HomeMy WebLinkAboutPermit Building 1982-7-8 (2)
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CITY OF SPRINGFIELD INFORflATION LJI\c
COMBHIATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftq. 1.lain
Heat :q. Ftg. Access.
07-7. /'r) Hater Heater Sq. Ftq. Other
'.-l UL flew Add A Her Eep.
Ran~e --Fence Demo Change/Use
I va~' 3~o5:7 ~ Other--
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'1 IrISPECTION LItlE.
726-3769
Job Address /'0-:7- AI, A-.....X
Legal De,cription \1 (J?-,?:>5 U 9
Owner .9~~
. ..-
Address 70;;! If/'
N~A
A-~
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Construction Lender
Address
DLSIGfl TEAf.1
(name)
Phone
(address'
Pri ma ry
1
Structural
Electrical
f1echanical
CONTRACTORS
Plllmb;no
::z. >ff! T 4 (" /f~ tt/ /f IJ
!;tl/6-e;ve.
19'o~
(exp; res)
/o)~Jn..
(ohane nn.'
(name)
{address'
(l iC5. no.'
General /f~c A'CO.PIYIC- / AlC,
'3+-(.O.:1.b'1'
Electrical
t.-
M~~han;ca'
PLUI1BltlG
ELECTRICAL
MECHANICAL
NO.
I FFF CHARG.E Nn
~~~ r~ARr,~ NO.
1="1="1=" fH.G.RhF
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(1 bath1
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Saae/? hpatpr and vpnt
Storm Sewer
Of
amps.
App 1 i ance vent
~paarate
Stationary evap.
cooler
Vent fan with
sinale ouct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
resirlenee
multi-r"amily, com. or
Inrlustrii'll
Additional bath
Hater service
COMM./IND. FEEDERS
Install/alter/relocate
rli<;.trib. fepdpr~
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAI~ REQUIRES that tile Electrical work be done by an
shall not be valil until the label has been signed by an Electrical
ISSUANCE OF PFRf11T
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed application 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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i ni n9 to the work descri bed herei n. and that rw OCCUPAHCY wil 1 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 ORS 701.055 will be used on this project.
fWIE(please print)MfC~L;:L. /toV ~Or SIGrIATU~';~"'./ ~......~
FOr. OFF I CE USE DilLY
l,/..
DAT~/.., L
1
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg.
Sq. FtQ.
Sq. Ftq.
t1ain
Access
Other
x
x
Value
Value
Value
x
TOTAL VALUATION S'I..s7.!!!2.-
BUILDING PERfllT ______3(,.a-, Pl an Ck. CommjInd
Charges and 6S%/Bldo Ppr Fee
Surcharges /.,-/,/ Plan Ck. Res
30%/Bl dq Per Fee
PLUt1BING PERMIT Fence
Charges and ------------
Surcharges Demo
ELECTRICAL PERfHT Sidewalk
Cha rges and ------------
Surcharges A/C Paving
f1ECHAN I CAL PERMIT Curb Cut
Charges and ------------
\ Surcharges
Systems Development
Charqe (I.Sr.) .
Total Comb. Permit
TOTAL
37.'IY
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100. lane County Map Reference
1/ 03 43
2. example- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 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. OESIGN TEM1 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 worksh~et 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:
Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
A'!l
date 7~f ,tf'L-
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