HomeMy WebLinkAboutPermit Building 1984-1-1
".
~ INSPECTION LINE
1 726-3769
.
CITY Uf SPRINGf IELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
t~ater Heater
Range
.
lNfORllATION llNl
726-3753
Sq, Ftq. I,tain
~q. Ftg. Access.
Sq. Ftg, Other
flew Add Alter Pep,
--Fence Demo Change/Use
Other- -
.
Job Address '2 ~7'3 OL YM.P/C;::
i.egal Oescription ,'.()'S"2&.'I;', (!j/,/t>t":>
sr
,
Owner Gsv' h~U.N r~ S -V ~
AddressZt:>7? t!)(.YMPI<:' 57.
5pp<.p. " CN, 9/ ~ on
,
Construction Lender
Phone
ValuE of Hork:
/~S-t:>, 00
BUilGinQ Permit Info:
Familv ~esidence With
Build Single
'^
~
~
~
Address
DlSIGN TEAf1
{name}
Phone
(address)
I
Describe Work(i~e,"
Attached Garaoe)
'7 r~.N~" ~'~'~f':Ut~~
~CJOS7'OJaf ..J>U/<D/N6.
Pt!:#7A1d~e::o
flics.no.)
~e'F.S
(exoires)
(ohane no.
Primary
"Qzy" ~ '."4
~"""'(/-&S41"y '$:5" b.,e. /~~ ;:G.v~. 0-",".
~ r' ,
~ 3''9~ ?_~(/f;
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
n i('<;. nn.'
(pxl)irp~'
(I)hnnp no )
Genera 1
Plumbino
Electrical
~1echan;cal
PLUflB I NG
ELECTRICAl.
MECHANICAl.
110, '
Each single fixture
, FFF 'fHARr.F ~n
t"t"C -'::~8.RG..E. ~JO
SQ, FT,
furnace/burner to
BTU's
. C'I-'.cJJAIlG.E.
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
~n~rp hp~tpr ~nrl v~nt
Storm Sewer
Of
CO~1,/IND, FEEDERS
Install/alter/relocate
rli~trih. fppdpr~
amps.
Appliance vent
seoariltp
Stationary evap.
cooler
Vent fan with
"inole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and dlJr:t
Additional bath
Sewer
Temporary Construction
Change in existing
res. i ~eJlcP
multifamily, comm. or
Tnd1J<;.tri~l
~Jater service
Wood stove/heater
Of
amps.
TOTAl. CHARGES
WHERE STATE L~H REQUIRES
shall not be vali~ until the
TOTAl. CHARGES
ISSUANCf OF PFRtlIT
TOTAl. CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri ngfi e 1 d and the laws of the State of Oregon perta i n i og to the work descri bed herei n. and that rw 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 ORS 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 701.055 will be used on this project.
IIM1E(please print)
5 I Gfl^TURF.
Fon OfFICE USE 0111. Y
Sq. Ftg,
Sq, Ft9,
Sq. Ftg,
DATE
Zone ~ t::.
Fi re Zone
Flood Plain
TYOe/Const,,zr-/ HA~Uni ts
Bedrooms Occy load
Stories ~ Occy Group~~~
'1ain x Value
Access x Va 1 ue
Other:5"~tt:F ~,. value-H:S"l::'.-
TOT^1. VALUATION
BUII.DING PERIIIT
Charges and
Surcharges
.17 -
---- --~----
68
Plan Ck, Comm/Ind
65%/Blda ~~r Fee
Plan Ck. Res
30t/Blda Per Fee
Fence
II. ()~
"D. '~-"jJ" -.,7
bo~V.~~
Isyste. ms Development
Charae (1.5~)
:z ~ 75"
", 1~-=7,,".';
.I:rW, ~tI&.
PI.Uf1BING PERMIT
Charges and
Surcharges
Demo
I Sidewal k
I A/C Paving
1 Curb Cut
I
ITotal Comb. Permit
/7.4t8
/ ,/:its
EI.ECTRICAI. PERIIIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAl.
...,
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
j, Applicant to furnish
A, Job Address
B. legal Description
I. examp.le- Tax lot 100, lane County Map Reference
II U3 4j
2, example- lot I, Block 3, 2nd Addition to
sprlngtield Estates
C. Name., etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. examyle- waterheaterjeJectrlcal/or solar
E. Square footage or valuation, etc.
I, 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. example - construct single family house with an
attached gar"ge
2. example - 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 (aJ 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.
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 penmit 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, BUllDING DIVISION STAFF WIll FIll OUT All FEES AND
CHARGES ON THE SCHEDULES
0, 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
Permit Clerk
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
signature
date
I