HomeMy WebLinkAboutPermit Building 1986-10-8
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, INFORlIATION LINt
726-3753
Sq. Ftg. 1,lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter ~ep.
-Fence Demo Change/Use
-Other- -
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CITY UF SPRINGFIELD
COMBIIIATION APPLlCATION/PERMIT
EilERGY SOURCES:
Heat
I~ater Heater
Ranqe
,
. Jo~"\.d;ress 2..2.80 M#/H
Legal De<criptionI7.()'g~3tf::_ 4.//.
'!5~E~
6)/~6/
ValUE of l'lode
ItJ2/~. ,.;>C>
BuilGinQ Penmit Info: Describe Work(i.e., Build Single
Family r!:esidence Hith JI..ttached GaraQe)
,K7~e-L 6-JS//'.H7'J... --!l..J7U ~
:J~,e 5~
Owner
V/NtD CA-/..,OW'ELl..
- - 71 ' 7)',,"-
Address OLD VdN7/AlI'dN 'l?",,,,,,,,, "~Ehone=o
-236t::> MA'/# ST./ 6iPft2? ,~ 9/'17?
Construction Lender '
Address
Ut~ 1 liU T E.Ar.1 t name I
Primary . /CH/IJ T4-'''-<!''A?
Structural
Electrical
t1echani ca 1
CONTRACTORS
Phone
(address)
(1 ics. no.)
(exniresl
(ohone no.)
Jj
~
(name)
(address)
(l ice;:. nn.)
(exoirpe;:)
(ohonp nn")
Genera 1
~/~-<J.e.:?
Plumbino
Electrical
~lechanical
PLUIIBItIG
ELECTRICAL
MECHAN ICAL
NO,
/ Each single fixture
.!Ye tft/.~('I-
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
Storm Sewer
!3..U.kR-.:>W ~e'v. ~ 7.5'0
h~ S..Pn'/...vh~
f FA'z:;~J'"'L~t/aJ5-
I
I
i-Jater servi ce
Sewer
I
I
FEF
[HAR!;F
I
furnace/burner to
1.'2 /V7 BTU's
rI--1A I?r. I=" NO.
Nn
FF'
<FF
rl-4Alml="
Residence of
I
7. SO>
SQ. FT.
7.5b
~ New circu~ts alts.
or extenslons
'26/i? 1iA6RI!;
SERVICES
n.~
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rps- j qe.nrp
multifamily. COIl1Tl. or
Tndu"trial
Appliance vent
"~Daratp
Stationary evap.
coolpr
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
~~
Of
I
amps,
COMI,I. II NO. FEEDERS
Install/alter/relocate
rli~trih fpprlpr~
Of
GA:os ;;0P/~
II//? 'P/ ~~
oz.....
c;',-
amps.
I SSUANCr OF PFR!nT
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
-;?a "'l:> TOTAL CHARGES 22. so=> TOTAL CHARGES /6.0"
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE ~AREFULL Y EXMHNED the comp 1 eted apfll i cati on for permit. and do hereby certify tha tall ; n format i on 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 !Jertaining to the work described herein, and that 110 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Goard is in full force and effect as required by ORS 701.055, that if exempt e basis for exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 7nl.05~ w. e used on his nroJ'ect.
~ .
~ I MIL) '71/U:12--- ~GllATURE jJ
FOr. OFFICE USE Q;ftY
Sq. Ftg.
Sq. Ft9.
Sq. Ftg.
NAHE(please print)
Zone t:: ~
Fi re Zone
Flood Plain
BUllDlIlG PERmT
Charges and
Surcharges'
PLur~BING PERMIT
Charges an,d
Surcharges,
ELECTRIC~.l PERrm
Cha rges anp
Surcharges.
MECHANICAL PERMIT
Charges and
Surcharges
DATE
/~JI?/&'6
,
TYDe/Const.~~
Bedrooms
Units
t1ain x Value
Access x Value
Other~~.J'lL""'_""'::' )( Value~..~......c:
TOTAL VALUATION
Occy Load
Occy GroUP~~('~i~
Stories
/
tJ'2"7' J:'.. . Plan Ck.
___L7J..-y-~__ 65%/Rldo
7 or".. Plan Ck.
I .......... 30%/B1 do
____~~~.:~ Fence
/.::2':> DllJIlo
__n~.?"~~JSidewalk
_ 90 ~ A/C Paving
I~. ode:) Curb Cut
__nu_ .-i~-I
ConmlInd
PM Fpp
Res
Per Fee
ISystems Development
Charoe (1.5~)
I
I
I
I
"28V. ~8
NAt.
Irotal Comb. rermit
,f'<6.7'1
&/0. b2
I
I TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
II 03 43
2, example- lot 1. Block 3, 2nd Addition to
sprfngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examyle- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electricalior SOlar
E. Square footage or valuation, etc. -----
1. exam~le- 1250 sq. foot house. 500 sq, foot garage
2. examole- if new project. check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
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 Special~y Code
H, DESIGN TEM~ AND CDNTRACTORS
I To avoid design or construction delays. Building
Division Staff must be able to contact apprGpriate
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
wi,ll 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:
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P.ERMIT VALIDATION
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Permit Clerk~____ ~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:,
PLANS REVIEWED BY:
nameLO};'N~ ?.c~~
signatur ~~_
~-
~~,
.,-
date
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