HomeMy WebLinkAboutPermit Building 1982-3-10
CITY OF SPRINGFIELD .',." INFORlIATION LINt
COMBINATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq, Ftg. '.Ia i n
Heat ~q, Ftg. Access.
I~a ter Hea ter Sq" Ftg. Other
flew Add A Her Rep.
Range -Fence Demo Change/Use
ValuE of Hork:.., '7.r. tlf Other--
BuiltiinQ Pennit Info: Deser be Work{Le., Build Single
Familv Residence With Attached Garaae'
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(,ies. no.) (exoires) (ohane no.
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:1 INSPECTION lINE ~ ,1
726-3769 "1..1') VV
Job Address . ';7~ /.1.,1 a...<--v1..
legal De,cription /1- 0 3--3t.- t.J L
2fJtX)
Owner.
}L/A-MM vl/^-"r -PWA-,e/<:~
d/ J \0., '"'2Mt~~ ~ Phone
Address
Address {).!
,OlSIGN IlAl-l
Cn-S-'k
l<- 111 C<.A-vi
(name)
Phone
(address)
Construction lender
, .
". Pnmary
Structural
Electrical
Mechanical
CONTRACTORS (name)
General CU<;JrJI'......
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(lies. no.'
tJf/~-~7"?
(phone no.) ,
(address 1
?lfCJ/'O.',v<" ~U:-v(C~ /,J {/
(exoirp.s)
Plumbina
Electrical
N~~hani~al
PlUIIBI NG
ELECTRICAL
_NO,
FFF CHARGF NO ~
Each single fixture
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
ntlfLl""It ~i/r~ ~/r-4t) ~[(/'-'
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:~r
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MECHANICAL
rrr r'JARliE. ...llO..-
r r "- .cHAllG.E.
SQ, FT.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~o~rp hp~tpr ~nd vpnt
amps.
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hnnd ~nd durt
~Ia ter servi ce
Temporary Construction
Change in existing
rps j qrJlcP
multifamily, comm. or
Jndustri~l
Sewer
Storm Sewer
Of
COMfl./IND. FEEDERS
Install/alter/relocate
dic;trih_ fppdprc;.
Of
Hood stove/heater
amps.
"
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ISSUANCE OF PFRruT
TOTAl. CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE l,'I~ REQUIRES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
J 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 performed 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 emPlOyee: who are in compliance with OP.S 701,055 will be used on this ~ect.
IlAr.IE(please print~1'9-5 /L L)" ~e,UI('Il^TU~A,&: ,- "! /~ DATF3 -/~-tl.._
FOR OfFICE USE Oill. Y
Zone
Fire Zone
Flood Plain
Tvpe/Canst.
Bedrooms
Units
Occy load
Occy Group
. P"Jl'fT/&'-
, Plan Ck,
65%/Bldo
------------"'Pian Ck.
. '3" 30%lBl do
Stories
BUILDiNG PERMIT
Charges and
Surcharges
Corrm/Ind
Ppr Fpp
R-es
Per Fee
"7". ......
PlUf~BING PERMIT
Charges and
Surcharges
Fence
O~mo
'S1dewalk
A/C Paving
ELECTRICAL PERlilT
Charges and
Surcharges
flECHANICAl PERMIT
Charges and
Surcharges
Curb Cut
Sq. Ftg. rl3in "l( Value
Sq. Ftc). Access .x Value
Sg, Ftg. Other x Value
11.$ -)7bcr::-,.......c"> TOTAL VALUATION
.Systems Development
Charoe tl.5~) "
iif ;>:!:'. u'"
I
I
ITotal Comb. Permit
I
I TOTAL
"'7- 76 \
\..
~
COMBINATION APPLICATION/PERMIT (CAP)
t. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. examole- Lot I. Block 3, 2nd Addition to
springtield Estates . ' ~
C. Name, etc. of owner and construction lender .
D. EnergY'.Sources" \ \ . ... . -"
1. .exam~le- heat/electrical ceilinqlor' forced air Qas
\2. exam~le~ waterheater/electrlcal/or-salar -
E. Square footage or valuation. etc.
I, examole- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project. check-new - if addition.
check add, etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
'3. exam~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 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
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. ---
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
signa ture.
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.
III.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
.
.. .
PERMIT VALIDATION
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p~it Clock
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Permit applicant exempt from registrati on with :-th.e BUi 1 der I s 'Board because: .
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date