HomeMy WebLinkAboutPermit Building 1983-12-23 (4)
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BuilGina P~rin;~t info: Describe Work(;-.e., Build Single
Farnilv.Residence With Attached Garaael
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'I IrlSPECTlON LINE
726-3769
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Job Address
1077
CITY Uf SPRINGFIELO
CmmIilATlON APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
Hater Heater
CJ'lh 1_ p
le9al Oe5cription\"l D?-, ? 2.1 ? 0
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Owner rt"7 oS 0< ,,'(I.,) C v-<:-I ""'-
Address 1077 ~~ '( D
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Constructlon lender
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Phone
Address
ut~lI.ir{ 1 t.Ml
(name)
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Phone
(address 1
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Primary
Structural
Electrical
Mechanical !2.....o~'S
CONTRACTORS (na~j
Genera I ,ft,., ,-II/-Ia 1/ e,^
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TOTAL CHARGES TOTAL CHARGES \ ':5. u:...;> TOTAL CHARGES \ (),...u
WHERE STATE LAW REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit
shall not be va111 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 performed 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 NO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 7n).055 w~be ~~on this project. _
HAI-IE(please print) ,Dou.-cf M '5'\II\,J~ SIt.HATl'RE Va.!! /L.. L1 OATE I ~h3/~5.
FO~ OffICE USE miL Y
Sq. Ftg. r1ain
Sq. Ft9. Access
Sq. Ftg. Other (0(0(')
Plumbina
Electrical
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r:y--c,<;~ ~ <) '^ '^
Hechanical
PLUIIBING
ELECTRICAL
NO.
fEF CHARt.F Nn
l....Err rH'.RG(...lIll.....1
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
INew circu~ts alts.
or extenslons
I SERVICES
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S.F. Residence
11 bath \
Duplex (1 bath)
each
Additional bath
ITempOrary Construction
Change in existing
rp:;:id!,;:nrp
multifamily, comm. or
Inrlus.trinl
~Iater service
Sewer
Storm Sewer
10f
ICO~1./INO. fEEDERS
I Install/alter/relocate
di~trih. fppdpr~
10f amp..1
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amps.
Zone C \-\ K
Tyoe/Const. S- \ \'>.:.
Bedrooms
Units
Occy Load
Occy Group~~'2_
Fire Zone -.
Flood Plain
Stories
'7~_
BUILOIllG PERI,IIT
Charges and
Surcharges
i") (-..., CO Plan Ck.
r....D, 65%/Rlrlo
-----,-"i".:..--- ~6~~B~~~
I Fence
I Dt1fI1o
I Sidewalk
I A/C Paving
I Curb Cut
I
IZ-/3-K3r;,Z/D Cj
.}/!?[;W (' t,
Comm!l nd
Ppr Fpp
Res
Per Fee
PLW1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surchar!les
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INFORlIATlON LINe
726-3753
Sq. ftg. I"ain
~q. Ftg. Access.
Sq. Ftg. Other
Hew Add Alter ~ep.
--Fence Demo Change/Use
-Other - -
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MECHANICAL
furnace/burner to
BTU's
I FFF I CHARGf
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Floor furnace
and vent
Recessed wall
~nnrp h~~tpr ~nrl vpnt
Appl iance vent
~"'oaratp
I' Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatinq or A.C. .
I Mechanical exhaust
hood and duct.
-I \.Jood stove/heater I
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ISSUANCE OF PfRlIIT
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x
Value
Value
Value
x
x
TOTAL VALUATlOtl
Systems Development
CharQe (J.5~) ,
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ITotal Comb. rermit
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I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. IName. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or SOlar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, SOD 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. examele - remodel existing garage into family room
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 TEM1 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
ar~ 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 ins tall ed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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. ---
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.
V. FOR OFFICE USE ONLY
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,PERMIT VALIDATION
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Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl i cant exempt from regi strati on with the Bui 1 der I s Board because':
Additional Project Information:
PLANS REVIEWED BY:
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name\ J~'-I ",. '. .:- '..
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