HomeMy WebLinkAboutPermit Building 1993-8-9
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lLNSPECTlON LINE
726-3769
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CITY OF SPRINGFIELD
CGrlBlIlATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
ValuE of I'lork:
,;;tJcrft!I
BuilrilnQ Permit Info: Oeser be Work(i.e.,
Familv Residence With Attached Garaael
INFORlIATlON UNt
726-3753
Sq. Ftq, ',Iain
:q. Ftg. Access.
Sq, Ft9, Other
New Add Alter Pep,
-Fence Demo Change/Use
Other - -
Job Address
143" Iv\. ~ - Sel/1J6FtELb
Legal De5cription /?~c.7''' 3G::~;l';l.. o"3/~t:>
,
Address
ot.b
/4If(,
L.AIJU; PoSEY
K IUfU- rA (JEll Al
MA-i,.;)
Owner.
Construction lender
Address
Ul:.~ HiN H.Ar1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbina
Electrical
"lechanical
-.!ill..,.
Phone 7Z"-
,,-qt'/
Build Single
(name)
Phone
(address 1
rcd~,j) Or.'aJ.1Jg"/ C""'ll"ifflucr/#tJ
I' I .
'AJIT'tf EIJMJ<; 4-{"'( AlIt/LII8LJ<'"
!ll.q(.
(lies. no.)
(exoires)
I
rohane no. '
*
(name)
(addrpss)
l1ics.no.)
(pxoirps) (ohonp nn.'
R A-IAJ 8tJw /(OOF'OJ{,
.:1.9715 Ct>t.o.r LitKE
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PLUI1BIrlG
ELECTRICAL
MECHANICAL
I FFF I r:HARr.E Nn I
Residence of
I-EEL' J:HARG.E .JilL...'
furnace/burner to
SQ, FT. BTU's
I ~~r Ir\..l~
Each single fixture
IRelocated building
(new fix, additional)
IS.F. Residence
(] bathl
IDuPlex (1 bath) each
IAdditiona1 bath
I ~Ia ter servi ce
I Sewer
I Storm Sewer
,/
New circuits alts.
or extensions
Floor furnace
and vent
ISERVICES
I
I!emporary Construction
IChange in existing
rpSi rLpn('_p
Imultifamily, comm. or
Jnoustrial
IOf amps,l
ICO~~,/IND, FEEDERS I
IInstall/alter/relocate I
oi~trih_ fppopr,
IOf amp~1
I
I
I
Recessed wall
Sn~('p hp~tpr ~nrl vpnt
Appliance vent
st:l:oarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
I Mechanical exhaust
hood and dur:t
I ~'Jood stove/heater
I
I
I
ISSUANCE OF PFR'llT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\H REQUIRES that tl,e Electrical work be done by an. Electr;cal Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 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 fm 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 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 7Q1.055 will be used on this project.
IWIE(please print)
Zone <: c::...
Fire Zone
Flood Plain
BUILDING PERI,IIT
Charges an~
Surcharges
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERlm
Cha rges and
Surcharges
MECHANtCAL PERMIT
Charges and
Surcharges
.sH€~RY ItJI L..SOtJ
SIGIIATURE~, ~
FO~ OFFICE USE DIlLY V
Sq. Ftg. Hai" ,x
Sq. Ft~. Access x
Sq, Ftg, Other Rl!!..1:t_",r:- x
,
TOTAL VALUATION
':2 If eJd>.-
DATE '!-"I-Y'1
Tyoe/Const,
Bedrooms
Stories
Units
Occy load
Occy Group
Value
Value
Value
<~ ...0 Plan Ck,
_ _ __ _ _: __ _ _ _ ..M!/Bldo
.-" Plan Ck,
... 30%/B1 do
Fence
Corrrn/! nd
Ppr Fpp
R"es
Per Fee
Systems Development
Charqe (1.5~) ,
Demo
Sidewalk
A/C Paving
____________, Curb Cut
I.
Total Comb. Permit
J
I
I TOTAL
:?t{.%
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COMBINATION APPLICATION/PERMIT (CAP)
'PERMIT VALIDATION
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III.
I. Appl icant to furnish
A, Job Address
B. legal Description
1, example- Tax lot 100, lane County Map Referen~e .
II 03 43
2, example- lot 1, Block 3, 2nd Addition to
_ ::iprlngtield Estates.
C. Name. etc. of owner and construction lender
D. Energy Sources . ' .
1. . examole- heat/electrical ceilinq/or forced air Qas
2. examele- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1, example- 1250 sq, foot house, 500 sq, foot garage
2. examp'le- if new project. check-new - if addition,
check add, etc,
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. examele - 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.
11. 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 DIVISION STAFF WIll FIll OUT All FEES AND
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. ---
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:
Permi t appl i cant exempt from regi strati on with the Builoer 's' Board because:
Additional Project Information:
PLANS REVIEWED BY:
"., -&rN- (Jl1Pj/Y 'i,,,t",.[ll~
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date