HomeMy WebLinkAboutPermit Building 1988-1-11
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
Range
ValuE of Hork:
-;;> ::;;. 0""::>, _b "'
BUilti;na Permit Info: Describe Work(i~e.t Build Single
Familv nesidence With Attached Garaoe)
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rl ics. no.l
I INSPECTION LINE
726-3769
.
Job Address
/08'1
,!?,J7A L
~,4 7-'
Legal Description 17"<1'3-~'?-<C>.<::J:::>t:.<:Js;
Owner hrA-rE &Rh? /Y7UTt-'AU
/Ms.
Address
Phone
Construction Lender
.
INFORlIATION llNl .1
726-3753
Sq. Ftg. 1.lain '
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
-Fence Demo Change/Use
Other- -
.
txl
\l~
l)
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Address Phone
DESIGN TEAI~ (name) I.ddr.,d
Primary 57Rr.E &A\'v.> /j~ /~:'/+.N" ~4~r
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address'
General
Plumbino rwr" ;::J,v~~ A8c?;... -::?e:;:T:J&> !y.
Electrical '/f./.?< l~J/R/L... -- - ~~~c;r
~'echani~al /)pR71IN #';Iz:;,
PLUIIB I NG
~I
I FH I r~ARr,1= NO
Each single fixture
Residence of
Relocated building
(new fix. additional)
(~~,o; res'
(ohone no.
(lies no.'
(p'trtiI"PC:;'
{I"lnnnp "n ,
lJ/_/~~.,.
,
r,:;~':f-/'//f,/
ELECTRICAL
MECHANICAL
SQ. FT.
:f.LIJ:I!AIlG.E _UQ....:
~ace/burner to
2 .'r_D~
Floor fu rnace
and vent
'l:'C'C' I t"L1AB!i.E.
6.- 1<'.....
New circuits alts.
Y" or extensions
'2 b~ ;>h&>n~
SERVICES
"2"2$
S.F. Residence
f1 bath \
Duplex (l bath)
each
Additional bath
Recessed wa 11
So~rp hp~tp~ ~nrl upnt
/
4q~ P~r.
Appliance vent
~~oarrJtp
, Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood ;tnd rlu('_t
6--
~Ia ter servi ce
Temporary Construction
Change in existing
rpsj~p"n('p
multifamily. comm. or
Tnrluo;.trial
I
I
I
I ~iood stove/heater I
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I ISSUANC, OF PFR!lIT /y..4'
~.,.., TOTAL CHARGES /& -.::>
WHERE STATE L,\\~ REQUIRES that the Electrical work be done by an" Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Sewer
Storm Sewer
I
~<'P
CO~~./IND. FEEDERS
Of
amps.
~/o;x::.
Of
Install/alter/relocate
rii",h"ih fpprip~c:;
amps.
TOTAL CHARGES
TOTAL CHARGES
I HAVE CAREFULLY EXAMINED 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 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 HO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
IWIE(please printl..D, <:ok.. 6~....(. e--:
SIGI1ATURE A:2:;t_~. L...-
DATE I - 1/ - , r
Zone ~ L
Fire Zone
Flood Plain
S--#.
Units
Occy Load
Occy Group
FOR OFFICE USE DillY
Sq. Ftg. t1ain ,x Value
Sq. Ftg. Access x Value
R- 2.. Sq. Ftg. Other~~.o~ ~_Value
TOTAL VALUATION
Type/Const.
Bedrooms
Stories
t
BUILOING PERHIT
Charges and
Surcharges /lIt,y.
PLUf1BING PERMIT
Charges and
Surcha rges
/.0...... Plan Ck.
_____ __.____ 65l/Rldo
Plan Ck.
.. ~t::> 30l/Bldo
Co"",lInd
Ppr Fpp
Res
Per Fee
Fence
ELECTRICAL PERIHT
Charges and
Surcharges
D~mo
'/0,,0 "Sidewalk
____-"2.I_..!..____
5 . ...-0 A/C Paving
_ _ __ ./....$.... ~ _ Curb Cut
r~
MECHANICAL PERMIT
Charges and
Surcharges
2S-_~.-
~
Systems Development
let/'l'" CharQe tl. 5~ 1
$f$~T.)~ ~~
... c E4/?/ ~~75.
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Nn4.
ITotal Comb. Permit
92.'ro
~
i ///.70
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
1/ oj 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates. , . .
C. Name, etc. of owner and construction lender .
D. Energy', Sources ~ . . .
1. exam~le. heat/electrical ceilinqjor forced air Qas
2. examyle- waterheaterteiectrical/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 pernit information:
1. example - construct single family house with an
attached garoge
2. exam~le - remodel existing garage into family room
3. exam~le - 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
.10 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 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
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.
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V. FOR DFFICE USE ONLY
Permit Cl erk
C0
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWEO BY:
.?LGi:f~ Signature~~~'
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date /-/S-Sg,
name Lb?J //e