HomeMy WebLinkAboutPermit Building 1982-12-1
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legal De~cription
17-03-35-41, Part of TL 5500
CITY Of SPRHIGflELO
Cm1BIilATION APPLICATION/PERMIT
E!lERGY SOORCES:
Heat
t'Jater Heater
Ran!1e
Valu' of l'lork:
3.200.00
Builriina Permit Info: Oeser be Work(i.e.,
Familv Residence With Attached Garaoe)
INfORlIATION liNt
726-37S3
Sq. ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
I HiSPECTIOrl L1IIE.
726-3769
Job Address
1005 ~Iain Street
Address
?c;O North "A" St:-r:~~t-
Phone
Build Single
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Owner
Springfield Utility Board
Snrin"field. OR
Construction Lender
97477
746-8451
Add wall in existing building
Add door and norch area
Address
UtSHiN ItAf-'
(name)
Phone
(addressl
!lies. no.l
(exoires)
J
(ohane no.l
Primary SUB
11echanical
CONTRACTORS
(name)
{address}
(1 ir:s. no. \
~
(PXD; rpc; Y (Dhone nn. )
Structural
Electrical
Gpnp"l Lee Built Construction Company
Plumbino
Electrical
~lechanica'
PLUI1BIIIG
ELECTRICAL
,FFF r.HARGF Nn
Residence of
SQ. FT.
New circuits alts.
1 or extensions
SERVICES
MECHANICAL
...JiQ.."
F'FF fHARGE. NO_
Each single fixture
furnace/burner to
BTO's
FFF rlJARGL
/
Relocated building
(new fix. additional)
10.0!
Floor furnace
and vent
S.F. Residence
11 bathl
Ouplex (1 bath) each
Recessed wall
Snac~ h~atpr and vpnt
Sewer
Temporary Construction
Change in existing
rpc; ; 4p~nce.
multifamily, CQIIII1. or
Tnrlustrial
1
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
3.00
Additional bath
\oJater service
Storm Sewer
Of
amps.
CO~1./INO. FEEOERS
Install/alter/relocate
d;<:trHL fppt1pr..
Of
amps.
ISSOANCE OF PFR!l1T
10.00
TOTAL CHARGES
WHEnE STATE L~W REQUIRES
shall not be vali~ until the
TOTAL CHARGES
10.00
TOTAL CHARGES
13.00
that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of this perr.1it
label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 oerformed 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 NO OCCUPAr~CY 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 ORS 701.055, that itEfthe basis for exemption is noted hereon, and that
only subcontractors and employees,who are in compliance with OPS 7n1. 55 il: be use~ this pj"oject.
1lAf.IE(please print).,..ltm-'9e"L H ;/v/-fJlf'/+~~J SIGilATOR. a.t-lL'JYI ~~ OATE 11-; ,. J V-
I FOP. OFFICE USE miL Y
Zone CC Tyoe/Const. VN Onits Sq. Ftg. !lain
Fire Zone Bedrooms Occy Load Sq. Ft~. Access
Flood Plain Stories 1 Occy Group B2 Sq. Ftg. Other Int.
x Value
x Value
Remocte,l Value
TOTAL VALUATION
3,:WU.UU
3.200.00
BOILOING PERl,lIT
Charges and
Surcharges
Plan Ck. Comm/lnd
28.00 65%/Bldo Per Fee
------------~n Ck. Res
1.12 30%/Bldo Per Fpp
Fence
18.20
Systems .Development
Charce (1.5%) ,
PLOt1BING PERMIT
Charges and
Surcha rges
Demo
ELECTRIU,L PER!~IT
Cha rges and
Surcharges
!lECHANICAL PERMIT
I' Cha rges and
Surcharges
10.00 Sidewalk
---------.~~-I A/C Paving
13.00 I Curb Cut
_n_n_n.~;_1
Total Comb. Permit
I
TOTAL
71. 24
.
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COMBINATION APPLICATION/PEm1IT (CAP)
PERMIT VALIDATION..
!
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100. lane County Map Reference
II U3 43
2. examole- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceiling/or forced air QdS
2. exam~le. waterheater/electrlcalJor SOlar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project, check-new - if addition,
enee k. add. ete.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - 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 TEM1 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name Lorne Pleger
signature ../~----" ~~ da~e
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