HomeMy WebLinkAboutPermit Building 1988-12-15
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CITY OF SPRINGFIE,D . INFDRHATION UN"
COMBIIIATlON APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. 1.lain
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
New Add XA Her Rep.
Ran~e --Fence Demo Change/Use
V 1 f'l# -Other- -
au(o ''/P:1S;JzJO.
Buil,;inq pknnit Info: Describe \'Jork{Le., Build Single
Famil~sidence With Attached Garaae)
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I INSPECTION LINE
'726-3769 '.
Job Address
;)50
Legal
Address
Description 17-'p3-.-"",--T2 ,"'2.;:>~
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Owner
Construction Lender
Address
DESIGN fEAH
(name)
Phone
(address)
(lies.no.l
(exoires)
(Dhone no.
Primary
Structural
..;
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l..I~oD
Electrical
Mechanical
CONTRACTORS
Plumblno
~ address)
(~AJ~&/V,
rf1;Lt~
(name)
KIt..1+
(l iC5. no.l
(exoires)
(ohonl'> nn.'
Genera 1
~>?,"""'2L. ~
Electrical
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~1echani ca 1
PLUrIBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGF NO
FFF rH~Rr,F Nn_
~FF rHARhF
SQ. FT.
furnace/burner to
BTll's
Each single fixture
Residence of
Relocated building
(new fix. additional)
~ New circuits alts.
." or extensions
"2 ~p JY'J~
SERVICES
~~
Floor furnace
and vent
S.F. Residence
11 bath)
IDuplex (1 bath) each
IAdditional bath
I~!ater service
I Sewer
Recessed wall
Sn~rp hp~tpr ~nd vpnt
Temporary Construction
Change in existing
re<; i dJ'nce
multifamily. comm. or
Jnd\l<;tri~ 1
". .#1...7't<9< Z:;J~~ tf
Appl i-ance vent
<;eo!lrate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd ~nd dud.
/5"..-
Storm Sewer
Of amps.
ICOf~r'L/lND. FEEDERS
Install/alter/relocate
di<;trih_ fppdflrc;
Wood stove/heater
Df
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\I~ REQUIRES that tile Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
I ISSUANCF OF PFR'IIT
::<'Z-S"'" I TOTAL CHARGES ~-V' /~ __0
Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAt1INED the completed application for Dermit. 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 Orel]on pertaining to the work described herein. and that NO OCCUPArKY 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with Or.S 7n1.055 will be used on this project.
Kt4-s;.1' SIr,rl^TURE~~ ~
FO~ OFFICE USE DIlLY
Tyoe/Const. <J;"~/#Z? ,Units So. Ftg.
Bedrooms Occy load Sq. Ft!:).
Stories -;z Occy Group ;;t?-;;2... Sq. Ftg.
DALE
-----
QATE
)2/;s~
IIAf.IE(please print)
)--
I Plan Ck.
65%/Bldo
Plan Ck.
30%lBl dQ
ffi 1'2--((~-H
COI1lJl/ I n:P-' l_~ . ,
Per Fee bJ3:l.70 IZ'1I<l
Res -
Per Fee
11ain x Value
Access x Value
Other&r>s"YOA'~~lue
TOTAL VALUATION
7:5: -=-&: ......,
,
Zone /: L
Fi re Zone
Flood Plain
BUILDING PERflIT
Charges an':
Surcharges
I
___~_:i:8i~
/7.90
ISystems Development I
Charge (1.5X)
PLUr~BING PERMIT
Charges and
Surcharges
Fence
Dama
ELECTRIUL PERr~IT .
Charges and \ j
Surcha rges ....,
~:::?_So Sidewalk
11ECHANICAL PERMIT
Charges and
Surcharges ~
/. /:3 A/C Paving
____f~'-~_ Curb Cut
-75"
Total Comb. Permit
TOTAL
~ /5: ZB
1
.
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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
17 03 43
2. exampJe- Lot 1. Block 3. 2nd Addition to
5prlngtield Estates
C. Name. etc. of owner and construction lender
D. . Energy Sources
1. example- heat/electrical ceiling/or forced air qas
"2. examole- waterheaterjelectrlcal/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 permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyle - 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 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.
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
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 OFFICE USE ONLY
Permit Clerk
C0
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name L~;r<>/Y'E /2:cc;. ~~
Signature4~#?.J?' date /;?-/9-&R,