HomeMy WebLinkAboutPermit Miscellaneous 1987-1-28
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CITY UF SPRINGFIELD
CD/IBIIIATION APPLlCATION/PERMrT
EilERGY SOURCES:
Heat
t'Jater Heater
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INFORt1ATION L!1'it
726-3753
Sq. Ftq. f.lain
~q. !='ta. Access.
Sq, Ftg. Other
Ilew Add Alter P.eD.
--Fence Demo Change/Use
Other - -
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I INSPECTION LINE
726-3769 ,
Job Address
1001 Main Street
l.egaIOe,cript;on 17-03-35 4.1
Lots 5300, 5400 & 5500
Springfield Utility Board
POB 300
Springfield, OR
97477
. RaMe
ValUE of Hark:
~ $30,000
Ph 746-84~lBullGlnq Pennlt Info: Describe l~ork{Le., Build Single
l/r;-- .. Famil'( nesldence \lith f\.ttached r,araoe)
.,,- 35,300 square foot asphalt overlay
5,360 square foot new paving
Owner
Address
Construction Lender
Address
UI:.)IGf{ TE.m1
lname)
Phone
(address)
(1 ics. no.)
(pxn; res)
(ohane no.
Primary
Virgil Alonso, SUB
~46-8451 ,,' 402
V
Structural
t1echanical
CONTRACTORS
(name 1
per bid process
(ilddress)
(1 ics. no. \
(pxoir~s'
{~hOf\P nn \
I
I
\
I
I
1
I
Electrical
Genera 1
Plumbino
Electrical
~lechani ca 1
PLUlIBING
ELECTRICAL
MECHANICAL
NO,I
-----lEach single fixture
Relocated building
(new fix. additional)
FFF
I rHllR(;F
I
~I Il=.:n.
I Res i dence of
SQ. FT.
!New circu~ts alts.
or extenSlons
I SERVICES
I rl-lll&.G..E ~ tl() I
I ~~~
I r\fAB..G.E. I
furnace/burner to
BTU's
Floor furnace
and vent
S.F. Residence
II bathl
Duplex (1 bath) each
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps
Appliance vent
c;.poarate
Stationarv evao.
cooler ~ .
Vent fan with
sinnle duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hnnd ilnd dll'"'"
Additional bath
Sewer
Temporary Construction
IChange in existing
residencp
Imul.ti-familY, COITDTI. or
Tnduc;t.rial
~!a ter servi ce
com\. II NO. FEEDERS
Install/alter/relocate
rlic;trih fppdprc;
Wood stove/heater
Of
amps.1
ISSUANC, OF PFR'lIT
TOTAL CHARG,S J TOTAL CHARGES
ImERE STATE L,\I~ REQUIRES that tile Electr;cal work be done by an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
Surervisor and returned to the Building Division
1 HAVE CAREFULLY EXMlINED the completed aprlication 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 Soringfield and the laws of the State of OreC]on pertaining to the work described herein, and that 1m OCCUPAIlCY \.,.i11 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 exemntion is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
IIAI-IE(please print) KICI-IIU:'T"c> 7"2=L.i./NA SIr,IIATURE~~:z:f!.. ,_
FO~ OFFICE USE OilL Y "
Zone_ C:C TYOe/constjJIv,,~ Units Sn. Ftg. Ila;n x Value
Fire Zone Bedrooms Occy load Sa. Ft~. Accessj\/E"W _~Jr/~ Value ~~~
Flood Plain Stories Occ,V Group Sq, ng. Other OV~~ Value~,~
!i6Te ~ F~ ~ ~N' pk'Y /ili~o/~ O#~ '7" TOTAL VALUATlml~---
BUILDING PER~IIT Plan Ck. CommlI.nd ~~.o3" syste.ms Development /'''. QC>
Charges an~ 65'.l:/Rldo Ppr Fpp -<~, ,. CharQe 0.5%) ~
Surcharges ------------""""i5"fan Ck. Res
30%/Bldo Per Fee
I Fence
om / /ZQ/87
PLU'1BING PERMIT
Charges and
Surcha rges
Demo
ELECTR ICAL PERI~IT
Cha rges and
Surcharges
IIECHAN I CAL PERMIT
Charges and
Surcharges
Sidewalk
------------
I A/e Pav; ng
________.____, Curb Cut
I
'Ii/. 5"t:J
ITota, Comb.
rermi t
LI'I, =>~
/33. 'tB
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
11 oj 43
2, ' example- Lot 1. Block 3. 2nd Addition to
Sprlngtleld Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. 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
a ttached garage
2. examole - remodel existing garage into family room
3. examyle - 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. OESIGN 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 OIVISION 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.
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V. FOR OFFICE USE ONLY
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Permit Clerk
C0
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMlCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
V ./2 ?-J-
name L..e.Jl?nE /L~g;;:p signatur"" //,1I.4e-('~=;; --
r
date /-/9-.87