HomeMy WebLinkAboutPermit Miscellaneous 1983-7-19
Job Address "2-~-?.-?J~t .., () r' [~&- fL
Legal omription \ () 03'3l r4-?_ tJJ~
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CITY Uf SPRINGfIELD
CoMBIllATIoN APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of Hark:
.
.
INFoRltATIoN
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
--Fence Demo Change/Use
Other- -
/( t-~~"lqZ7
LINt I~
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--
0<)
0('
,INSPECTION LINE
i 726-3769
Owner ~c I~ Co
Address ~ Dv-
.ru,u tJl1.
Construction lender j
Pho oJ Buildino Permit Info: Describe Work(i.e., Build Single
n7~.& 'AS ' Famil v nesidence Hith Attached Garaoe)
I....., r1Tu\_-, \"" ~ ~ J'\ )
,1\0 ". ..... " I
-
,
Address
Dl~JGN TlAl'1
(name)
Phone
(address)
llics.no.)
(exoiresl
(ohane no.')
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
f1 ir.o;;. nn.)
(pxoirp,,)
(ohnnp nn. \
Genera 1
!! Plumbina
El ectrica 1
LuAi1"h C.('ryu.I'l_-
/
/__M~
PLUlIBIrlG
ELECTRICAL
rrL _C1JARliJ Nn
MECHANICAL
.~
r;
~1echanical
NO,
FEE CHARGE NO
Each single fixture
Residence of
I ~~~ 1...cHARG..E.
SQ. FT.
furnace/burner to
BTU's
/
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath) each
IAdditional bath Temporary Construction
I' ~Ia ter servi ce Change in ex i sti ng
rp~jr1pnrp
I Sewer Imultifamily, comm. or
Indll~triil.l
I Storm Sewer IOf amps.
I ICOMI'I./INo, FEEDERS I
Ir, ' . I Install/alter/relocate I
~.. ~+)" r1idrih f~~r1~"'c:.
IL..J.d lA :-tc9-f ,,"00 IOf amps.1 I
I I I
I '/101.21) I I
I I I I ISSUANCE nF PERIHT
TOTAL CHARGES .<:{.20 TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\ll REQUIRES that the Electrical work be done by an<Electrical Contractor, the electrical portion of this permit
shall not be vali] until the label has been signed by an Electrical Supervisor and returned to the Building Division
SERVICES
I Floor furnace
and vent
I' Recessed wall
~nil.rp hpil.t~r il.nd
I
vpnt
New circuits alts.
or extensions
Appliance vent
'i~oarM.p
Stationary evap.
cool~r
I Vent fan wi th
sinol~ duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hnnd il.nd dud
I ~Jood stove/heater
I
Zone
Fire Zone
Flood Plain
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct. and 1 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 Or~on pertaining to the work described herein, and that UO OCCUPA[~CY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and emploY7"; who are in compliance with ORS 7~I.055 ~ill be used on this project. J' J'
IIAIIE(please print)L"bJp?ua ,/1 ~ SIGNATUR ~hY-<<hJ ~ /k.hn~"f OATE~
1 Fon OFFICE USE ~rlo (I 1 /
Units t Sq. Ftg. t1ain ,x VValue
Occy Load Sq. Ft~. Access x Value
Occy Group Sq. Ftg. Other x Value
Type/Canst,
Bedrooms
Stories
TOTAL VALUATION
BUILDING PERNIT
Charges and
Surcharges
Plan Ck.
____________ ~/Blda
Plan Ck.
30%/Bldo
.e:: a 0 Fence
-~.:..._-------
."'2..0 Demo
I'Sidewa 1 k
I Ale Paving
I Curb Cut
I
Corrm/lnd
Ppr Fpp
Res
Per Fee
Sys tems Deve 1 opment I
Charoe (1.5~) .
PLUI~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI:IT
Charges and
Surcharges
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
'-
TOTAL :; . ~O
.
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 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. exam~le- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, SDO sq. foot garage
2. example- if new project. check new - if addition,
cneck add, etc.
F. Building pennit information:
I. exam~le - construct single family house with an
attached garage
2. examFle - 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 TEM4 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 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 permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,PERMIT VALIDATION
o~
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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