HomeMy WebLinkAboutPermit Building 1985-10-22
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I IIISPECTlON LINE
726-376g
Job Address
legal Description
Owner
Address
Construction lender
Add:tess
UDlliN Il:.AH
i Primary
Strllctural
Eler:trical
.
.
3422~Otymp~Q St.
!7-0Z--3() fY) - jq 1/
CITY OF SPRIIIGFIELO
C0/1BIIIATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Heat .
'l~a,(e'r Hea ter
Ranqe
Valu€. of Hark: ,
$5.000.00*'*
BuiloiM Permit Info: Describe Work(i .e.,
Familv nesidence I-lith fi.ttached (1araae)
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Gtw U:tteVl
Phone
747-6218
B/./ OWVlVt'
(name)
Phone
(address)
P.ta.Mblj OWVlVt
Mechanical
~TRACTORS Inamel
General H/./.ta.Vld & SOM. . TVlQ.
Plumbina
Electrical
~'echanical
-1iQ.,.
, address 1
5140 FkaVl~Vl Blvd
PLUrlBltIG
ELECTRICAL
, FEF I CHARr.F NO
Residence of
Each single fixture
SQ. FT.
IRelocated building
(new fix. additional)
S.F. Residence
11 bath)
Ouplex'(l bath) each
IS~
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TOTAL CHARGES I TOTAL CHMGES /S': ~ I TOTAL CHARGES h?/A/. /eP. ~
WHERE STATE L\I~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical rortion of this pernit
shall not be vali~ until the label has been signed by an Electrical Surervisor and returned to the Building Division
Additional bath
I ~Ia ter servi ce
I Sewe r
\Storm Sewer
I
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~New circu~ts alts.
~e~~~1?6
ISERVICES
I
lTemporary Construction
IChange in existing
rp'} i qr.nrp
Imultifamily, carom. or
InrllJc:.trial
IOf
Ico~1./IND. FEEDERS
Install/alter/relocate
rl;~trih fp",rll'lr~
amps.1
Of
amps.
(lics. no.)
flics.no.)
-. 4788
tEL U:.llARGl. fin
INFOR/IATION liNt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
-Fence Demo Change/Use
Other - -
~
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I~
"<0
~
Build Single
(exnires)
,
II
(ohone no. I
',. ",
(exolres)
/2-31-85
(ohon,.. nn_ \_
747-4622
MECHANICAL
furnace/burner to
BTU's
(EL1.tIlAB.UE..
Floor furnace
and vent
~dW'~
"'ilir ilnd
ven+-i 6-
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Appliance vent
~poarate
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart
heatino or A.C.
Mechanical exhaust
hood ~nd rlurt
from
Wood stove/heater
I SSUAflCF nr PFR!lIT
1 HAVE CAREFULLY EXNllNED the completed application for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and ~ll work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ofe,qon pertaining to the work described herein, and that 1m OCCUPAIKY 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 basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with Or.S 701.055 will be used on this rroject.
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NM1E(please print)
Zone .a M H
Fire Zone
Flood Plain
BUILOING PWIIT
Charges and
Surcharges
PLU!1BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PER!nI
Cha rges and
Surcharges
IIECHANICAL PERMIT
Charges and
Surcharges
EJ;.v.,p\
~d:1y "-
S IG,IATURE
FO~ OFFICE USE DilLY
$0.' :rtg.
Sq. Ftg.
;J?-2 Sq. Ftg.
"
Tyoe/Const.
Bedrooms
Stories
. S::-h
Units
Occy load
Occy Group
t1ain )l' Value
Access x Value
Other~b~ Value-J<)7
TOTAL VALUATION
OATE. hft.z/r:s-
/
. ere.
, -Z-?......... 'PlanCk.
___~~..:___'_ 6S%lBldo
/ -:>6 Plan Ck.
. -.:;;> 30%/Bl do
Fence
ConmlI nd
Pl'lr F'pp
Res
Per Fee
4e,loS5rO RHP'
\ to 00 Syste. os Development
. Charoe (1. 5~)
M-
I Oemo
__LcL:~~_J Sidewalk
- 00 I A/C Paving
r---'~~b~-: Curb Cu't
j
~h &V/EW litE:
~~7~,fl I '1.80
I
Total Comb. re'rmi t I
: TOTAL ~ Y:08'
.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100, Lane C~unty Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction l~nder
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation. etc. ------
I. examole- 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 - construct single family house with an
attached garage .
2. example - remodel existing' garage into family room
3. examole - 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. OESIGN TEN1 ANO CONTRACTORS
To avoid design or construction delays, Bunding
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
fu 11 schedu 1 es
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
. CHARGES ON THE SCHEDULES
O. 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 s;'gn 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.
~V. 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.
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V. FOR OFfICE USE ONLY
Permit Clerk
trY
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArlCY:
", ","l~'
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
L. O~H~' ~~~5?'fgnature ~ Z_ _ ,C2:: _...
,., .r
" date
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