HomeMy WebLinkAboutPermit Building 1984-6-8
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INFORtlATION liNt
726-3753
Sq. Ftq. Hain
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Sq '. Ftg, Other
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1 I"SPECTIO" LIflE CITY OF SPRINGFIELD
. 7~6-3769 ~. . ,,' COMBINATION APPLICATION/PERMIT
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Job Address Q' ~ 'Q"<3,.:' 7")D}IlA""~tQO 0, Heat t:..\..\-t\-\. ILJC,
, " ,. ~ ( 'Wat~r Heater \
Legal Description:
Address
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, I, --- ~_/ /..... / -: V~ UE of Hork \ S(j",,-:--
U.s..{a,u L-f.lA:T' /- /' 500, "_) .L.) .
. 'rr,t,. ' Buildina PermU.,Info: , Describe Work( i.e., Bui ld Single"
Phone 1'TfD-::Zf17 vFamHy-nesTdence Hi th' ,Ilttached Gara(1~)
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Owner
Construction Lender ~~
Address
DES I GN TEAr~
(name)
",\Q4MJt~l ~.Q.rIJ'CQ
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Phone
(address)
t "" c... qq,
{ "2. S"7
(lies. no.)
( Vl:,k" ~ \2 c:L
~~~.. a,e
(exnires)
(phone no .')
Primary
N&..sL-
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(p~7.' 0"113
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, Structural
Electrical
Mechanical
, CONTRACTORS
Genera l'
(name) ,
S6L~
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".V~
(address)
'Q.. (~.s,o'-I
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(1 ics. no.)
(expires)
(ohone no. )
Plumbino'
: El ectri ca 1
~'ech~nical
, ,
PtUf1B'ING; :
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ELECTRICAL
MECHANICAL.
" ,;."
NO.
FEE CHARGE NO.
FFF rHARGF NO.
FFF rHARGF
Each s ingl e f,i xtur.e
Residence of
SQ. FT.
,furnace/burner to
BTlI's
Relocat~dbuilding,
(new fix,. additional)
S.F. Residence
'11 bath)
Duplex (lbath) each
New circuits alts. '
or extensions
Fl oOr furnace
'and. vent
ISERVICES
I
'Recessed wall
,Soace heatpr and vpnt
,
I
,
I
I
I
Appliance vent
seoarate
Stationary evap.
cooler
I Vent fan ,w.ith
sinole duct "
I Vent ,system apart from I
heatinQ or A.C.
Mechanical exhaust I
hood and duct
Wood stove/heater , I
I
I
I
,
I
Additional ,bath
Temporary Construction'
Change in existing.
residence
'Imultifamily,comm. or I'
Industrial
10f amps.1
'COMM./IND. FEEDERS I
11nstall/alter/relocate I
distrih, feeders .
, 10f amps.!
I I
I I
II , ,
TOTAL CHARGES \.J :~. TOTAL CHARGES \\ .~ TOTAL CHARGES \.\~,
, WHERE STATE L'\~ REQUIRES that the Electrical ,work be done by an. Electr~cal cont~~e electr~ca~ por~i~n ,of this permit
shall not ,be valid until the label has been signed'by an Electrical Supervlsor and ;I-__rned~o the BUlldlng Dlvlslon '
I HAVE CAREFULLY EXAI1INED the completed application for permit, and do hereby certify hat all information hereon is true
and correct, and I further certify that any and all work performed shall be done in ace dance with the Ordinances of the City
of Springfield,and the Laws of the State of Oregon pertaining to the work descr' ed he ein, and that NO OCCUPAr~CY will be made
of, any structure without the permission of the Building Division. .I further ce tify hat my registratio~D/"iith the Builder's
Board is in full force and effect as required, by ORS 701.055, that if exempt t e b is for exemption' noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will e sed ~n this proj
NAf.lE(please print)' GR~,f.o-/
I .
~Ja ter, servi ce
Sewer
Storm Sewer
I SSUANCF OF PF.Rr1IT
SIGNATURE
FOf"OFFICE USE or~L Y
~ATE tv!V IlL
Zone r_C- TYDe/Cons t.\ ) - \ C:;fi:'.\ I,Uni ts Sa. Ftg. t1ain
Fire Zone . Bedrooms \
Occy Load Sq. Ftg: Access
Flood Plain \J") Stori es ? Occy Group ~ <2.. \ . Sq. Ftg. Other ~~m
Value
x Va 1 ue
x"?C> Value \~q() -
TOTAL VALUATION ,. ~Q. 0 -
BUILDING PER~1IT
Charges 'and ,
Surcharges
_~LG~.~~____
. c.:..'~'
Plan Ck. Comm/Ind
65%/Rlrlo ppr ~pe
Plan' Ck: Res ---
30%/Bldq Per Fee
" l (), \,.l 0
Sys terns Deve 1 opmen t I
Charqe (1.5%) ,
~~.8~
PLW~BING PERMIT
Charges and
Surcharges
Fence
------------
I D~mo
I 'Si dewal k
I A/C paving.
J Curb Cut
------------L
ITotal Comb. Permit
I
I TOTAL 50. 89
-~ ,
ELECTRICAL PER~IT'
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLI CATION/PERMI! (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". LotI. Block 3, 2nd Addition ,to',
Springfield Estat~s "
C. Name, etc. of owner and 'construction lender
D. 'Energy Sources,
1. example-heat/electrical ceilinq/or forced air qas
2." examPTe~ waterheater/electricaljor solar,
~. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, checknew-if addition,
check add, etc. ' , "
F. Building permit information: '
1. example';' constru'ct single family house with an
attached garage' '
'2., '~xample - remodel eiisting garage into'family r60m
, 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, Buil~ing
Division Staff must be able to contact appropriate
,~ 'persons, regarding design information or job site
, .torrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
" porti on of' the Mechan i ca 1 and El ectri ca 1 Schedu 1 es ,
th~ applicant need fill-in only th~ No.' Boxes adjacent
to the approPrtate item(s) to, be installed,
B. ,Full Plumbing, Mechanical, and Electrical Schedules
are available at the Buildi~g Division
1. To ,conserve space on the permit form the 'schedules
have been abbreviated ,', .
2. If theitem(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
supervi sor. The genera 1 contractor ,i s ,not authori zed
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
~_applicatio,n, ,and no plans will beprocessed,until these_
fees are paid. All other fees and charges are due and
payable when the permit is issued.
PERMIT VALIDATION'
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'V. FOR OFFICE USE ONLY ,
Permit Clerk
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PROJECT CONDITIONS TO BE' SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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