HomeMy WebLinkAboutPermit Building 1984-10-8
'INSPECTION LINE CITY OF SPRINGFIELD INFORf1ATION UNt
726-3769 COMBINATION APPLICATION/PERMIT 726-3753
Job Address Q., ~ ~~-r ~QIllK'~~(.) Or- ~~~~GY ~a:,~ ~~: ~i~: ~~~~ss.
Lega 1 \( (() . ~, ,.::t\ ~'() 0\ DO Ha ter Hea ter \ Sq. Ftg. Other
Description _ " ~ _ (J\ , Ne\~ Add Alter, Rep.
~ Rilnge..- _ -Fence Demo Change/Use
Owner,' Mll\~/\ 0s~u~~ --1iu~~Ork\~ Other- -
~ ('" ' ~ Buildina Permit-JflfO: Descr,be Work(i.e., Build Single
Address rz\ s- ~ S~ ~..1'nV. Phone~ >- rllr.1ily fl.esldenCe ~-lith jI,ttached Garaae)
-" AJ..L ~\...~ -\0 0.\-kuv4\4--
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Constructi on Lender N6\.c9-,
Address
DES I GN TEAr~
(name)
\U-tt.w'''''l ~.Q .rtJruz.
rgr-~ <.lL~ AJS 0<..
Phone
(address)
(We... o,q
t2S7
(lics. no.)
( vl:,&f L ~ \2 ci..
-~'-'- .. a,"
(expires)
(ohone no.)
Primary
N6\uz-
~<.t~G
(P~7' o'l13
~<(~'~CA~
Structural
Electrical
, f1echanical
CONTRACTORS
Plumbina
(name)
S6L~
^-l~
I\J~
V~
_ (address)
p (\4.",<.5,0\ I
I
(1 ics. no.)
(exoires)
(ohone no.)
Genera 1
, Electrical
~1echanical
PLUf,1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARG~ NO
'" rHARr" NO.
'" rHARr"
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
ITempOrary Construction
Change in existing
residence
, multifamily, comm. or
Industrial
10f amps~
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
10f amp~1
I I
I I
I I I
TOTAL CHARGES \J .~ . TOTAL CHARGES \ \ .~ TOTAL CHARGES \0. ~
WHERE STATE L'l.H REQUIRES that the Electrical work be done by an':Electrical' Cont~~eelectrii:al po'rtionqof 'this permit
shall not be vali1 until the 'label has been signed by an Electrical Supervisor and;l-__rned~o the Building Division
I HAVE CAREFULLY EXNllNED the completed app.lication for permit, and do hereby certify hat all information hereon is true
and correct, and I further certify that any and all work oerformed'shall be done in' acc 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 OCCVPANCY will be made
of any structure without the permission of the Building Division. I further ce tify hat my registratiorvwith 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 on this proj
l<AllE!p,,,,, p,;ot) . G -EJ,USP!
I
-\~its
Occy Load
Occy Group ~ l2.. \
IS.F. Residence
(l bath)
IDuPlex (1 bath)
IAdditional bath
~Ia ter servi ce
each
ISERVICES
I
Recessed wa 11
Soace hentpr nnd vpot
Sewer
I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan with
sinale duct
" Vent system apart from I
heating or A.C.
I Mechanical exhaust
hood and duct
I ~Jood stove/heater
I
I
I
I
I
I
I
I
I
I
I
'I
Storm Sewer
I SSUANCE OF PFRI1IT
\ Fire Zone -
\ Flood Plain lY)
~ \, BUILDING PER~llT
\ Charges and
Surcha rges
'PLW1BING PERt.llT
~arges and
{rcharges
\
iCTRICJ!.L PERfm
\
\ges and
harges
\
\~jICAL PERMIT
\S and , '
, \ges
~
Type/Const.U
Bedrooms
Stories 1
SIGNATURE
FOR OFFICE USE ONLY
Sq. Ftg. /1ain
Sq. Ftg. Access
Sq. Ftg. Other~ \D
(,
DATE /iJ /9 I~(
Zone r.G
/--
~ ~
Value
x Value
x"30 Value \5QO-
TOTAL VALUATION \ ~QO -
\ r 00 Plan Ck.
~. 65%/Blda
----~c:~---- ~6~~B~~~
I F,ence
I D~Rlo
ISidewal k
I'A/C Pavi ng
I Curb Cut
------~-----,I
Comm!Ind
P~r Fee
Res
Per Fee
lO.~lO
I Sys terns Development I
Charge (1~5%) ",
I
I
I
I'
!Total
I
I TOTAL
'2. 3 .8~
Comb. Permit
J.?P:. ~:
........1011,11
,~
COMBINATION APPLICATION/PERMIT (CAP)
PERMI'T VALIDATION
IV.
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
, ,Springfield Estates:, ;':.'
C. 'Name, etc. of owner and construction lender
O. Energy Sources
1. example- 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, checknew - if addition,
check add, etc. '
. F. ,Building 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 (chan~e 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 contact appropriate
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanicali & 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 instal.led '
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. -,
Applicant to sign and date
Whenever possible, the initial application will b~ 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.
Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until the~e
fees are paid. All other fees and charges are due and
payable when the permit is issued.
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III.
V. FOR OFFICE USE ONLY
Permit Clerk
.R
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
Permit applicant exempt from registration with the Builder's Board ,because:
Additional Project Information:
PLANS REVIEWED BY:
Signat~~_"--_ d~;e'S~'2~-""~
nam~\)\D~ [5 U\
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