone
_YQEJ<" /:~L1~ '/(,0" qiP-"6'/2--'11'"7
Construction Lender
Build Single
AL-r'EIL
E.)( IS1'/,.}{'- ROil n w(..
Address
DESIGN TEAI1
Phone
(address)
(name)
(lies. no. l
{exoiresl
(ohane no.
Primary
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\Yi'
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fp~oirp~' (ohn~p nn 1
J/6(" ?'4....!L9 )0 ')'
Structura 1
Electrical
Mechanical
CONTRACTORS tnamel (address) (lire;" nn.'
General PA.Rp...C....AJ~n?uc:.r"'.v P6 R.,,,,, 77l(~T;.1fIFv~ IQ21",,-
Plumbino f).""" LFIJV'" R.U_IS/~I-
Electricalr+ '" ELI[;:.7"A.IL
MeChanical
PlUllB IrlG
ELECTRICAL
MECHANICAL
rlO_
FE<
rHAR(;E"
I
furn~e/burner to
In kW BTU's
.. ,
Floor furnace
and vent
I="I="L1...c.HAB.G..E. NO
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I
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I
I
I
I
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I "IT-1...c.HAB.G..E.
Each single fixture
~ao
I
t:. CIC'
i:>'
SQ. FT.
I'New circuits alts.
2...- or exte~sions .
I SERVICES
I
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tp~ ~nrl vpnt
ITemporary Construction
IChange in existing
rp~ i rtf'~nrp
Imultifamily, comm. or
Tnrlllc;tri<'l.l
IOf amps_I
ICO~1./IND. FEEOERS
IInstall/alter/relocate I
rl;~t~;k fpo~prc;
IOf amp~1
I
I
I
Appliance vent
~eoarat.~
Stationary evap.
cooler
Vent 'fan wi th
~inol~ duct.
Vent system apart from I
heatino or A,C-
I Mechanical exhaust I
hood and c:lurt
I Hood stove/heater I
I I
I I
I I
I
I
I
I
\ola ter servi ce
Sewer
Storm Sewer
ISSUANcr OF PFRllIT
TOTAL CHARGES J'?t//I. ft:::?<>P TOTAL CHARGES /.,t:;: - TOTAL CHARGES M/H. /t::).-
WHERE STATE l.'H REQUIREs 'that the Electrical work be done by an, Electrical Contractor, the electrical portion of this pernit
shall not be valiJ until t~e label has been signed by an Electrical~ Sup'ervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 OreC]on 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 Builderls
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 compliarce with OP.S 7Q1.055 will be used on this project.
S I-C,NATURJ J
FOP. OFFICE USE OHl Y
Sq. Ftg. f1ain ,j( Value
Sq. Ft9. Access x Value
Sq. Ftg. Other~~ Value~~O-
~ ~ 1.p55D:J.- TOTAL VAlUATlDrl
)1\\ () ? f. "'0 syste, ms Oevelopment
. od <- Charoe (1. 5~) -.
NAJ.lE(please printl.J(IIV,,1-0 W. ~~~
DATE~I/~'
Zone~1!
Fire Zone
Flood Plain
Tyoe/Cons t.-..5::#
Bedrooms
Stories
Units
Occy load ~
ocd Group-Z!-2
/
UI::Z...... Plan Ck. Co","!lnd
_____.L.&i?~___ 65%/Bld(l Per Fee
/ c Plan Ck. Res
. r< 30%lBldo Per Fee
_n_.i.ttP-'-_~_1 Fence
. 'Ie> D6mo
____~_~J Sidewalk
.6() I AIC Paving
/.t2.. -'>e>> I Curb Cut
__n -.-~o-I
BUIlOItlG PERflIT
Charges and
Surcharges
U:A
I /~. _0 I
-
I I
I I
I ITotal Comb. Permit It' ~ 3'2 J
I I
I I TOTAL lo"{. ~Z
PlU'1BItlG PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charge~ and
Surcharges
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COMBINATION APPlICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
II oj 43
2. exam~le- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources . .
1. exam21e- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electr;cal/or solar .
E. Square footage or valuation, etc.. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition.
cneck. add. etc.
F. .Building permit information:
1. example - construct single family house with an
attached gar~ge
2. exam~le - 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. OESIGN TEAM 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
fu 11 schedu 1 es
C. BUilDING OIVISION STAFF WIll FIll OUT All FEES AND
CHARGES ON THE SCHEOUlES
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.
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V. FOR OFFICE USE ONLY
Permit Clerk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
]
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: ~..c- C:::;~cc..r~~'" k--,",",,='-7/~___
(~~~-=-u L/l-?~ ,.;;,-r
PLANS REVIEWED BY:
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