HomeMy WebLinkAboutPermit Building 1985-6-26
I IIISPECTION LINE
726-3769
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CITY Of Srl'\!11uniLD
COMBIIIATION APPLICATION/PERMIT
INFORHATION lI"t
726-3753
Sq. Ftq. 1.lain
:q. Ftg. Access.
SQ. Ftg. Other
Ilew Add A lter ~ep.
--Fence Demo Change/Use
-Other - -
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(/ II
Job Address 2(7.5 5< If.AX
Legal DescriPtion\"'1D~ ~-5~? n-',n)
E!IERGY SOURCES:
Heat
Nater Heater
--..
Construction lender
\--
Address
UeSIGN TEAr.'
(name)
Phone
(address)
(exo;res)
(ohane
I
no. l
Primary
Structura 1
Electrical
r~echanical
CONTRACTORS Iname)
General!tJ2J::3- AI}~~/'!f....d/(;
(address)
(1 ic:s. no.)
(p)(n;res)
~h~
(ohonp M.)
Plumbina
-:zgo74'C--/(t')J{/ /{~
!::::t/ tf-,&f;1// e 7 r!)1t &. -
"...."_A_-t
i, r..........
$I'lt?,?
"7AA6?,<['L
Electrical
~'echanical
PLUllBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGF NO
EFE rHAR{;F tln_
F'F'F rI-lAI:U~F
Each single fixture
Res i dence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.f. Residence
(1 b,th 1
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~~P hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
App 1 i ance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood rind duct
Wood stove/heater
Additional bath
~Ia ter servi ce
Temporary Construction
Change in existing
rp<;ic:len('p
multifamily. comm. or
Tnclus.triill
Sewer
...,
/tAMVL
V L//6
1
COMM,/IND. FEEDERS
Install/alter/relocate
ni<:trih. fpprlpr<:
-;Jr/-. 00
.9'&;'
Of
amps.
ISSUANC, OF PFR'lIT
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valij until the
,:;:y-;. '! h I TOTAL CHARGES
that tile Eiectrical work be done by an.
label has been signed by an Electrical
I TOTAL CHARGES
Electrical Contractor. the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArllNEO the completed apfllication for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore1]on pertaining to the work described herein. and that UO OCCUPAfKY 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 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.
lIAr-IE (p I ease print)~;' /f-'~ /(C?~ SIG~~
FO~ OFFICe-USE DIlLY
Zone Type/Canst. Units Sq. Ftg. riain
Fi re Zone Bedrooms Occy load Sq. FttJ. Access
Flood Plain Stories Occy Group Sq, Ftg. Other
~
DATE
eh/8' '7
x
x
x
Value
Value
Value
TOTAL VALUATION
BUILDING PER/lIT
Charges anC:
Surcharges
Plan Ck. Comm/lnd
65%/Bldo Per Fpp
Plan Ck. Res
30%lBldo Per Fee
Fence
ISystems Development I
CharQe (1.5~)
PLU'~BING PERMIT
Charges and
Surcharges
Demo
I Side';,].
------------
AlC Paving
Total Comb. Permit
ELECTRICAL PERIHI
Charges and
Surcharges
,t?l.-- 're-s+-
I f'"f"
0< L../, .0,,0
'1~
TOTAL
j c2tt9~1
IIECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
.
.
I~
~
..
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exa~le- Tax Lot 100. Lane County Map Reference
II U3 43
2. examele- Lot 1. Block 3, 2nd Addition to
~pr'ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources ,"
1. examole- heat/electrical ceilinq/or forced air Qas
2. exa~\e- waterl1eater/electnca(/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 gar~ge
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.
.{qq b
{6 \0 ~5
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V. FOR OFFICE USE ONLY
Permit Clerk
(PI
..
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
signature
date