HomeMy WebLinkAboutPermit Building 1990-6-5
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CITY Uf SPRINGfiELD
CDMBlIIATlON APPLICATION/PERMIT
--
EilERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE. of Hork:
b !-j ) <i1(JO
BuildinQ Pennit Info: Oeser be \~ork(Le"
Famjlv ~esidence With Attached Garaae'
'<We_vr)(')\2 B\dJ
.
INFORf1ATION liNt
726-3) 53
Sq. Ftg. r.lain-
~q. Ftg. AcceS5.
Sq, Ftg. Other
New Add Alter ~ep.
-Fence Demo Change/Use
-Other - -
jINSPECTION LINE
726-3769 ..
.
Address
~ AYL ~H(JI"""
, } ')( (' ../(7 -e<.. .J-
So C \('Ji n P..
Phone
Build Single
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Job Address L.j I J /\}, A S,-t
Legal Description 1/0").,'.:<, c;.:l., I - n CSl./(')r)
Owner
.
Construction Lender
Address
UCS lliN n:.M1
{name)
Phone
{address 1
(lies. no.)
(exoires)
I
(ohane no.l
Electrical
LA IIV'.r~1A A . 4< rvJ-; he>
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t=! S 10{~S- lOJ&lqn
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Primary
Structural
f1echanical
CONTRACTORS Inamel
Uvv--c,qlA'" (Otl(,i..'~~
r.O .. 0
(address'
(lies. no. \
(pxn;rec;\
(ohonp nn. ,
General
Plumbina
C/)....\ ,S~DO
Electrical
~lechanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
HE '[HAR!;F Nt"
FFF rH~Rr.F NO.
. FCF rHARr.F
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building .
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~~p heater nnd vent
Storm Sewer
Of
amps.
Appl iance- vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hond and dll~t
Wood stove/heater
~Iater servi ce
Temporary Construction
Change in existing
re$ i cl~.nce
multifamily, carom. or
Industriill
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
distrih. fppdprc;
tp
Of
amps.
TOTAL CHARGES
WHERE STATE I.'W REQUIRES
shall not be valiJ until the
ISSUANCE OF PFRt11T
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnl;cation for.permit. and do hereby certify th3t all information hereon is true
and correct, and I further certify that any and all work Derformed 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 IJO OCCUPAHCY will be made
of any structure without the permission of the Builrling Division. I further certify that my registration with the Builder's
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 a~e in compliance with OP.S 701.055,wi be used on this oject.
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories'
Units
Occy load
Occy Group
SIr,' ,/ I
FOP. OFFlC~ USE OJIIV
Sq. Ftg. Hain
Sq. FtlJ. Access
Sq. Ftg. Other
DmUd9D
IJAJ.tE(please print)&r)A.IA-e.D~JenP-fJ
x
x
x
Vafue
Value.
Value
TOTAL VALUATION
PLU'1BING PERMIT
Charges and
Surcha rges
I. t P1an Ck. Comm/lnd
__51l,-SD___ 65%1"1~n ppr Fpp
Plan Ck. R'es
'd. .S ~ 3D%/Bldq Per Fee
Fence
ISystems Development
Charqe (1.5%)
BUILDING PERMIT
Charges an~
Surcharges ~
Demo
EI.ECTRICA.L PERI11T
Cha rges and
Surcharges
Sidewalk
A/C Paving
Total Comb. Permit
tlECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
.1bS3,03
1
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example~ Tax Lot 100, Lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3. 2nd Addition to
Springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation. etc. -----
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
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, 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 {tem(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
O. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.BQ1 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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Permit Cl erk
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Permit applicant,exempt, from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
."
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