HomeMy WebLinkAboutPermit Building 1984-8-8
Owner
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Construction le~er
Address
UlolGrl TEAl,'
Primary
Structural
Electrical
(name)
Phone
(address)
(ohone no.1
f1 ics. no.)
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Mechanical
CONTRACTORS InameJ
General,--1\\.i' L~\"i111.
Plumbino \ \
i Electrical
~lechanical
Jq \~dCM/lfin~~;r r'i:., ,,~i~;lJ(LJ
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PLUr'BING
ELECTRICAL MECHANICAL
or< r"~ ~In ~J:'J:' ruAB.G..E.
Residence of furnace/burner to
SQ. FT. BTU's
New circuits alts. 6:- 'Oc::o Floor furnace
or extensions and vent
SERVICES Recessed wall
~n~rp np~tpr ~nrl vpnt
---llih I
r~ Each
Relocated building
(new fix. additional)
single fixture
IS.F. Residence
(] bathl
IDuPlex (1 bath)
IAdditional bath
Iwater service
I Sewer
\Storm Sewer
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TOTAL CHARGES (,..., S, CO TOTAL CHARGES
WHERE STATE L\\I REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
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 oerformed 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 UO 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. ~ ~
rlAl.IE(please print) . T A. SlV'-ilH SIGrMTuRE .-# ~ tf'-y-cffC
FO~ OFFICE USE OlIL Y
~q. Ftg.
Sq. Ftg.
Sq, Ftg.
Zone CC
Fire Zone -
Flood Plain ----
BUILDING PERfIIT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICft,L PERr:n
Charges and
Surcharges
~
MECHANICAL PERMIT
Charges and
Surcharges
FFF
rHARr.F
NO
5:-
Co'5~
\
each
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(~ at:
Temporary Construction
Change in existing
rpo;.ic:lflJl~P
mult ifamily, COnIn. or
Industrial
IOf
ICOMM,/IND. FEEDERS
I Install/alter/relocate
di"t.rin. fppdpro;.
IOf amp~1
Appliance vent
, <;'f'oarat~
I' Stationary evap.
cooler
Vent fan with
'sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood rind durt.
I
I
I
I
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\5.00
?
~-
from I
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t\'\\.. '1\ ""-\ '" '"" ~~.e:o
amps.1
Wood stove/heater
ISSUANCf OF PFRr,n
TOTAL CHARGES
\0.00
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
Tyoe/Const.
Bedrooms
Stories \
Units
Occy Load
Occy Group ~- ~
t1ain x Value
Access x Value
Other x Va 1 ue
;I) TOTAL VALUATlOII
\-:1... ro {t,~'.. Systems Development
.- ), ~1; ~ Charoe (].5~)
i
Plan Ck. Comm/lnd
65%/Bld~ P~r fpp
Plan Ck. Res
30%/Bldo Per Fee
___~'2.Q~__
___Ca.5.....~___ Fence
'2. _ <CO
___J_~",~___ Sidewalk
CeO
\.0 .00 I Curb Cut
n_~ ~~o--I.
D~mo
Ale Paving
To~al Comb. rermit
1-
I'OTAL
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COMBINATION APPLICATION/PERMIT (CAP)
.::
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example-Tax Lot 100, Lane County Map Reference
I! U3 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qa$
2. examole- 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 new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. exa~le - 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 TEAfI 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
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. ---
Ill. 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 pennit is issued.
".
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V, FOR OFFICE USE ONLY
Permit Clerk,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: ~LL QE<d\:)\~D '!.\:)"~?EC');'OU ~~~
S "r=. L!:)L,_"\~\\\a\.)~ "'" ~l"., ~WQ()\lED D~ s..~\:\~~\En
BE~0QE Occ..l.l~t\X.'"
PLANS REVIEWED BY:
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date 9,- ~- ~\....\