HomeMy WebLinkAboutPermit Building 1986-3-31
CITY Uf SPRINGflE~D
COMBINATION APP~ICATION/PERMIT
EIIERGY SOURCES:
Meat '
l~ater Heater
Range
Val,uJ'. nf Work:
37 c::t::>, ...-1>
Suiloina Permit Info: Describe Work(i.e.,
Familv Residence Hith .A.ttached Garaae)
_.~"..-~ ".- _.- -.- ..... -....-.. ".
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I
I INSPECTION ~INE
726-3769
Job Address
e
J t:/6 2 h?.I9.&' .~7: -11'-7-/2
Legal Description 17-tJ"3-9'$'-l./1 ~4"9~
/
Owner "6:"~i~RBs/ ~~~W/7'Y" ~v/~,
Address lOb '2 m-~ 5;7";. Phone
")7-:>r:d::> O'1=': 9':? y/;;> n~-8F.:2S
Construction lender
INFORllATlON liNt
726-3753
Sq. Ftg. "lain
~q. Ftg. .Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
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O()~
l.oJ
Build Single
//hc.-r'$/~ ~el'~-.a;: Z
UN.rr~ 9-/?
Address
Ut~l~N T~AM (name)
Phone
(address)
(lfcs. no.)
Primarv /?WN~ .
Structural
Electrical
Mechanical
CONTRACTORS I name I
General ""'IN&~
(addrpssl
(li('5. nn. \
h
Plumbino
, E1ectrical-'2:'t
~lechan;cal
L(-7~Yt, M.L,ft ~ PIll
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PLUflBI NG
ELECTRICAL
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FFF C'iARC,F
#IllY .
7. 5::> 1'5. ~
Nn~
u.L1..cJJAB.liE. "n
Residence of
/
Each Single fixture
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
o-2e~>>i~""/1~
SERVICES
or
225':
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp} i rlJ'J1l":P
multifamily. comm. or
TnrllJ,tri~l
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I
I
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I I
~ '2~~"'2)
Water servi ce
I
I
amps.l
Sewer
Storm Sewer
Of
ICOffi1./IND. FEEDERS
l'Install/alter/relocate
di,trih fpprlp~~
10f amp..1
I
I
I
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
15: DC> TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the BUilding Division
Tb
(exoires1 (ohone no.)
j
*"
(pxoirpc;.l (ohanp nn.. \
MECHANICAL
c><
r"1l.RliE
furnace/burner to
BTU1s
Fl oar furnace
and vent
Recessed wall
Sn~l":p np~tp~ Anrl ~pnt
Appliance vent
SPOijratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnnrl i'lnd duct
Wood stove/heater
ISSUANCE OF PFRr1n
TOTAL CHARGES
I HAVE CAREFULLY EXAMINED 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 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 Builder1s
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 OP.S 701.055 will b~ used on this project.
IWIE(p1ease print~~)./AI >>~cP~/...>t:f# SIGNATURE4 ~ ~~~ DATE...J-f,/ .J-t!,
FO~ OFFICEJM OIIL Y ~
Zone~ TYDe/const;~r;v ??':'1inits /"2. ~/l>7. Sq. Ftg. riain x Value
. ..r..~
Fire Zone Bedrooms uccy load Sq. Ftg. Access x Value
Flood Plain 'Stories I Occy Group if?-/ Sq. Ftg. OtherAk........P~x Va1ue~ .,...'
..... ~ .
TOTAL V ALUA TI ON
BUILDING PERfllT
Charges ant:
Surcharges
Plan Ck. Comm/Ind
65~/Rldo Ppr ~pp
Plan Ck. Res
30%/B1do Per Fe.
,...-.- -- ~ Systems Development
, "'ZR_ ,.. ~'3 CharQe tI.5~) ,
J/. /4 .
ELECTRICAL PERI~IT
Charges and
SurCharges
f1ECMANICA~ PERMIT
Charges and
Surcharges
____'i.'i.:.sc
-;. 7~
___../;5;_~__ Fence
. 60
"':(<-:5""""::::> ISidewalk
------~-?O--I A/C Paving
I Curb Cut
------------1
PLUr~BING PERMIT
Charges and
Surcharges
D/j1l1o
Total Comb. Permit
J?5"-2B -'.
::11 tt. 2l
I
I TOTAL
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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 Uj 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates .
C. Name. etc. of owner and construction lender
O. Energy Sources ~~
1.' examole- heat/electrical ceilinq/or forced air QdS
2. example- waterheater/electrlcaltor solar
E. Square footage or valuation. etc. ------
I. example- 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. examele - construct single family house with an
attached garage
2. example - 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, Buildlng
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. ---
III. Applicant to sign and date
Whenever possible. the initial application will b~ 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 penmit 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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PERMIT VALIDATION
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1)-\ \0
~~ $..
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Permit Clerk
~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
'. .'-
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name
LC>"R~tE ~~~
Signature~~_ -'
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date t;/--:?~
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