HomeMy WebLinkAboutPermit Building 1984-9-21
CITY OF SPRINuFIElD ~ INfORllATIDN lINl
COMBINATION APPlICATIONfPERMIT . 726-3753
E!lERGY SOURCES: Sq. Ftg. 1.la;n
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
flew Add Alter Rep.
Range~____.___.=__ -Fence Demo Change/Use
. Valu, of Hork: Other- -
~ ; /.:; .::JO~b1J:.A) a83S3b.5' io 1}{Jt),~
Address /J /- IJ 1_11 ""'1 / BuilciinQ Pennit Info: Describe I~ork(;.,e., Build Single
"'7Q.;:;j, , t...-, . Y.i./ZflYtl.t. /Ol~- Familv nes;dence With Attached Garaoel
~)O"",(UII..~ J 1tJ4- /.:;'1/iL 10/HAndd ~ - ~f/__ f'.JAU
Construction Lender ~ ...-:I!:r/ ..ru:ztfl --: _~ ~ / a ~A L
I cu/ dl / -!' C?/ IA,rrL/.J?...,
. flUs. no.) (Hoires)
\J~~"""'?lE, "\"'\ffi\C,,\' E\'i(n~ '~\\.~\\.~ "\\.\'In1ft \tJ~. C\~
IIIISPECTIOII 1I11E
726.3769
Job Address J 9 Ci 0 (tJ! {,/ M j; (~ .
I I
legal Description
Owner
Address
UlSluN flNl
Primary
Structural
.~ Electrical
Mechanical
..€lJNTRACTORS
I~ Genera 1
Plumbina
Electrical
11 ~'echan; ca 1
-
~
(name)
{name}
PlUllBIIIG
\
Each single fixture
IRelocated building
(new fix. additional)
Is.F. Residence
II bathl
IOuPlex (I bath) each
IAdditional bath
I~Jater service
I Sewer
lstorm Sewer
I
I I
~'~~"'U~~\:M-;: I
- I
I
I
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TOTAL CHARGES \C).eo TOTAl CHARGES \ ~ ClO TOTAL CHARGES \C'I.cP
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~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 UO OCCUPAUCY 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 as's ?or exe~~n is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7~1.055 wil u d 0 i ~ject.
IIAllE(please princ:?t'J&8.777)/;9-JJ SIGIIATU Y# - - DATE9kh:
FOP. OFFICE usf OIIL Y ./ /'
Sq. Ftg. riain x Value
Sq. Ft~. Access x Value
Sq. Ftg. Other x Value
(J. ~;1iJ./' l TOTAL VAlUATIOtl.Qf"YV....,--
"'2 -:2 t!O P/.,... if ISystems Development \"....
~ 7. _ Q fa PloCharoe (l.5~) ",1 t'll.
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Zone CC_
Fi re Zone
Flood Plain
BUILDING PER~1lT
Charges anC:
Surcharges
PlUIiBING PERMIT
Charges and
Surcha rges
ELECTRICAl PER/lIT
Charges and
SUTcharges
11ECHANICAl PERMIT
Charges and
Surcharges
-
#/l..t
Phone
(address)
iXj
~
-..S)
<:)
~
~,
(ohone no. I
(address)
(1 it's. no.)
(pxnirps)
(ohnnp nn,)
ElECTRICAL
FEE rHARr.E Nn
Residence of
S.- SQ. FT.
New circuits alts.
\ or extensions
SERVICES
MECHANICAl
<<c. J:IiARliE. NO
ILELJ:IiARliE.
furnace/burner to
BTU's
\s-:"
Floor fu rnace
and vent
Recessed wall
SOn;P hp~tpr ~nrl ~pnt
ITemporary Construction
IChange in existing
rp~ i rleJlcP
Imultifamily, comm. or
Inrlllstri<ll
IOf amps.1
ICOW1.fINO_ FEEDERS I
IInstall/alter/relocate I
rli<:.trih fppnpr<:.
Appliance vent
c;.poa rn te
Stationary evap.
cooler
V.ent fan wi th
sinole duct.
Vent system apart from
heatina or A.C.
I Mechanical exhaust
hnnrl <lnd rlUi.t.
I Hood stove/heater
~\\.)7E~\\
I (~r;:."I~~\<"I\."
I - 'J
I
I
I
I
~:-
I
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n-
Of
amps.
I SSUAIICF OF PFRIIlT
TyoefCons~~~
Bedrooms
Stories \
. t::. f") - Plan Ck. Co""'fInd
____ilJ.'-_____~/B'rln Per Fpp
f") C>'2. Plan Ck_ Res
L. 30%fBI do Per Fee
\~ Fence
__ __ u...>~=-____
"0
.___~~~:____J S1dewalk
. cc> I AlC Paving
_____\Q:.~_J Curb Cut
. ,",0 I
_Units
Occy Load
Occy Group ~'l_
DtjII10
ITotal Comb. Permit
I
I TOTAl
qo.~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
11 oj 43
2. example- lot I. Block 3, 2nd Addition to
~pringtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examyle~ waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. exam91e- 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. examele - 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 ANO CONTRACTORS
To avoid design or construction delays. Building
~ivision 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 approp~iate 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. BOIlDING OIVISION STAFF WIll Fill OOT 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. ---
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 OSE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
PERMIT VALIDATION
'\ SJ & 30-0
;JrY ~\?
. +
~
Permit Clerk
k
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation: ~~\~~'~_~\~'F. F_~'~""''I>~5')
~\C~ ~\ c..~ ~\.~ "t\~l_~~ ("'(X"\.\?~'ir~
PLANS REVIEWED BY:
---nam~~~
signaturE~::lu.r' ~'Q-'k.-I\r-'" da~eC\-C?_\-~4
.