HomeMy WebLinkAboutPermit Building 1989-10-6
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I INSPECTION LINE . CITY U~ SPKINGFIECD -.
726-3769 COMBHIAT~ON APPLICATION/PERMIT ,
Job Address r!J~ 6~,f\ A ~r~". ~~;~GY SOURCES:
Cegal Dmription \c")O'2)-2>~~?~O~('Y l~aterHeater
Range
INFORliATION LINE
726-3753
Sq, Ftg, liain
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter\lRep,
--Fence Demo Chlnge/Use
Owner ,~~-'l~' ~+\\\tu ~d \ <)l'tl ~/nm.dJ I Other- -
Address~ ""':) I.. rt ~~I 1'\ Pho;;etA1o BUllciino rermit Info: Describe Work(i.e., Build Single
N . .----::> 1. ~ ~ lieN Family ~esidence Hith Attached GaraQe'
tll1:J] R4SJ
~
-
o
1(5
(name)
Phone
(address)
~-Qffi{)
Address
DES1GN IEAli
(l ics. no.)
(exoires)
(ohone no.
Primary
Structural
Electrical
Hechanical
::::::~~\\illKe~~\)htl~,,"\1~;;:' ~ ~'
Plumbina ~
(phonp no. l
-,4kr8.llXl
El e~trlca 1
~fp.chani ca 1
PLUliBING
ELECTRICAL
MECHANICAL
-1!Q
FEF rHI\Rr,F Nf"l
~~~ rHARU[ NO
FFF rHr,&liE
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Soace hp~tpr ~nn vpnt
Storm Sewer
Of
~mps.
Appliance vent
seoaratf'
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re~ j cJe.nce
multifamily, comm. or
Tnrlll~trial
Water servi ce
COMI'I.IIND, FEEDERS
Install/alter/relocate
distrib. fppners
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valiJ until the
, TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
ISSUANCF OF PFR!lIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon ;s 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 UO OCCUPAIKY will be made
of any structure without the permission of the ~uilding Division. I further certi y t -my-. istration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt a' for exemp ion is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 wi sed on this oject.
1lAf.1E(please print-VE ~"r)(JFE,IL. SIGI T 1
, '
I FOr. OFF! CE \i5ronCY
Zone Type/Const. Units S~. Ftg.
Fire Zone Bedrooms Occy load Sq. Ft~.
Flood Plain Stories Occy Group Sq. Ftg.
DATE/d-l-e9
tiain
Access
Other
x
Value
BUILDING PERIIIT I __t~4 .50 I PI an Ck, Conmflnd
Charges and 651:/Bldo Ppr Fpe
Surcharges lo.1~ Plan Ck. Res
30%fBldo Per Fee
PLU/1BING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERliIT Sidewalk
Cha rges and ------------
Surcharges A/C Paving
liECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Value
Value
TOT^L VALUATION Iq,UC JDPU
ISystems Development I
Charae (1.5~)
x
x
Total Comb. rermit
TOTAL
J\4\.'b3 I
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
17 oj 43
2. examole- lot 1. Block 3. 2nd Addition to
~pringfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exa~~le- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. examjple- if new project. check-new - if addition.
check add. etc.
F. Building permit information:
1. example - construct single family house with an
attached gardge
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 ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES DN 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 b~ 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
ct~
C0Q
\0\0. lo 1-
,SO
Permit Clerk
,
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Permit applicant exempt from registration with the Builder's Board because:
"
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date