HomeMy WebLinkAboutPermit Building 1984-3-15
i INSPECTION L1IIE
1726-3769
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Job Address
CiTY OF SPRINGFIELD
COMBIilATION APPLICATION/PERMIT
10 4~ Cql.."",::y
Legal Description \ '1 (') 2> ?? 7[)
LC)T 0/7~")n
Owner A<;<;oc....\_1 [)V'<Jl~_"
- -, . "
Address (Q"7 i (' "",k.--..=" /
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Construction lender
Address
UI:.SHiN 1l:.m.1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
INFORlIATION u,.,
726-3753
Sq, Ftg, 1,Iain
:q. Ftg. Access.
Sq, Ftg, Other
New Add Alter ~ep,
--Fence Demo Change/Use
Other- -
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.........
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~~;~~C~~~ff) \\\~
!-later Heater A..crr-
Ranqe
l ValuE of Work:
l...o<I~ ;::r 2S-oo
-/) Phon:"7t6b.J1 ',J1'ullciinli Penl1lt Info: Describe Work(i-.e., Build Single
"C..f Cr T -, Familv nesidence Uith Attached Garaae\
, ~~ "50;;> "'"<!.. -e.X.S'_ W"'\ Is P-
'" Jd "'/\"." 7,,' v-e...... ""'iils
( ..,~"
I
(name)
Phone
(address)
(ohone no.
(1 ics. no.)
(exnires)
enamel
(addrp,,'i )
(lire:;. no.)
(~xoi res'
(ohonp nn.l
(~"'" c,,,,kt__
I=?'\ C;;G...v L.. ~
M "II l.!vll",..
Genera 1
(oo;:s-<;-.. I Z. '")
Plumbino
Electrical /V\ <,_\(",-.A?_'<"
~1echanical
r:;J~<h-,c..
PLUIIBIIIG
ELECTRICAL
MECHANICAL
NO.1
Each single fixture
FFF CHARGE Nn H~ rI-lAR(::i:" NO,
Residence of furnace/burner to
SQ, FT, BTU's
j;j;j; rl-l./1r:u::j; ~
Relocated building
(new fix, additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
Hater service
Sewer
Storm Sewer
\
New circuits alts.
or extensions
Floor furnace
and vent
\s:- \'S q;; ,
SERVICES
Recessed wall
~narp hpa~pr ~nrl vpnt
Temporary Construction
Change in existing
rpc;,i de.ncp
Imultifamily. corran. or
Inrltl<:;trial
IOf amps.
I COMfl. II NO, FEEDERS
I Install/alter/relocate
rli<:;trih fppdpr<:;
IOf amps.
I
I
I
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole rlllrt
Vent system apart from I
heating or A.C-
Mechanical exhaust
hood and durt
Hood stove/heater
I
I
\S:~
ISSUANCE OF PFR!lIT
TOTAL CHARGES
\..)~
TOTAL CHARGES
WHERE STATE L1W REQUIRES
shall not be vali~ until the
I HAVE CAREFULLY EXNlINED the completed application for permit. and do hereby certify that all infonnation 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 UO 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.
OoJ /l-- L1
IIWIE(please print)
Zone r r
Fire Zone -
Flood Plain ----
BUILDING PER~IIT
Charges an~
Surcharges
PLU'1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI:IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL CHARGES
that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
DC:l~
S" '" \:ct-<.ov-
DATE 3!I'..d5tV
S IGIIATURE
FOr. OfFICE USE OIIL Y
$0, Ftg,
Sq, Ftg,
Sq, Ftg,
x
Tvoe/ConSt\\\.- \ \\17
Bedrooms
Stories
Units
x
x
Value
Value
Value
t1ain
Access
Other
Occy Load
Occy Group ,?-,-?
TOTAL VALUATION
r J 11 QU Plan Ck,
l-.:\: 65%/Bldo
-- - QG----"PiiinCk..
. ,0 30%!Bldo
. \:J.\\
_____J:______
I Demo
\ ~ CQ- I Sidewalk
.. --- .. -(~---I A/C Paving
I Curb Cut
I
;;"'''Y' '" ~~ 5"T i'
~c:> ;b'-d"
Systems Development \ '\ ~
Cha roe (1. Sn . t-.J XI.
]:15\6'"12102 \l)\'. lL5 O\J L Y
ConmlI nd
Ppr J:'jOoP
Res
Per Fee
Fence
I
Irotal Comb. rermit
I
I TOTAL
l.\O. ~
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B, Legal Description
1. example. Tax lot 100, Lane County Map Reference
11 oj 43
2. ~xampJe- Lot I, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinQ/or forced air qas
2. examole- waterheater/electrica(/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq, foot house, 500 sq, foot garage
2. exam~le- if new project. check-new - if addition,
cheCK add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examEle - remodel existing garage into family raam
3. example - 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 TEAl.' 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 SCHEDULES
0, 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 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.
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V, FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY;
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Permit appl icant exempt from registration with the Builder's Board because.;
Additional Project Information:
.
PLANS REVIEWED BY;
nam~\J\D M )6\.1\
SignaturMIA..r\ ~ _ y--~ da~e~-?5t-~l.\
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