HomeMy WebLinkAboutPermit Building 1987-9-23
I INSPECTION LINE
726-3769
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INFORlIATION LINt
726-3753
Sq. Ftq. r.lain
:q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other - -
Job Address
'i?21c
AJ,
CITY Uf SPRINGfIELD
COMBIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
t.Jater Heater
o "L-7eo
Address
c:t<.ev-, _
o
\/1 /
Description /'7n ~ -?_ eI::J
,; /.-'
Kfl I~-c~n-h )
()
Ranqe
Legal
Phone
ValuE: of Hark:
1000
BuildinQ Permit Info: Describe Work{i~e.. Build
Fami}?~t?~ara/kd )
,-' '! /
Single
~
~
i~
~
--+:...
J
Owner
Construction lender
'h'
I'
I;J /J-
Address
UI:.SHiN 11:.A1'
(name)
Phone
(address)
(l ics. no.)
(exn; res)
{ohane
Primary
Structural
r ,,0
\O~
11~5
Electrical
Mechanical
CONTRACTORS
Genera 1
An_I
tju-
/CiU,n ~
(address'
(lies. no.'
(pxnirpc;)
(ohane no.)
Pl umb; nC)
v
fl'-1-1G.
\ I '
Electrical
IV
~lechanical
ft._IllS
ELECTRICAL
MECHANICAL
NO.
FH I rHAllr.F .1JO
~~~...G.I:i8.RG..E Nn
~~I=' r~ARG.E.
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Re located bunding
(new fix~ add]timmal)
S.F. P..es;der.lce
f1 MtM
Duplex (I batb) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
Stann S~r
Of
amps.
Appliance vent
<;floa ra tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hoor! ilnd dUr't
Additional bath
~Iater se"iice
Temporary Construction
Change in existing
rpc;;dJIJlr'P'
multifamily, comm. or
Tnouc;triill
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
ni"trih. fppdprc;
Wood stove/heater
Of
amps.
\t7\
TOTAL CHARGES
WHERE STATE L.~ REQUIRES
shall not be valiJ antil the
TOTAL CHARGES
that tile Electrical work be done by an. "Electrical
label has been signed by an Electrical Supervisor
ISSUANC, OF PFRIIIT
TOTAL CHARGES
Contractor. the electrical portion of this permit
and returned to the Building Division
I HAVE CAREfUllY [XAt1INED the completed ap["llication 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 fW OCCUPArKY will be made
of any st~cture 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subc()lltriICto... =d,::IOyeeS Iw~(~~e, in, comDliance with ORS 701.055 W11 b~:.z this :ect.
NAIIE(please print) '-''-- N '''~ ~ / DATECJ'2J~')
Zone
Fi re Zone
Flood Plain
Tyoe/Cons t.
Bedrooms
Stories
Units
Occy load
Occy Group
t1ain
S . Access
Sq. Ftg. Other
x
x
x
Value
Val ue
Value
TOTAL VALUATION
BUILDING PERNIT
Charges an:::: ~.
Surcharges #
(1 '-0 Plan n.
'C/ 65%/Blda
------------ Plan Ck.
f-g 30%/Bl do
Conm/Ind
Ppr Fpp
Res
Per Fee
Systems Development
Charoe (1.5~)
PLU!1BING PERMIT
Charges and
Surcha rges
Fence
DfJmo
ELECTRICAL PERI:IT
Cha rges and
Surcha rges
'Sidewalk
AIC Paving
Total Comb. rermit
TOTAL
I /?; 3 r
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
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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
II oj 4j
2. example- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ce;'in~/or forced air qas
2. examyle- waterheater/electrlcal/or ~
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. examele - construct single family house with an
attached gar~ge
2. example - 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 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.
!a ;)5 f
q-2'f-r1
V. FOR OFFICE USE ONLY
Permit Clerk
CC--
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
,
-{,' .Permit applicant exempt from regist,ration with the Builder!'s Board because:
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Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
date
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