HomeMy WebLinkAboutPermit Building 1986-9-9
v
l INSPECTION LINE
726-3769
Job Address lDl..\O to,) p\ ~T,
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Address ~,O,~X
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Buil~inQ Perulit Info: Describe Work(i.e.~
Familv ~esidence With Attached Garaae'
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INFORlIATlDN LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other- -
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Build Single
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FPOERAJ
I Ranqe
Owner'
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Address
DESlGN H:J\f~
(name)
Phone
(address)
~ a=f'f2..0DPlt0G- ",-~'0JOF
101T~ 13--Pl-...'Y DI.0G~ -C5U~\rJ&-
0' 'I-~, ,'\'\ aD ttJ
{lies. no. \ (exnires) {phone no.}
Construction Lender
Primary
Structural
Electrical
Mechanical
CONTRACTORS (namel
(General) "",...,r:: i'GOnf',D6---
(address)
(lies. no.) (pxnires)
~i'1D5 1'!'-lIRlD
(phone no_)
'L'1iD,4 Cr,>,)W fMJ f-\JC,.
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Plumbina
Electrical
~lechanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FFF
CHARGF
NO_ I
Residence of
FFF
CHARGF NO.'
FFF
I rHARr::;F
Each single fixture
sq. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (I batb) each
Add it i ona 1 ba th
SERVICES
Recessed wall
So~rp hPAtpr And vpnt
Storm Sewer
Of
amps.
Appliance vent
sPDaratp
Stationary evao.
cooler ~ .
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and rlurt
Woad stave/heater
Sewer
Temporary Construction
Change in existing
res;0pY1c-e
multifamily, comm. or
TndIJ<;tr;al
~Jater service
COMI-I./lND. FEEDERS
Install/alter/relocate
distrib, fpprlers
Of
amps.
TDTAL CHARGES . TOTAL CHARGES
WHERE STATE LA], REQUIRES that the Electrical work be done by an.
shall not be valiJ until the label has been signed by an Electrical
ISSUANCE OF ?F.RlIIT
TOTAL CHARGES
Electrical Contractor, the electrical portion 'of "this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct, and 1 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 Oregon pertaining to the work described herein, and that HO 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 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 ~~rOject.
lJAl.IE(please print) ::r- \ M \P\:) ~ ~ SIG1IATURE J ~r..J.:::L, DATEs..\ 'T \ "f.L,
I FO~ OFFICE USE DriLY
Zone Type/Canst. Units Sq. Ftg.
Fire Zone Bedrooms Occy Load Sq. Ft9.
Flood Plain Stories Occy Group Sq. Ftg.
x
Value
Value
Value/s:?o 1::9'3-~
VALUATION
Access
Other,&p60F
x
x
TOTAL
BOILDING PER~IIT
Charges and
SurCharges
/7/) r PlanCk.
:/7 .~O 6S%/Bldo
- - -- ~f" ~ "-is - - ;6~~Bi~~
Fence
Corrm/Ind
Pf'r Fep
Res
Per Fee
i:i.dl- .
Systems Development I
Charqe (1.51,) '.
Iv4
PLUt1BJNG PERMIT
Charges and
Surcharges
DI1A10
I'Sidewal k
------------
I A/C~Pav'ng
- I Curb Cut
------------1
I
I"
I
TQtal~~om~..rermit
ELECTRICAL PERI~IT
Charges and
Surcharg~s
tlECHANICAL PERM(T
Charges and
Surcharges
.. TOTAL
I
/39, ga
.
.0
.
COMBINATION APPLICATIDN/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. example- Lot 1. Block 3. 2nd Addition to
Springtield Estates
C. Name, etc. of owner and' construction lender
D. ,Energy Sources J../
1. example- heat/electrical eei ling/or forced air Qas
2. example- waterheater/electrical/or solar'
E. Square footage or valuation, etc. -
1. exam~le- 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. 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 CONTRACTDRS
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
supervi sor. The genera 1 contractor is ,not authori zed
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
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Ad,dih(lna 1 Project Infor:mation:
\
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PLANS REVIEWED BY:
n~~ Signatur~~~-
- ,,,.'
name / oFM/E
..
,.
date <7- "7-8'<::
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