HomeMy WebLinkAboutPermit Building 1985-10-15 (2)
'I IrISPECT ION LINE
726-3769
Job Address
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INfOR/tATlON UN"
726-3753
Sq. Ftg. 1.la i"
~q. Ftg. Access.
Sq. Ftg. Other
XNew Add Alter ~ep.
-Fence Oemo Change/Use
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CITY UF SPRINGFIELO
COMB iliA Tl ON APPLI CA Tl ON/ PERllIT
EIIERGY SOURCES:
Heat
Hater Heater
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Build Single I ~
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'2.15'7
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Legal Oescription 1'0(;/,-27-7 l( ~e>~
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Range
ValuE of Work:
f'~.~"
Bul1rilno Permit Info: Describe Work{i.e..
Fa~ilv nesidence With Attached Garaoe)
V'&N
l//,Jiij. $'"~&: LA-~"
G......:::~~.
Owner
Address
Construction lender
Address
Ut::'l{jr~ TI:.Al1
Primary
Structural
Electrical
Phone
V~-99YI,/
F~~NPA'7"'M'AJ ....,.......t': c,.. F~;p
/"~.N..,;p .c.t:J. ~,t""""e;O:;:
- ..
WAN,r;-;fIz)U'>~
(lies. nO.l
(ohone no.l
lname)
Phone
(address)
(exnires)
/"_N~.I?
Mechanical
CONTRACTORS ln~mel
General ~WA/~
Plumbino
Electrical
~lechanical
NO_
(address )
(lies. no.)
I
(pxnirpc:l
(ohnnp nt).....l-
PLUIIBIlIG
'MECHANICAL
I....EEL 1.cJlAillif. .JlQ... I
furnace/burner to
BTU's
.'
ELECTRICAL
~
Each Single fixture
I.I~ $~1!JIt.I.
Relocated building
(new fix. additional)
rrL CHARGE .Jill..... I
-cJ Residence of
s:- ~ SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
I
I
I 10f
I I I ICOMl'I.IINO. FEEOERS
I I I l'Install/alter/relocate I
rl;~tr;h fpprlpr~
-I i r+- amp~:
I I I I I
I I I I I ISSUANCE OF PFR/IIT
TOTAL CHARGES ~ I TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L.'tl REQUIRES that the Electrical work be done by an,'E1ectrica1 Contractor, the. electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
IS.F. Residence
11 batb I
IOuplex (1 bath)
IAdditional bath
jwater service
I Sewer
I Storm Sewer
I..E.E.L 1.cJlAillif.
SERVICES
Recessed wall
~'-'?"'u.e.i'Itpl'" i'Inrl v".nL_
each
ITemporary Construction
IChange in existing
rp'S- i dpnr':p
Imultifamily, COJT1Tl. or
Tnnuo;.trii'll
Appliance vent
5ellaratp
I Stationary evap.
cooler
I Vent fan with
~inole duC'.t.
I Vent system apart from I
heatina or A.Co
I'MeChanical exhaust
tlnnd fl!'lrl rl,.,-t
I Uoo.d ~toveiheater
amps.1
I HAVE CAREFULLY EXAMINEO 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 UO OCCUPAllCY 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 ORS 701.055 will be used on this project.
llAl.IE(please print)
Zone M ~
Fire Zone
Flood Plaf"
BUILOING PER/liT
Charges an~
Surcharges
PLUI~B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~lT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Src,NATURE
Far. OFF I CE USE Oill. Y
Sq. Ftg.
Sq. Ftg.
Sq. Ftg.
'-0
QATE
Tyoe/Const. ,c;--)(/
Bedrooms
Stories '2
Units
Occy Load
Occy Group '{f - '2
riainx Value
Access x Va 1 ue
Other ~.JV.7.:l.(,___""",a"t:Ya1ue 41~.
TOTAL VALUATION
-" ~ 00 Plan Ck. Corrrn/lnd
____~_<;?~____~/Bldo PJ~r J=pp
/ /~ Plan n. Res
. ~ 30%/B1dn Per F..
____$'ct:J.... Fence
/.2~ Oemo
___________-' Sidewalk
I AlC Paving
____________1 Curb Cut
I
Isystems Development
CharQe tl.5~) .
~.o P'E ~"z;>
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~-,?' \
~...::., ~ ... ~ ..... ~ \
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I
ITotal Comb. Permit
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
~
PERMIT VALIDATION
III .
I. Applicant to furnish
A. Job Address ,-...-.
B: Legal Description I
I. examDle- Tax Lot 100;' Lane County Map Reference
II oj 43
2. exa~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources ~
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. exam~le- waterheater/eJectricaJ/or solar
E. Square footage or valuation, etc. ------
I. examDle- ]250 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. examole - 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. DESIGN TEN1 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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. ---
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 ar~ paid. All other fees and charges are due and
payable when the permit is issued.
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V. FOR OFFICE USE ONLY
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Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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7 HE ;;;;~(Y.
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
, I
name / .....,d;Y~ ?~~signature
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date~ -/s __..J-