HomeMy WebLinkAboutPermit Building 1987-8-13
IiISPECTIOfl LINE
726-3769 .
Job Address 423 'tv
Legal Description
"'-
~it,!fj;i
CITY OF SPRINGFIELD
C0/1BlilATION APPLICATION/PERMIT
.I___~ EnERGY SOURCES:
Heat
['later Heater
Rance
ValuE of l'lork:
NFORflAT;.;:i ll,,~
726-3753
Sq. Ftc). f'ia i n
~q. Ftg. Access..
Sq. FtC). Other
New Add Alter Pep.
--Fence Demo Change/Use
--Other -- --
cf>!
~'~
Owner \\\.e.Vn. ~.\ \ee~~. ','
Address ~WJUlli~U hi! Phone
~("?2.e~ I -
Construction L;nd~r- 0 ( \A.rlt"^,,,,&'\,hI'A :\\.J\..~
\ . Ci '
Phone
(address)
Buih;inq Permit Info: Describe l'lork( i.e., Bui ld
~~\e IJi6(t~Dr,AP), ~tt.
r' (\ ~ ',) 1\
(~3()OD \j~)~
I (lies. no.) (exnir<es)
Single
o
eN
or
Address
DESIGfl TENl
(nnme)
(ohone no. )
Primary
Structural
q)J, c;0.IOCJ
Electrical
~1echani ca 1
CONTRACTORS
(name).l1 (\
lkVl\L K()O\i~
4\00 \Rs~ ''-liD L.l^-. ~.': 4-~(l1ti)O'~~r<s- '6__-,"hOO' 00,1
'_^'~O^ S.
Genera 1
Plumbinq
Electrical
f1echanical
PLUf1BING
ELECTRICAL
MECHANICAL
/i0.1
~I CHARGE NO I
Residence of
1-I.EL..1.DiARGL1~1
1..llLJ ..GHARGLI
Each single fixture
Relocated building
(new fix. additional)
furnace/burner to
SQ. FT. BTlI' s
New circuits alts.
or extensions
Floor furnace
and vent
, S. F. Residence
(I bath)
I Duplex (1 bath)
IAdditional bath
I Hater service
Sewer
each
I
I
I
I
I I Imultifamily, comm. or
Industrial
1~_IOf
I I ~MM./IND. FEEDERS
falter/relocate
. feeders
/SERVICES
I
Recessed wall
Soace heater nnd vent
I Temporary
IChanoe in
residence
Sewer
amps./
Apoliance vent
seoarate
Stationary evap.
cooler
'Vent fan wi th
sinole duct
I Vent system apart from j
heatina or A.C. ,
Mechanical exhaust
hood and duct
Wood stove 'heater
\
!
I
f
l
3<1) 501
Construct i 0.11
existing
I
I I
TOTAL CHARGES J TOTAL CHARGES
I.JHERE STATE L'lv REQUIRES that the Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
Storm
I
I
,
I
I
/
Install
distrib
q Of
y
.,
\~
amps./
I
~>>~'f'
I SSUANCE OF PFRI1IT
TOTAL CHARGES
'31) so
J.
Zone
I HAVE CAREFULLY EXAmNED the completed apnlication for [Jermit, 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 Orenon oertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without the permission of the Building Division. I further cer.-t-'fy that my registration ~Iith the Builder's
130ard is in full force and effect as required by ons 701.055, that if exempt-the asis for ){ mot on is noted hereon, and that
00 ly ,"b""'m'oc'r1~~ ~~o '$i, ~"q ':ml ';:,;;.ith ORS 701. OSS--;,j 11 ;;~:d"," j,"" ;,t. / , _ / ,/
'IMIE I pi"" pn "'1\ fj {J. h '.Ii m, s'm I r-y ~~'ATURE, ' ~4d/~", , 0-ff~TE ~/,;2 PIP; 7
, FO~ OFFICE USE (DilL Y / .4'\ ~ ~ 'I
TYDe/Const. Units So. Ftg. r{ain v x Value
Bedrooms Occy Load Sq. Ftg. Access x Value
Stories Occy Group Sq. Ftg. Other x Value
Electrical Contractor, the electrical portion of this per~;t
Supervisor and returned to the Building Division
,Fire Zone
Flood Plain
BUILDING PERmT
Charges anc
Surcharges
TOTAL VALUATION_
PLUI1BING PERMIT
Charges and
Surcha rges
Plan Ck. Comm/lnd
65%/Bldo Per Fee
------------, ~b~~B~~~ ~:~ Fee
,
,
I
I
I
I
I
Syste~s Development
Charge (1. 50/,)
MECHANICAL PERMIT
Charges and \ n
Surcharges \.f"
I Fence
I Demo
I S i dewa 1 k
I A/C Paving
---315~?!2 Curb Cut
------------
------------
,ELECTRIU,L PERf~IT
Cha rges and
Surcha rges
/Total Comb. rermit
l_ilT"
! II! I1L
3g.~
i
J
1
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Refer.ence
17 03 43
2. example- Lot 1; Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 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. 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 TEAr,' 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
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 preoare 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.
(Jb~
~~
"
V. FOR OFFICE USE ONLY
Permi t Cl erk Q.V
~
,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder1s Board because:
i Additional Project Information:
1
1
PLANS REVIEWED BY:
name
signature
date