HomeMy WebLinkAboutPermit Building 1984-8-22
..-
':"llII
\:
) ,:;,NSPf,CnON LINE
('i'26- 37 6'9
Job Address
! Lega 1
Z 3$ & S/-/,..~~/"-
Description Yl(~~lD~ \ ()~ \ffi
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat .
t'later Heater
(name)
Phone
(address)
Range
V1~.k~
Buildinq Permit Info: Describe l1ork(Le., Build Single
Family ~esidence With Attached Garaqe)
~VL' 7029""; ~",9"-L A'
a-~.~A-:<7:~ ~ -9 ~~
~~ o/'"~~.
, '. (lics. no.) (exoires)
INFORl1ATION liNt
, 726-3753
Sq. Ftg. r.la in
:q. Ftg. Access.
Sq. Ftg. Other
Ne\>/ AddJ(A lter Rep,
--Fence Demo Change/Use
--Other- --
Owner' ~~;t?Y ,M?/L'-'T.zr:4'l: 9"
Address S-#-~E /~~.
'"
~
'-...D
, ~
:s:-
,\.X)
Construction Lender,
Address
DES I GN TEAr~
(phone no:)
Pri ma ry
Structural
: Electrical
. r~echanical
CONTRACTORS (name)
'~.JV ?h?f,("'~/~ C-~
, ~~. -~~ .#'
.~~ r-z~/rl~/':/ ~
Electrical '-';>E ~c:.~_7',
(address)
(1 i cs. no.)
(exoires)
. (ohone no.)
General
~ Plumbinq
\ ~1echanical
PLUf1BING'
ELECTRICAL
MECHANICAL
NO.
FEE ,CHARGE NO_
FFF rHARGF NO.
FFF r,HAPGr: t
SQ, FT.
furnace/burner to
BTlI's
,<
Each single' fixture
~o .'
l~ (&t!IC.
., ..
I
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
~6j;
Floor fu rnace
and vent
IS.F. Residence'
(1 bath) "
IDuPlex (1 bath) each
I Addi.tional bath
IHater se,rvice
I Sewer
I Storm Sewer'
SERVICES
Recessed wall 'I
Soace heater and vent ;
I
I
I
I
I
I
I
I
I
I
I
~~ e>(> 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
I
ITempOrary Constructibn I
IChange in existing I
residence .
Imultifamily, comm. or I
Industrial
10f
ICOMM./IND. FEEDERS
Ilnstall/alter/relocate
distrib. feeders
10f amp~1
I I
amps.1
I
I
Appliance vent
separate
Stationarv evao.
cooler. ,
Vent fan with
sinale duct
I Vent sys tern apa rt from..,
heatina or A.C.
I Mechanical exhaust
hood and duct
I 'Wood stove/heater
I
I
I
I
'I
I
.1
I
I
I
ISSUANCE OF PF.R11IT
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
/0. <<:::1 TOTAL CHARGES
I HAVE CAREFULLY EXAMINED the completed application for per.mit, 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 OCCUPAr~CY will be made
of any structure without the permission of the Building Division, I further certify that my registration ~Iith the Builder's I
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 ORS 701.0:5 ~ used on this project.
rW1E(please print)L",:V''1 6:. lV\ uU 0. vl<e,-!_SIGN~~a/l/i0~du.;!'/4~~/ D/m ~..y-r<?'
t Far. OFFICE-U'SEAlr~LY J V /' (
Zone Type/Const. Units Sa. Ftg. f1ain x Value
Fire Zone Bedroo~s Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PER~lIT
Charges and
Surcharges
, /0 t:>r?>
--- -_...:._----
..,/0
_ _ __L ~ '-~ _ Fence
,.. i~
jO"GO ISidew'alk
---- --~~'-O-I A/C Paving
I Curb Cut
I
Plan Ck.
65%/Blda
Plan Ck.
30%/Bldq
Comm/Ind
Per Fee
Res
Per Fee
/v, A- .
Systems, Development I
Charge tl.5%) ,
/;/./1. '
PL1Ir1BING PERMIT
Charges and
Surcharges
D6mo
ELECTRICAL PERMIT '
Charges and
Su.r:charges
ITotal Comb. rermit
I TOTAL
;:) /. =<~
MECHANICAL PERMIT
Cha rges and
Surcharges
,.....
COMBINATION APPLICATION/PERMIT' (CAP)
I. Applicant to furnish
A, Job Address
B.' Legal Description '. ". ',:, .~\;
1. example- Tax Lot 100, Lane County Map Reference
17 03 43 ~._'.' .
2. example- Lot 1, Block 3, 2nd Addition to'
~. ?p(ingfield Estates ..'
C. . Name; efc. of'owner and construction render' _
D. . Energy Sources' , , .
'l.~. . e'xamp 1 e- . hea t/ e"l ectFi ca r"ceil fnq;or' forced air qas
2.' example- waterheater/e1.ectrical/'or'/s.olar
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. Bui.lding permit information:'
1. example,- construct single family house with an
attached garage
2. example '- 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must. be able to ~ontact approp~iate
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 insta'lled are not covered on
the abbreviated schedules you should consult the
full schedul 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.
Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only, Where possible, Building Division Staff
wi 11 prepare a type written' copy and return it to the
applicant at the time the actual permit is issued for his
signature.
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.
"
.,~.,'f(~-
IlL
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SArlSFIED BEFORE OCCUPANCY:
-~
PERMIT VALIDATION
/ ~
" -
..
,
, .
t.
.._...:..\ .I .,i'
/ .' .. - ,
" , "
)
I'
; ,...\ I.. .;.... ".,'.....
. . ')
, J ~ ~~.
Permit Clerk
_\'-. r
JL
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
... .',., --
,
~:
PLANS REVIEWED BY:
name
signature
.\
'-...
.~>. ~
, \
. "
J ',.'
date
ff ~Q
.