HomeMy WebLinkAboutPermit Building 1998-1-22
CITY U~ SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
\~ater Heater
Range
ValuE of Work:
-=< ;5'<:::> c:: c.e> "
BuildinQ Permit Info: Describe Work(l~e.. Build Single
Famill nesidence With Attached Garaael
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INSPECTION LINE
i 726-3769
Job Address / '/'7'Z? .i'\.4..e;t'/"v
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Legal Description
Owner ;7;;h.VLE" TA^" r.!>/V
Address /7#"7 ,I<-/?,# //Y
C;:PFc..P. _ C:>7-? .
~~
Phone
'57,
7l././~~
74;;-///:::<
Construction lender
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Address
UlSIGN TEAI1
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
CONTRACTORS (name) faddrf!ssl (1ir.~, \"10.'
General ~J,.../VE/ii:'
Plumbina .1A.."50..-v 4.c"'~Ar (//7,0/-__7) C.s:;,..".-" 7.)
Electric'l~pC:R~S/vE -CC::::~C7 .(///'/9-;'~RA<<s~)
~1echanical
PLUI1B I NG
ELECTRICAL
NO.1
~ Each single fixture
INFORlIATION UNl
726-3753
Sq. Ftg. '.Iain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
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(exoires) (ohane no.
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(pl(l);rpc:.\
(n,",onp no ,
MECHANICAL
, FEE IJdjARGF Nn I I !'I.L'J:liARliE. Nn I
Residence of furnace/burner to
?S~"'32- SQ. FT. BTU's
.I='H" 'rl1ARG.E.
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TOTAL CHARGES -3'.P.- ~ TOTAL CHARGES '::?-::?....,S7!/' TOTAL CHARGES ~ -t>o
WHERE STATE L,'lj REQUIRES that the Electrical work be done by an..Electrical Contractor, the electrical portion of "this permit
shall not be vali~.u~til the label has been signed by an Electrical Supervisor and returned to the Build~ng Division
I HAVE CAREFUllY EXAMINED the completed application for permit. and do her~by certify that all information hereon is true
and correct, and I further ~ertify 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 OCCUPArKY will be made
of any structure without the permission of the Building Division. I further cert' J ~I,,"~ ~registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exempt ba~" for e~emption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7QI.055 . be ~sed on thjs project.
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SIGIlATURE _ . __j:~"::,;~__ OATE /-Z2-P'ff
FOr. OFFICE USElorJf-r~ /' ~ /~
Zone c:::. c::.. Type/Canst. r")~# Units Sq. Ftg. fifth x Value
Fire Zone Bedrooms Occy Load Sq. FtD. Access x Value
Flood Plain Stories I Occy Group)f-r Sq. Ftg. Other HrT' ~Value ~c.s-'O
#6Tc~E.J=~ ~jfj<C.~'?,~ L~~A' ~,;9/=p W/~TOTAlVAlUATION
7i?'~6o/'R,.:::::J:) p~t?i>/:r5". .
BUilDING PWIIT 7"/ $~ Plan Ck. Conm/lnd ..c-:;. A~ Systems Development ;( / LJ
Charges ant: _____~.:_____ 65%/Rldo P-,~!, Fpe VV..Vd Charqe (1.51,;)" ~.~ .
Surcharges ~ C>~ Plan Ck. Res .
~~ G) 30%/Blda Per Fee
.6::2 cs-6 I Fence
--- ~:-';;--I DfIAlO
____f~_~JSjde...alk
;:?- -::?5' I A/C P~ving
__--1~_~__J Curb C~t
- "70 I
Relocated building
(new fix. additional)
~ New circuits alts.
or~xt:;;s)&l's___~~
SERVICES
478'
I
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Temporary Construction
Change in existing
rp} i rtP!H~P
multifamily. comm. or
Tnrlllc;.t.r;ill
~Iater service
Sewer
Storm Sewer
Of
amps.
COMl-I. /IND. FEEDERS
I Install/alter/relocate
rlic;.tr;n fpprlpl"<:::
IOf
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I
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amps.
NAr.IE(please print) D 'itU c..
T/Cl (\J '\t[) t.J
PlU'~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERlilT
Charges and
Surcharges
ITotal Comb.
I
I TOTAL
MECHANICAL PERMIT
Charges and
Surcharges
Floor furnace
and vent
Recessed wall
So~~P hpatpr ilnn vpnt
/;.-
I
Appliance vent
seoarntp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino 01" AC.
Mechanical exhaust
hood nnd rlut't
~--
Wood stove/heater
ISSUANCE OF PFR!lIT
Permi t
"2/?l ~
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76C! c?S
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. . Energy Sources ~ ~_" .
1. examDle~ heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electrica(/or solar
E. Square footage or valuation. etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
f. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. examEle - 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 - "
correct ions, 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
fu 11 schedu 1 es
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 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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PERMIT VALIDATION
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Pennit Cl erk
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'PROJECT CONDITIONS TO BE SATISF~EpBEFORE OCCUPANCY:
V~/T ~ fr~ ~~v=-"25 ~O ~/,;.-/
CO~/~ ~ 6Ce::c=,,-~:..:,,~ ~o"..-& 6A?C9.
Permit applicant exempt from registration with the Builderis' Board becaus~:
Additional Project. Infonnation:
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PLANS REVIEWED BY:
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signature
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date /--;:;J~' e &
nam~ &8H-G~;-~G/f'
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