HomeMy WebLinkAboutPermit Building 1987-1-20
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I IrISPECTION LINE
726-3769
Job Address /5'~ m/"l//Y -:5T
Legal Description /7'G>'3--:rh--=?/ ,,::> Y7.c:::>2
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CITY OF SPRINGFIELO
COHBIIIATION APPLICATION/PERMIT
E!IERGY SOORCES:
Heat
('Sater Heater
I Range
ValuE of Hark:
Owner .T/#.._.._U;1.:; ~E:R;:? II/c::-a::>. =
t1d - - . Ph BufltilnQ Permit Info: Describe l~ork(Le.. Build Single
A rcss::?.s?~/ <;.,.,..; ___-..,.1,,'/"',,"":;;:;,. o;;r;~~Fami1v Residence Hith Mtached Garaael
&-'.? ,C,c:::-/ ~. 6K' "'5~<;"-&,~ r C6;'9""$~c..>C.7 ,(,.--,:::; A>-~ m":h ,:";;-
Construction Lender / r0..J'/'!"~ T' ;)"'..??"?~_;;\" ~ .
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INFOR/lATION liNe
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access. -:J.:?~
Sq. Ftg. Other
Ilew Add Alter Poep.
-Fence Demo Change/Ose
Dther- -
Address ~/t.r,A..<'l.1JA~'
UtSIGN HAH . fname{--- - 1/
IJ
Phone
(address 1
Mechanical
CONTRACTORS rnan~ )
Genera I ~.....~,o:;;::-~
Plumbina
( address)
fl ics. no.) lexnires\ (ohane no.
,-.., - .-. A
,(t"j 1~~
/-- ~ L:V11
./ ./V v ....
II ir:s-. no.) (pxoirpc;,l (ohonp nnl
Primary
Structura1
Electrical
Electrical
/)/'1-tY
..,,;-
~lechanicClJ
i'tllllEm:;
ELECTRICAL
MECHANICAL
NO.
Each sinq,~e fixt~re
l FfF I r.HARr,F Nn I
Residence of
I li.L i....c.HAQr.~ NO I
Il;l;l; 1..cHAR.G..E.
furnace/burner to
SQ. FT. BTU's
Relocated building
(new fix. additional)
S.F. P.e~ide1Lce
(l bath)
Duple. (1 bathl each
AdditillMr batll
I ~Iater serl."l-ce
I Sewer
I Storm ~~1f"
I
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing
rP'l j d~nrp
Imultifamily, comm. or
Induc;,triil1
IOf amps.
I COI~.1. fiND. FEEDERS
IInstall/alter/relocate
dic;.trih_ fpprfprc;,
IOf amps.
I
I
I
Appliance vent
c;,f"oaratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
TOTAL CH/lI>IE,!S
WIlERE STATE L\\J REQUI RES
shall not be vali1 until the
TOTAL CHMGES
ISSUANCF OF PFRrllT
TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor, the electrical rortion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CJ.I.'F.:EFULlY EXArlINED 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 Orel]on pertaining to the work described herein, and that 1m OCCUPAIKY will be made
of any str~ture without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in '"11 force pnd effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontr~ctors and employees who are in compliance with OP.S 701.055 will be used on this project.
IJAl.IE(please print)-T.4toM4J ~. fll€4iL SIGIIATURE~ ""'(~.
FO~ OrF I CE USE OIIL Y
Sq. Ftg.
Sq. Ft9.
;z? - 2. Sq. Ftg.
DATE/-';>""" - $"7
Zone .c. c
Fi re Zone
Flood Plain
Tyoe/Const.
Bedrooms
,~7"'v Units
Occy Load
/ Occy Group
/"~
<1)/ Plan Ck.
___~.2:"<:?__ 65%/Bldn
/ / '72 Plan Ck.
...,. ;;;> ./ 3D%/Bldo
riain
Access
Other
,
Value
Value
ValuE'
/~~.-
Stories
'22 <'/0 <f' x
r
,
/
TOTAL VALUATIOU
BUILDING PERltIT
Cha rges ant:
Surcharges
Com/! nd
Ppr Fpp
Res
Per Fee
..,,4 ~ "3
syste. ms Development I A / ~
CharQe (1.5~) /Jl'fIY- .
7$5 H / A~K6??677
/ ';..,.1 ,#/9' Ot ~/?';oo'=-'
l..s~~~e .0 2Y~
I ~/''''''''V6'''Z>
ITotal Comb. Permit
q-O.6?3
PLU/1BING PERMIT
Charges and
Surcha rges
Fence
DeRlO
I
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I
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I
I
I TOTAL
ILl? CJ6
ELECTRICAL PERI~IT
Charges and
Surcharges
Sidewalk
I A/C Paving
I Cu"rb Cut
I
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
17 D3 43
2. example- lot I. Block 3, 2nd Addition to
~prlngtield Estates
. C. . Name. etc. of owner and construction lender
.0. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrical/or SOlar
E. Square footage or valuation, etc. -----
1. example- 125D sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition.
checl< add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garoge
2. example - remodel existing garage into family room
3. exa~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 TEAM AND CONTRACTDRS
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. BUILDING DIVISION STAFF WILL' FILL DUT 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.
(31&l--
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V. FOR OFFICE USE ONLY
Permit Clerk
c.c
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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
~;qK-= 10-"-. _~ ".
Signature,.~ ;:__~~
date ::Z-/~~"7