HomeMy WebLinkAboutPermit Building 1985-10-29 (3)
CITY OF SPRINGFIELD
COMBIJlATION APPLICATION/PERMIT
-
E~IERGY SOURCES:
Heat
!~ater Heater
Range
Value of I-Inrk:
tfz. ~'? 00_,
BuilciltlO Permit Info: Describe \~ork( i'.e. I
Familv nes;dence Hith /l.ttached Garaae}
Nn I
IRes i dence of
SQ. FT.
INew circuits alts.
or extensions
ISERVICES
IrISPECTIOII LINE
726-376r
.
Job Ad~,~~'ss ~/~ 7 t?~N ?<?';P~r-
Legal D~scription / 7 0 3 ? 7 .:;J '-I - '?So 0
k',~~ l:11fllvw J.tPA.tl.<..AJ
If I 'ir. ~ 1Q.c.\,,; ~o...o.c 6
~J~ () ~
Construction lend~r
Owner
Address
Phone 'f~'I' .
"i'fl('1
Address
Ul:~lliN TE.AH
lname)
Phone
(addressl
Primary /)WN"':R
Structura 1
Electrical
11echanical
CONTRACTORS
(n~l
(address)
Genera 1
-~
Th-,J.."'; r~'
- 0,
9. /<:. .rl. ~
Plumbina
Electrical
~1echanical
PLUllB ING
ELECTRICAL
NO.
FFf
CHARr.F
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(J bath)
Duplex (1 bath) each
I
I
I
:;i'~grStorm Sewer I
I l~mbYA""l~.5~
I I
1 I
1 I
I
I
.
INFORJIATlON L1N.
726-3753
Sq. Ftq. 1.lain 29.-r9
~Cl. Ftg. Access.
Sq. Ftq. Other
)LIlew_Add-"1 ter _Rep.
Fence Demo Change/Use
Other- -
I~
I&.
\)
L-:,
00
Build Single
,~.,'-,~ JUdie ~:I'
.f). '10-0 4)./ lJ"j.
M~~:L;, 0. ,,-r
flies. no.1 rexoireg (ahoM nn I
(1irs nn.)
(pxoirpc:,\
(I)hn!'lp nl"l \
'T8S-~C?g
MECHANICAL
"F
rHARr,1= NO_
I=H" rI-lARr.1=
furnace/burner to
BTU's
I' Floor furnace
and vent
Recessed wall
~I)~rp hp~tpr ~nrl vpnt
I
1
I
I
3: -16-<110
I
1
I
1/t7.-
I
I
1$"'"
Additional bath
7z'll'ater service
//(1'1 Sewer
Z<!:),-
%~-
,S"'"
<5-
J' ITemporary Construction
IChange in existing
rl?5.i d_ence
ImultifamilYt camm. or
Induc;.triil.l
I 10f 'Z~ amps,
COMM./INO. FEEDERS
Install/alter/relocate
di<;trih. fppdpr<';.
Of
Appliance vent
seoaratp
Stationary evap.
cooler
~ 1 Vent fan with
c:;.. sinole duct
I' Vent system apart from
heatina or A.C.
I Mechanical exhaust
hnnd <l.nd du(',t
I Hood stove/heater
I
I
I
amps.
ISSUANCF OF PFRIIIT
TOTAL CHARGES ~,,) _ ", TOTAL CHARGES ?"). ..>, TOTAL CHARGES M/#. /~. -
WHERE STATE L\l~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this perr.1it
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAt1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel)on pertaining to the work described herein. and that HC 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 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.
UAI.IE(please print)kV\""'..th....F r.;.'J~~ ha~IGUATURE ~ ~ J1J (\~f) OATE..J~ ~.:J9'~'i'
. -'~FICE USE OULY
Sq. Ft9'~ /Zff..y ..,_,'alue
Sq. Ft9.~51~VS'E /A:1!)A' ',. . valueD... ~.s.-
Sq, Ftg. Other ~/h'~ x~~ Value ~:0.::e9.-
..z:::....._ L'/.......__ I/. TOTA.LVALUATIONgZ.ffc:::'?''''''
r~/""T 7~ 1f~~-. .,
, q""",-- 'Systems Development ' /"">.L./.-r-
_ . ~~ Charoo (1.5~) ... ~ ...".. ~ '"'>L-
.
/
Zone--1'Y!Jl.A TYDe/Const. .:'I-At Units
Fire Zone Bedrooms Occy Load /~
Flood Plain Stories 2 Occy Group g "Z
ri!:JVNI?/f-T/ON /-r.~~/'r /5~c.>~1>
BUILDING PERIJ!T I i~..D ".. 'Plan Ck. conm/.lnd
Charges an~ ___ '-:;OJ.7-A____ 65%/BldC1 P'pr__~""
Surcharoes ~,.~ Plan Ck. Res
,a;v 4J, cJ" 30%/BldCl Per Fee
PLUI1BING PERMIT a:>: dIC> Fence
Charges and - - - - -
. Surcha rges =? y.o DURIO
____3f>:.:.~_ S1dewalk 1'/..7'
/. Sft> A/C Pavi ng
_____/C2'!..~_ Curb Cut
. rG'
ELECTRICAL PERI:IT
Cha rges and-
SurCharges
MECMANICAL PERMIT
Charges and
Surcharges
~3'
/7.61
'lB. dO
/5:~
Irotal Comb. Permit
3~/.~
---
//)j6L~G \
I
I TOTAL
.
.
COMBINATION APPLICATION/PERMIT (CAP)
"
,
..' ,.;;
PERMIT VALIDATION
1. Appl icant to furnish
A. Job Address
B. Legal Description
1, example- Tax Lot lOa, Lane County Map Reference
II oj 43
2, example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/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. exam~le w 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 (al of the
Structural Specialty Code
H. OESIGN TE~I 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
fu 11 schedu 1 es
C. BUILDING OIVISION 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.
V. FOR OFFICE USE ONLY
Permi t Cl erk.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~r); rr
\0("/
I
..' ,
w
.
. Permi t appl i cant exempt from regi strati on with the Buil der I s Board' because:
, '-
Addi.tional Project Information:
PLANS REVIEWED BY:
. name Lt:1RNe' R~~
. .,' , "7->
'sig'iiature /~~~,
date /".2~-8S"