HomeMy WebLinkAboutPermit Building 1987-6-23
CITY Uf SPRINGfiElD
COMBIIIATION APPliCATION/PERMIT
EHERbY SOURCES:
Heat
Hater Heater
Temporary Construction
Change in existing
re<;, i qe.nrp
Imultifamily, camm. or
TndlJc;trial
.
IIIISPECTION liNE
726-3769
. /AI! . o;;~'E
Job Address '2~,)<::::) {'-tf~./I1 #.?CA
legal Description /7~o~'~'E>-i/ Ih7?OC::>
, .
(J)/MAivm- ~;O-
Address ~0s f-J~m .rr II! R(~ne
q,;;, /_/-1 JW~~ ,;jtJYV q;f.
Construction lender ~ 6 C)720S
Owner
Address
Ulo I uN TlAl1
(name)
Phone
(address)
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
Ail ')jmel r;/l;!J; r/h'; 0.-<2
(addrpsc;)
Plumbina
Electrical
~lechani ca 1
PlUIIB I NG
ElECTRICAl
-Hlh
FEF rHARr:F Nn
Each single fixture
Relocated building ~
(new fix. additional)
/
5.F. Residence I
(1 bathl
Dupl x (1 bath) e h
Additi nal bath
Hater se vice/
Sewer
Residence of
./
New circuits alts.
or extensions .~
"2. L'/?;Z. Ah~&;e
SERVICES
Of
.
INFORllATION LINl
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access. /
Sq. Ftg .\Other
New Add Alter pep.
-Fence Demo Change/Use
Other- -
~
~
I~
".
~.
Ran~e
ValuE.
oNkh / LZJeJ
Bulldino' Pennit Info: Describe 14ork(Le. t Build Single
Fam~;dence Hit!' P.ttached Garaoel
i ~:::1:-/~t 1t:;~ YJ-/UL
flies. no.)
(exnires)
(ohone no.}
G \ 'tSJ II
n<1Y1
...~--
~ L,/ ., ,/
IV' I"J
f1 in. nn.'
(pxoirpc:,l
("hnT'lp !'In..'
.1:0/,- 5?3 f-/6%'2
7217 - Ie;- ;;/1
MECHANICAl
~~~ r~ NO
1=1='1= rl-l
SQ. FT.
furnace/burner to
BTU's
22-~
Floor fu rnace
and vent
Recessed wa 11
SOnrp hp~tpr ~nrl vpnt
amps.
Appliance vent
spoaratp
Stationary evap.
cooler
Vent fan with
sinole dur:t
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and durt
I I'load stove/heater
1A-l-7e!?'l ~ t:;)(l2!C4: D
'~L.oL::rVP'6~ _
r
I
b-"""
COMM,/IND, FEEDERS
Install/alter/relocate
distrih. fppdprs
Of
"
amps.
v
I SSUANCF OF PFRIIlT
TOTAl CHARGES TOTAl CHARGES =<,2..&0 TOTAl CHARGES /7'4'/-/. ,?,<:;: er~
WHERE STATE l.'lj REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXmlINED 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 UC OCCUPArKY will be made
of any structure without the permission of the Building Division. I further ertify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055. that if exe he basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7Ql.0S will be used on this project.
SrGllATUR
FO~ OfF I CE USff OIIL Y
,
Sq. Ftg. riain x Value
Sq. FtfJ. Access_.x Value
Sq. Ftg. OtherL~' ~ ,b~alue
TOTAl VAlUATION
HAI.IE(please print)
Zone ~MR
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
/
Units
Occy load
Occy Group]?- 2-
BUIlDING PERflIT
Charges and /"'\\
Surcharges t....#
___ Plan Ck.
"= 2 ~SC:> 65%'Rl do
------------ Plan Ck.
';?~~C) 30%/Bldo
r1l
Conro/I rnr
Ppr Fpp
R-es
Per Fee
PlU'1BING PERMIT
Char.ges and
Surcha rges
Fence
Demo
~~;~~:~C~~/ERr:IT ___~?:::<):::_ Sidewalk
Surcharges (Cj) "5'0 A/C Paving
11ECHANICAl PERMIT 1':- ""'= Curb Cut
Charges and ri\ - - - _t..d - ~ - ---
Surcharges I Iv - 60
~ DATEt.J2.']/8'?
C::'2~ =e>
1i-lf~f1
.1/ ~jp ;;".1342'/73
Systems Development
CharQe (1.5~)
/iff-
ITotal Comb. rermit
I
I TOTAL
/ocj =
.
.
'-
.
'cOMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1
1
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
'1I oj 43
2. examp)e- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example~ heat/electrical ceili~Q/or forced air Qas
2. example- waterheater/electrlcal/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 permit information:
1. example~~ ~onstruct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence into
restau~ant (change of use)
G. Value of work as defined in Section 303 (a) of the
S tructura I Spec i a lty 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.
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 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. ---
Ill. 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.
/7b ft! 1-:3-
00 3 0J~ JiJ ( 64rf)
V. FOR OFFICE USE ONLY Permit Clerk
,
n I
PROJECT CONDITIONS TO BE SATISFIED.BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Addit~onal Project Information:
PLANS REVIEWED BY:
name
signature
date