HomeMy WebLinkAboutPermit Miscellaneous 1982-1-5
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INFORlIATlON llNt
726-3753
, Sq. Ftg. "lain
~C]. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other - -
'I BlSPECTIOII LIIIE.
726-3769
CITY Of SPRlIlGflELD
COI1BI;IATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Job Address t{lOr M/J/Al ~r.
legal Description ~PRJNhf1&UJ i/Tll-Irf WARD
e-B(..>T'{<It'.> OPr::j</tTlPJJ0-{D.
Owner ~,{), &
Address '2-0 NORrH
A.
or.
-; 1J./9~ :;"
'PhonY'
Valu~ Harle
I. tJ tl1J
BuilGlnQ'Pernlit Info: Oeser.be Work(i.e.,
Familv nesidence With Attached Garaae)
Build Single
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I..IJ
W
IJJ
Ranqe
Construction lender ~
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IIlfJmll.-- et'/A#. lJf<MMO/'/tt;f, m U
f/.J1'.JjJfV/100 10 IY '5V!<./vr SettfV'-,
Address
Ot:>lf.ir~ TEAf,'
(name)
Phone
(address)
!lies. no.l
(emires)
(ohone no.'
Primary
1)/%/(:1jJ ~i~~ f'tJ gm ?'<HhJV~. (JR. "'17407, 6f33{/f3cR
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Structural
Electrical
fiechan i ca 1
CONTRACTORS lnamel
Genera 1 MJ 13
Plumbino I-ImY-I/P./ U/I/
(addrp<;.c;)
11 ic:C';.. no.)
1f
(nhon~ nn
Electrical
f.lechani ca 1
PlUlIB HIG
NO.
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
~Iater service
Sewer
/~i?' Storm Sewer
ElECTRICAl
MECHANICAl
FrF FHI\BlI.L Nn >>> CHARGE ....llil....
Residence of furnace/burner to
SQ. FT. BTU's
CELI.cHARliE.
I
I
New circuits alts.
or extensions
Floor fu rnace
and vent
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl upnt
Temporary Construction
Change in existing
rPS i d_e.nce
Imultifamily, COrml. or
lndus.tri~l
10f amps.1
ICO~1./INO. FEEDERS I
IInstall/alter/relocate I
r1ic;.trih_ fpprlprc;.
10f amp~1
I I
I I
I I lSSUANCE OF PFR!IIT
TOTAl CHARGES It? <><-' TOTAl CHARGES I TOTAl CHARGES
WHERE STATE l~H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
1tJ.-
Appliance vent
s.eoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
I'Vent system apart from
,heating or A.C.
I Mechanical exhaust
hood and duct
I ~lood s tove/hea ter
I
I
I
Fi re Zone
Flood Plain
I HAVE CAREFUllY EXMIINEO 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 NO OCCUPAr~CY will be made
of any structure without the per~ission 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 employees who are in compliance with ORS 7Ql.055 will be used on this project.
SIGNATURE tJ/"'ZCAa 4f..Ia
FOn OFF! CE USE Qill Y
So. Ftg.
Sq. Ftg.
Sq. Ftg.
Crlt<-1S
A
sm/71t
OATE~
IWIE(please print)
Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
riain
Access
Other
x
Value
Value
Value
x
x
TOT^l VAlUATION
PlUI1BING PERMIT
Charges and
Surcha rges
~.:oo~
______1<_:.___
.'1"
Plan Ck. Comm/Ind
65%/Bldo PJ.r Fpe
Plan Ck. Res
30%181 do Per Fee
Fence
Systems Development
Charoe tl.5~) .
BUIlDING PERIIIT
Charges an':
Surcharges
ElECTRICAl PERI~IT
Charges and
Surcharges
Demo
I Sidewalk
I AIC Paving
I Curb Cut
--------~~~]
ITotal Comb. Permit I
: TOTAl I
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b
/1ECHMIICAl PERMIT
Cha rges and
Surcharges
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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 I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exa~~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house. 500 sq. foot garage
Z. examole- if new project, check-new - if addition,
ehee k add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garllge
Z. example - remodel existing garage into family room
3. examole - 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
8. 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
O. 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. ---
Ill. 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.
V. FOR OFFICE USE ONlY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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) 0-83
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Pennit Clerk
({\f\(\ )
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWEO BY:
name
signature
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date
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