HomeMy WebLinkAboutPermit Building 1985-10-29 (4)
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i INSPECTION LINE
726-3769
CITY OF SPRINGFIE~D
COMBINATION APPLICATION/PERMIT
I E!IERGY SOURCES:
Heat
Nater Heater
Range
ValuE of \.Jnrk:
I.fz.~~ --',
BuilofhCl Pennft Info: Describe Wor~:.(Le.,
Familv nesidence With Attached Garaoel
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Job Address "2./.&; 7 t?~N ?~;:>~P""
Legal Oe,cription I 7 0 3 'd. 7 ,;J 'f - 'S'O 0
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Build Single ';;::'
~. . ._~~;;~/, ~:j :f::ry ~
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flies. no,) (exoires'f (ohone no,
Owner J(,~ l-tuL JJ.PA.tlJU\.J
Address I I{ ~~ C' ~ 6
"1 " ., Q.q ,.. ~'-",-,,<>
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~O~
Construction lender
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Pc.-.,..t.."" r~~'
Q.I<::. )-! 'i'~ ~
II
Address
Ul~tGN T<A11
Primary OWN~R
Structural
Electrical
f1echani ca 1
CONTRACTORS
Genera 1
Plumbina
Electrical
~'echanical
NO,
Each single fixture
Phone '6'1' .
'l9l(tf
{name}
Phone
(address)
I name l
(address)
PlUlIB ING
ELECTRICAL
FFF r"IlBliL ...I'n
Residence of
SQ. F1.
Relocated building
(new fix. additional)
S.F. Residence
II bath)
Duplex (I bath) each
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~" ~torm Sewer I
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I HAVE CAREFULLY EXAMINED 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 Oregon pertaining to the work described herein. and that 1m 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 7Ql.055 will be used on this project.
IWIE(please print)kY'l"t\f'th.; r.;.~~_IGNATURE ~ ~ _xt~tI~t) DATE 1(J;":J9~~'
FlXt OFF I CE USE OIIL Y I'
Zone.....1Y1JI.tIJ Type/Const. ;)'-At Units Sn. Ftg.~ /:e~x~~Value '
Fire Zone Bedrooms Occy Load-----LS Sq, Ft~.~6!~(.I5'E ~$'''' ~',-,' valuea~3-
Flood Plain Stories:Z Occy Group 8~2. Sq. Ftg. Other ~""H~ x9~ Value ?:~.-
re:JUN&MT'/OH ?.6'1~....r /S~&.>~l> ~~ 9'~- ~T~~ALUATlON~~,. ?d?:"'!II
BUILDING PERIIIT 'j;'::"_ "4> Plan Ck. COllm/lnd ".QJO'~ Systems' Development /-::'<<Y ...-_
Charges ant: ___"'.,.':01J~__ 6S2:/Rlda p.pr Fpp . ~~ Charqe (1.5~) .. 4J '"'7'....I-J
Surcharaes. ~ ~J' Plan Ck. Res .
"""'-~ ~- ''i. iJ', c;t-., 30%/Blda Per Fee
____a~dC> Fence
=1. Sf 0 Dgmo
____3~:.~JSrdewalk I'I?"
/. ~ 1 A/C Paving
It;:;? ai> 1 Curb Cut
--~-- -~"ici-I
Additional bath
7Z' I/ater service
,
//4 Sewer
/
PLUI1BlNG PERMIT
Charges and
Surcha rges
ELECTRICAL .PERIHT
Charges and....
SurCharges
/lECHAN I CAL PERMIT
Charges and
Surcharges
New circuits alts.
or extensions
SERVICES
/
Temporary Construction
Change in existing
rpc;j4p'nr:~
multifamily, COrml. or
Inrlllc:trial
2r:J. -
2~-
'JS"" I
-S-
Of
"Z~
amps.1
COMM./IND. FEEDERS
Install/alter/relocate
rlic:trih. fpprlprc:
10f
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amps.
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INFORlIATlON L1Nl "1
726-3753
Sq. Ftq. 1,la;n :2'c;I~'L-
~q. Ftg. Access.
.S~: Ftg. Other
)(.!Iew_ Add _A Iter -Yep.
Fence Demo Change/Use
-Other - -
.
(lies. nn.)
(pxoi rpc:)
(ohonp no, ,
'T8S~~~g ,
MECHANICAL
""L J:I!ARliE: Jill....
~J:."~ nH~.RG.E. ~
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
~o~rp hp~tpr ~nrl vpnt
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Appliance vent
seoa ra tp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heat;na or A.C.
Mechanical exhaust
hood and rlurt.
2
~- 6,..OC'
Wood stove/heater
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/7.Cl/
~B. c:o::>
/5:~
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Total Comb. Permit
.3t./.~
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I TOTAL
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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 oj 43
2. example- Lot I. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
0, Energy Sources
"I. exam~le- heat/electrical ceiling/or forced air Qas
2. examole~ waterheater/electrical/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. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exa~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. OESIGN 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 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
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 sign and date
Whenever possible, the initial application will b~ 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.
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V. FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT,~ONpITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'\ '_'Permit appli cant, exempt fr~m regi strati on wi\th, the' B~il der I s-:Board 'because:
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....Addi.tional Project Information:
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PLANS REVIEWED BY:
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'na~e~ R~~ '\~~:~a~ure#U~~;
date /1).2~~3S'
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