HomeMy WebLinkAboutPermit Building 1986-6-25
9T.
CITY OF SPRINGfIELD
COMBIIIATlON APPLlCATlONIPERMlT
EIIERGY SOURCES:
Heat
t~ater Heater
I Ranqe_;;::.___-_-_'-
I Valu'"of Hork: ~
.p;2.4-47-',
Bui16inQ Permit Info: Describe Work(i.e., Build Single -"
Familv ~es;dence With Attached Garaoe) ~
/fE1fOOF ~EA/( PJ.III PEe-A-- WIT. ~
()W~JtlS-CO/(/lII/tI? YP5c-~/-AlC r--....
C?Jl-Y5 '/'1/fJlOOF A7'7PM~/...Y
(lies. no.) (~xoires) (ohane no. \
~
._~\1@~
I ItlSPECTlON LItlE
726-376g
.
Job Address
L93h
Ai!}f//!/
INfORlIATlON UNo
726-3753
Sq. Ftg. 1.lain
~q. ~tg. Access.
Sq. Ftg. Other
t1ew Add Alter ~ep.
--Fence Demo ChangelUse
Other - --
~
:)
::)
legal Description
"
Owner MIfS . ~,VV. )fEEiJ
Address $?f? t HlrJfL.f)),(/ IfIJ
<;/,.fIAJ6--,t::-J13W 0/71-77
Construction lender
Phone
7~b7a{J
Address
U~, HiN TEAH
(name)
Phone
(address)
Primary
Structura 1
Electrical
t
Mechanical
CONTRACTORS
.
(name)
(addr~c;.s) (lir.s_ no.)
(pxqirpc;)
//IP4/;r;,
/ I
(ohnnp on \
General )f()E tfOOp/J/G IJ./C
Plumbina
;Z {50M c,f()/U liP >If;/~O~
80cY!i3,ve 97fCJ;z..
::?A-4fJ7/'Cf
Electrical
~'echanical
NO.1
-----lEach single fixture
I Relocated building
(new fix. additional)
IS.F. Residence
11 bath)
IDuPlex (1 bath) each
IAdditional bath I!emporary Construction
Iwater service IChange in existing
r~$ j d...epcF!
I Sewer Imultifamily, corrm. or
Industrial
I 10f amps.1
Storm Sewer
I ICOffi~.IINo. FEEDERS I
I IInstall/alter/relocate I
di~trih_ fppdpr~
I lof
I I
I I
I I ISSUANCf OF PFR!IIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L1W REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this penmit
shall nOt be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
fff
rHARGf
Nn
eee
'MECHANICAL
rHI\RG.E ....lliL....1
I furnace/burner to
BTU's
I Floor furnace
and vent
I Recessed wall
~o~~p np~tpr ~nrl vpnt
I
I eeL IJ:IiABJiE.
PLUllB I NG
ELECTRICAL
Residence of
SQ. fT.
New circuits alts.
or extensions
SERVICES
I App 1 i anee vent
s.eoarate
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood and duct
Wood stove/heater
amps.
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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that 110 OCCUPAUCY 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 ons 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 701.055 will be used on this project.
Zone
Fire Zonp
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIG:1AT~~~~ ~
FOr. OfFICE...uSE O1TLY
Sq. Ftg. Itain x
Sq. Ft~. Access x
Sq. Ftg. Other x
DATE
6~/&'
1lAf.IE(please print)
M /C/f.ll-EL
/(, ,I/O;:;:'
Value
Value
Value
TOTAL VALUATION
BUILDING PER~1lT
Charges and
Surcharges
n". 5D Plan Ck. COITll1JInd
-lb.- 65%/Rldo PM' Fpl'"
-------TSLf ~b~~B~~~ ~:~ Fee
Fence
Systems Development
Charqe (1.5~)
PLUI1BING PERMIT
Cha rges and
Surcharges
D/IIIIo
___________-' Sidewalk
I AIC Paving
___________-' Curb Cut
I
I
ITotal Comb. Permit
I
I TOTAL
#J(aot/
ELECTRICAL PERI~lT
Charges and
Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
II 03 43
,2, exam~le' Lot I. Block 3. 2nd Addition to
spr,ngtield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. examEle- heat/electrical ceilinq/or forced air Qas
2. example- waterheater!electrlcal/or solar
E. Square footage or valuation, etc. ------
I.. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check:ruew - if addition,
Check add. etc.
F. Building pennit information:
1. example. construct single family house with an
attached garage
2. examele - 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 TEM1 ANO 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
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 Clerk
PERMIT VALIDATION
~r~~
~ ~/
J Ira-
\Q
w
. .
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
. I
date