HomeMy WebLinkAboutPermit Miscellaneous 1988-4-27
CITY OF SPRINGFIELD
COMBINATION APPlICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of Work:
(~,5CO _.:3C:>
BuiloinQ Permit Info: Describe Work(i~e., Build Single
Familv nesidence With Attached Garaoel
,AAt.<.,I' ,...7J/HUhV/'.. Lpr 7' 5/=
~'- /h?pq~//~~-"",T' /:'4ii? ~"'-cC>
~EP/T ~/aA>'.
.............. flies. no.l l~xoires)
//~'- 6'=?~-&B
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Job Address /alt) /vZ4IN Sr.
legal Oe,cription /7-()~. ?S. 4/1 ~Z'>?
, -
Owner '.'<:'€LCC:> c"::.?P'Z>/ r C.N'/ON
Address //J/~ ~A'-/# ~T . Phone
t?,P-A:..o. <:::s)"? <77o/'?'?
Construction Lender
Address
Ut~lbN ItN~ (name)
Primary LARRY E_.<:~ <
,
Phone
(address)
29.J:?~ h?A7.>/~
(ohane no.
7"'7.€JIR ~~~ ,~ (' --:: -=;-.-"<E'
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Structural
Electrical
Mechanical
CONTRACTORS lnamel
General 4-/./N"'-'~~/"""'-;...
Plumbino
Electrical
~1echanical
PlUllB I NG
NO,I
Each single fixture
I FEE I r"ARr,F
Nn I
Residence of
Relocated building
(new fix. additional)
",
)
.
~
~
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INFORltATION LINt
726-3753
Sq. Ftg. "lain
~q. Ftg. Access.
Sq. Ftg. Other
~lew_Add_Alter~ep,
Fence Demo Change/Use
Other:<;; r~ /__~
"
:>~+"-~41'
~
-y.-
1T (l1hr'llip nf'l \
(address 1
(lie" no.'
(pxoirp",'
!3'er"i' - "3l::>~
ELECTRICAL
MECHANICAL
SQ. FT.
I <<I Nn I
furnace/burner to
BTU's
i ~~Li..t..l:lAR..G.E
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp np~tpr ~nn vpnt
amps.
Appliance vent
seOnr'itF=!
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A_f
Mechanical exhaust
hnod and duct
Wood stove/heater
~Iater service
Temporary Construction
Change in existing
rps.itjp.n('p
multifamily, comm. or
Inrll/c:tri~l
COMM./INO. FEEDERS
Install/alter/relocate
r1ic:trih. fpprlprc:
. Sewer
1M Storm Sewer
/ ~;jfi-.;~.,4~6P
~"' O~"..'~
~~.-
.7.$2>
Of
Of
-y'
CiO ,q I
amps.
TOTAL CHARGES ?,""7.:S-0
WHERE STATE l~W REQUIRES
shall not be vali~ until the
ISSUANCE OF PFRllIT
., , : TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~lOn pertaining to the work described herein, and that UO OCCUPAIKY 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
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I
I
I
Aic Paving , ' ~ I /t:Y/. 50
Curb C~t ....(.~~~ 2"W~'9, .,..
~~Jtf~4d'~ 3~' 1~?~6'.70
HM1E(please print)
AlaVI J ~~'"
Zone C"-:
Fire Zone
Flood Plain
Type/Const.~LI/~~
Bedrooms
Stories
Units
Occy load
Occy ~Grol,Jp
.. ',"-.....
.... ...
, '
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/lnd
____________ 65%/Bldo P.rr F'PP
Plan Ck, Res
30%/Bldo Per Fee
PlUI1BING PERMIT
Charges and ~
Surcha rges ~
?".?:. f'~. _ _:.. ':",_ _
2B8'~,:'.:.-J
I Demo'
Fence
ELECTRICAL PERrm
Charges and
Surcharges
.;. -' "
MECHANICAl'PERMIT
Charges and
Surcharges
'Sidewal k
DATE tf/?. W R-a -
I
. .
SIGIIATURE
FOr. OFFICE USE miL Y
Sq. Ftg.
Sq. Ftg,
Sq, Ftg:
/I
r1ai" )l' Value
Access x Value
Othe.-:?/.r""-~~~alue /g. ;")~-
TOTAL. VALUATION
._,..... -
.-'Systems Development ...-~-~~ ~
'4:::>, CharQe (I.5~)' ~_..,i::::>
'{.I{'
16,~o
-+/;
ITotal Comb. Permi\ .
I
I TOTAL
'I3'Z.G8'"
'2.:10, 18
..
I-
...-..-
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
I! 03 43
2. examp]e- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examDle- heat/electrical ceilinq/or forced air qas
2. examDlew waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garl!lge
2. exam~le w 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 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
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.
.
III.
V. FOR.OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
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Permi t C1 erk
chrz~
Permit applicant exempt from registration with the Builder's Board because:
. 'Additi.ona1 Project Informati on: ~ Z/.c- ~ L> L./ '7',"7......A"
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,: ~~~5E"'~ r /~.;.s- #-,880'3 '3"/
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PLANS REVIEWED BY:
'.',
name: LoRN€ ?.c~~ ' sign'ature4 .?-
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.~~ 'La!-date ~-/9-S:<~,
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