HomeMy WebLinkAboutPermit Building 1984-3-27
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Job Address 3~ I .!ill. ro +. - L J
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Legal Description Sc..ho~L CD'" \"'1'\
\1 D~.Q~O~_ (jC&Q)
Owner', c;.?~,V\~'~ \J C;::L~a.L 'i\,~\..'\c.T
Address 52. S \rn~ \\ ~,""--.,. Phone
CITY DF SPRINGFIELD
Cm1BINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
Range
INFORllATION UNt
726-3753
Sq. Ftg. r.1a in
~q. Ftg.Access.
Sq. Ftg. Other ._
--1~ew__Add__Alter)(Rep.
Fence Demo Ch~ge/Use
Val~ 'irJOl --Other-- --
Builclinq ~ermit Inft: Describe Hork(i.e., Build Single
Family Residence With Attached Garaae)
J
~ INSPECTION LINE
1726-3769
Construction Lender
G. V91 'Reo C' \ "" - ~ '00 ~
T^.e& o~@.
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Address
DESIGN TEAI~
(name)
Phone
(address)
(lies. no.)
(exoires)
(phone no.)
Pri ma ry
Structural
l,i.
Electrical
,Mechanical
. CONTRACTORS
(name)
(address)
/~t"ld ,10.: {,)
c --'-. - ,
(lies. no.)
(exoires)
(ohone no. )
General
(h~_- -
Plumbina
Electrical
" ~lechanical
PLUflBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF rHARr,F NO.
,
FFF rHARC:F.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
-'
Relocated building
(new fix~ additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
ISERVICES
I
I
I
I
I
I Recessed wall
Soace heat.er and
'I
vent.
ITempOrary Construction
IChange in existing
residence
I multifamily, comm. or
Industrial
10f
ICOMM./IND. FbEDERS
I Install/alter/relocate
distrib. feeders
10f amps.1
I I
I I
I J
. TOTAL CHARGES I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, 'the electrical portion of 'this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I Sewer
Istorm Sewer
I
I
I
I
I
I
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
s i na'l educt
Vent system apart
heating or A.C.
Mechani~al exhaust
hood and duct
llood stove/heater
from
Additional bath
~jater service
I
ISSUANCE OF PFRt1IT
TOTAL CHARGES
I HAVE CAREFULLY EXA~lINED 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 performed'shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPANCY will be made
of any structure without the permission of the 8uilding 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.
Zone
Fire Zone
FloodPlain
Type/Const.
Bedrooms
Stori es
Units
Occy Load
Occy Group
SIGNATURE ,~o.J\J\.U k- V\'\. ,
FOR OFFI~E USE DNLY : '
Sq. Ftg . ria i n
Sq. Ftg. Access
Sq. Ftg. Other
Dim ~-27~8l.f
rW1E(please print)
'-A~~'<
\<.\~G.
x
x
Val ue
Value
Value
x
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcharges
0.. 0 Plan Ck.
__~~.:;.g-:____ 65%/Blda
, eJ Plan Ck.
j.l b 30%/Bldq
'I Fence
------------, Dt;mo
Sidewalk
Comm!Ind
Per Fee
Res
Per Fee
Systems Development
Cha rge (1. 5%) ,
PLU/~BING PERMIT
Charges 'and
Surcharges
ELECTRICAL PERMIT
Cha rges and
Surcharges
A/C Paving
I Curb Cut
I
1
I
I
ITotal Comb. Permit
I TOTAL
3~,2~
I
MECHANICAL PERMIT
Charges and
Surcharges
.~~,1I11 .MlIioJolI~1 h~...
\
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
1703 43
2. example~ Lot 1. Block 3, 2nd Addition to
Springfield Estates
,C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air gas
2. example- waterheater/electrical/or solar
E. Square {ootage or valuation, etc.
~. 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 hou'se 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 CONTRACTORS
To avoid design or construction delays, Buil~ing
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 appli~ant 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
el~ctri~al contractor for signature by his el~ctrical
supervisor. The general contractor is not authorized
to sian the electrical l~bel.
ApplicantJto'sign and date
Wheneve~ possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wil;l prepa re a type ,wri tten copy and return it to the
applicant at the time the actual permit is issued for his
signature.
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.,
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Permit appl icant exempt from registration with the Builder' s Board because:
'Additional Project Information:
PLANS REVIEWED BY:
name
signat~re
.-
date