HomeMy WebLinkAboutPermit Building 1986-3-7
CITY OF SPRINGriElD
COMBINATION APPLICATION/PERMIT
n07 -? ~ . EIIERGY SOURCES:
Job Address 0<....::; /YI.1 ~ Heat
Legal Oescription /7.o'J ,,:z.:f".a./2. ~//b~ liater Heater
, Range
Owner' ~~ ~ 'ilW~1.-~~~J-?~Ofc200~.
Address "ld7..' ~ t1tn T" "~A , Phone /1 if I) Buildino Pennit Info: Describe Work(Le., Build Single
~ ~ ~~ 'I ~ Familv nesidence With Attached Garaoel
e5q() t&/J?tIJrlPtl 4/1 4,i//~ p, l,r"""L-
.~LJ/"re =3/"
I
I INSPECTION LINE
726-3769
Construction lender
Address
Ut~lliN If:.Ar~
Primary
Structural
Electrical
-.~'.'-_':
.. -.., -........... ,-....--..- -. ... "--.~ '..--~
.
.
~ lA Itro-rldfr
-lNFORllATlON LINt
726-3753
Sq. Ftg. I-lain
~Q. Ftg. Access.
SQ. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
~.
f;'
10
--..
v
~
I
(name)
Phone
(address)
(exoiresl
(ohane no.')
llics. no.l
Mechanical
CONTRACTORS {namel
General ..s",. A a/V (!1J7U}~./Z~
(addri='ss)
G<J( &.~
I .
flies. no.)
(p"lCr:lirpo::\
(I'lhnnp nn ,
Cf -..:l f- Xb /I,g~ <;'fn
_I (./ &. 7, .3
Plumbina
. Electrical ~N'12:>.K~~C:::::r:. %t.'r:~#t.
. ,
~1echan1cal
NO.
LI<.lJ'-'
1".t96- /6'< 8
PLUIIBI NG
ELECTRICAL
MECHANICAL
FH (':I..rARr.F NO
~~~ r~A~ ~
CCLJ:IlARlif.
l5'C>
Residence of
furnace/burner to
BTU's
Each Single fixture
SQ. FT.
/
Relocated building
(new fix. additional)
'Z:t. ~ .
Floor furnace
and vent
S.F. Residence
11 bath \
Ouplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
-" New circuits alts.
or exten.,iions
? ",R ~"'E
SERVICES
Recessed wa 11
~~~rp kp~~o~ ~~~ ~P"t
Temporary Construction
Change in existing
I"P~ j dJ>J1rp
multifamily, comm. or
Industrial
Appliance vent
~poa ra tp
Stat.i"onary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart from
hea t i n<l or A. C.
I Mechanical exhaust
hnnd and durt
I Hood stove/heater I
1A1~~&.-
I I
Of
amps.1
COHfI./IND. FEEDERS
Install/alter/relocate
d;~tl"ih_ fppdpr~
Of
amps. I
I
I
I
TOTAL CHARGES ~H. /5'". -"&> TOTAL CHARGES -:<' :z.Se> TOTAL CHARGES M/H. /~ 00
WHERE STATE L\l/ 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 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 oerformed 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 OCCUPAIICY will be made
of any structure without the permission of the Building Division. 1 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 ORS 701.055 will b~ used on this project.
NAHE(please print) _ JA..<;17>"\.. ~""t.o._". >IGIl^TURE '~.a../
FOr. OFFICE USE oury
Sq, Ftg. 11ain x Value
Sq. Ftg. Access ~ Value
SQ. Ftg. Other~~iC?&?:. Value :;>""""r'.
.;/ TOTAL VALUATION
~. ':c"-2'?"Bc>
~ J./~~'.AU' Systems Development
.... <...:... "" -7/ Charoe (J.5~) .
Zone
Fire Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
PLUHBING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges. and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
ISSUANCE OF PFRruT
DATE:J- ,-&
Tyoe/Const~R .
Bed rooms
Stories
Units
Occy Load
Occy Groupfl-Z.
Plan Ck. Comm/lnd
65%/Bldn Pffr Fee
Plan Ck. Res
30%/B1do Per Fee
__2_:?~?:q__
1.30
/ s: - Fence
___l..__=-_____
.66
":Z-;Z'DP I Sidewalk
------~-.,~-I A/C Paving
./..:2.. .....,. I Curb Cut
--- - ~-~~--I .
.t<I-.<J
Demo
Total Comb. Permit
9~. qc:>
$. Y-D
TOTAL
.
.
e
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc~ of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. exam~le- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project, check-nfw - if addition,
cneck add, etc.
F. Building permit information: .
1. example -construct single family house with an
attached garage
2. example - remodel existing garage into family foom
3. exam~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 TEM4 ANO 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 ANO '
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. ---
II 1. App 1 i cant to, sign and da te
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.
# &&01 (
.99 -J, 1'" QG
V. FOR OFFICE USE ONLY
Permi t Cl erk LG
PROJECT CONQITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
na~e~_""i"'~"'-E ?t~l!?'f" Signature.#~~ date :r'-S-&"6
I