HomeMy WebLinkAboutPermit Building 1989-8-2
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- INSPECTION LINE
;}26-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
t~a ter Hea ter
Range
ValuE of Hark.:
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BuiltiinQ Pernlit Info: Describe Work(i.e.. Build Single
Family nesidence With Attached GaraQel
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IHFORllATlON L1Nl
726-3753
SQ. FtQ. I~ain
~q: Ftg. Access.
SQ. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
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1"-.
.: Job Address
/19'0
legal De5cription
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Ow~er /fiLk( L?7#/E"' .
Address 19~/. n~?,A2- Z)2?
,
yPL-D. .//'K
Construction Lender /
I
,
? '1:::>-:7"-<Y.3
Phone
Address
DI:.~ H:iN lI:.Ar~
lname)
Phone
(address)
(lies. no.~
{exoires1
(ohone no.
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS {name~ (address' (lies. no. 1 (~~nirps1 (ohonp no.'
General #/??E ~?5"V/C/2C/P~'1 U:~MCC~I'!'N"f ~2:,,)~::?-9~. Y'A"'-::?Y~
Plumbina
Electrical
~1echanical
PlUI1BING
ELECTRICAL
MECHANICAL
NO.
FEE r.HARGF: ~n_
FFF r.H~Rr,F Nn_
FH rHQ.RGF
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole !flirt
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct.
~Ia ter servi ce
Temporary Construction
Change in existing
resiqr,nce
multifamily, comm. or
Inc1uc;triill
Additional bath
Sewer
COW1./IND. FEEDERS
Install/alter/relocate
distrib. fpeders
Wood stove/heater
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
I SSUANCF OF PFRIIIT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed application for permit. and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all work perfonned 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 rm OCCUPA[{CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by O~S 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be lJsed on 'this project.
NAHE(please print) \\rH\C~ ~(''''V1cl<Q.vy~\s SIGN^TURE ~ CllMU, ~VlCM'lce,..,
FOr. OFFICE USE OULY I
Sq. Ftg. t1ain
Sq. FtO. Access
SQ. Ftg. Other
DATE Bh;/r~q
Stories
Units
Occy Load
Occy Group
x
Value
Value
Zone
Tvpe/Const.
Bed rooms
x
Fi re Zone
Flood Plain
x
Value
TOT^l VALUATlml
BUILDING PERfllT
Charges and
Surcharges
I --::? e:2? c::-'..-" I Plan Ck. COllll1!1nd
~_,:.)~~......d~_ ~/Blc1o P.l'!r Fpp
Plan Ck. Res
/. 9::::3 30%/BldQ Per Fee
Fence
syste.ms Development
CharQe O.5~ .,
PlU'~BING PERMIT
Charges and
Surcharges
I D~mo
.Sidewa 1 k
ELECTRICAL PERlHT
Charges and
Surcharges
flECHANICAl PERMIT
Charges and
Surcharges
I
AIC Paving
Total Comb. Permit
Curb Cut
TOTAL
7"~ y 3
.
.
.
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
II OJ 43
2. examEle- lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or va1uation, etc. ------
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new - if addition,
cneck add. ete.
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~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
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 SCHEOULES
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 penmit 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
I payable 'when the permit is issued. '
V. FOR OFFICE OSE ONLY
Permit Clerk
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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name
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