HomeMy WebLinkAboutPermit Building 1988-4-28 (3)
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CITY Uf SPRINGFIElD
COMBINATION APPlICATION/PERMtT
EIIERGY SOURCES:
Meat
l~ater Heater
RanQe
ValuE of Hark:
~~~. c:<e
BuilrilnQ Permit Info: Describe Work(i-.e..
Familv nesidence With Attached Garaae)
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I INSPECTION lINE
726-3769
INFORlIATION LINt
726-3753
SQ. FtQ. I.lain '
~q. Ftg. Access.
SQ. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- --
Owner' ORP':;:;O/S( _1?1-~
Address ~~ < W M~..4.b~
.7i,ri'TL~k7/ ~: 97<'~
Construction lender ~
Phone
Build Single
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\S
11
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Job Address //~(j 6A7i!F'W4'r L~p
legal Description /7'C>3'~ ,t?:?'S"'c::'O
,
,7JR'7' ~~T ~~./A' ,#7- E~s--"
7;;, 6#TESoYA"''r' OrF./CE ?~7A6.
Address
Ut~lGN TtAM (name)
Primary '&Ut:.!! #
Phone
(address) !lies. no.)
.tt:: ." / d ,'?5~&. /:?T.:LAv~
/~8~~~A<./Ji' 7.7?"'KTZr"""'1 &>~' ~~_?..:
(exo;res)
(ohone no..
"7 '3i9-7r;'Zb
Structural
Electrical
Mechanical
CONTRACTDRS
I name)
Caddresd
(1 ics. no.1
(pxoirp,,)
(ohnnp nn )
General~""~~~ /(/~c.r",: ~/ ~E,~E~~~
Plomhioo
~:Z2g?
Electrical
t..lechan; ea 1
PlUI,IBING
ElECTRICAl
rHAOO.! NO
MECHANICAl
ND.
FEF
rHARr.F
NO I I ~~~
Residence of
l HF I rHAIU:;F
Each single fixture
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps_
App 1 i ance vent
'il:'oaratp
Stationary evap.
cooler
Vent fan wi th
sino 1 educt
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and durt
Sewer
Temporary Construction
Change in existing
rPi- j dJ,t1rp
multifamily, comm. or
Tnrlllc:trial
Water service
CO~1./IND. FEEDERS
Install/alter/relocate
rli,trih_ fppdpl",
Hood stove/heater
Of
amps.
TOTAl CHARGES TOTAl CMARGES
WHERE STATE L\H REQUIRES that the Electrical work ba dona by an
shall not be valid until the label has been signed by an Electrical
I SSUANC, OF PFR/IIT
TOTAl CHARGES
Electrical Contractor, the electrical portion of this penmit
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 Derformed 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, nd that NO OCCUPAUCY will be made
of any structure without the permission of the Building Div~;v". : ;~her certify that my .stration with the Builder's
Board is in full force and effect as required by ORS 701.0~~,^!~at if ex pt the basi or exe ion is noted hereon, and that
only subcontractors and employees who are in comoliance wi~ 70r.055 ,ill b~S on 's p ject.~.J1.
IWIE(please print).J1 /)1:'(-; ~(f t< /.., / /../ ~SC~~,),M. .? U DATE U-::2~-~J'
- , nDR OFFICE USE 0111, Y t /
Tyoe/Const. "'-/#.k' .Units Sq. Ft~. Ila;n x Value
Bedrooms Occy load Sq. Ftn. Access x Value
Stories '2.. Occy Group f?~2. Sq. Ft~. OtherQy7H"" n~~......?? Value ..y,,;:'~. <rl>
TOTAl V AlUA TI ON
";\./1 .....! u'?/I!5'~. Systems Development A / A
".? ~~ <,I.:l~~'Ij Charqe (J.5~) /Y r?
Zone Cr-:
Fire lone
Flood Plain
;
~ Plan Ck. Comm/Ind
__.:;zt:'..r5:c;2___ 65%/Rldo P.pr <pp
Plan Ck. Res
, 30%/Bl do Per Fee
I Fence
I Demo
I S1dewalk
I A/C Paving
I Curb Cut
I
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BUIlDING PER~IIT
Charges and
Surcharges
PlUl~BING PERMIT
Charges and
Surcha rges
ElECTRICAl PERfiIT
Cha rges and
Surcharges
MECHANICAl PERMIT
Charges and
Surcharges
.ITotal
I
I TOTAl
J3.' c9 3'
Comb. Permit
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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/ oj 43
2. examele- Lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical'ceilinq/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. ------
t. examele- t250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition.
cneck add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family raam
3. examale - 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 ANO 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
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 ba 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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.. PERMIT VALIDATION
'!?s=7't=IP/ //c.f18 .
Permit Clerk~. ~.....u-..
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
L~:R/'/lF ~~~
Signature~.......
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date
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