HomeMy WebLinkAboutPermit Building 1988-5-11
CITY OF "I',u'IGFIELD
COMBINATION APPLICATION/PERMIT
6- a uJ /' --If-- ~ iT ENERGY SOURCES:
,=5 -( " L.I2AL.lL-17n-tcl./ Heat
Legal Description ('f) ~ ~cLLo ') Hater Heater
, '- ./ Range
/7.~?-~7~~. ~8ac. ,J Value: of Hork: 0 -tJ
Owner V~L.f J' , q iJl,J tecb (t J tJ1J , .
Address q S 0 - I/'" ' Phone Buildinq Permit Info: Describe l1ork(i,.e., Build Single
- 7 a..A.......... Famil y Res i dence Hith Attached Ga raqe )
do gU/(:er rf!)(}/Ir"er foJ'l-N31 tLh.._~ ' .... ~p'~ //A~~-f~uAk/1
Construction Lender ,~ " ~.P' ,.~
Address Phone #-- (\14. e::: ~~
DESIGN TEAt~ (name) (address) ~ - -(lics. no.) (expires) (ohone no.)
New circuits alts.
/ or ex~sions ...,.., c-,
7- 'n ~l1fe ""'04 "V.
"S.F. Residence I ISERVICES I I
(l bath)
I Duplex (lbath) each I I I I
IAdditional bath I ITempOrary Construction I I
IHater service I IChange in existing I I
residence
I Sewer I I multifamily, comm. or I 1"'7
Industrial ""i
I Storm Sewer I, I Of ~ ~6- amps.1 ~ ~
I I I COMf.1./IND. FEEDERS I I I
I I I Install/alter/relocate I I I
distrib. feeders
I I I Of amp~1 I 1
I I I I I I
I I I I I I
I I I I I I I I SSUANCF OF PF.Rr1IT
TOTAL CHARGES ?;? 5<=' I TOTAL CHARGES hP...-e> I TOTAL CHARGES /8.-
WHERE STATE L'l.H 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
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I HAVE CAREFULLY EXAt1INED 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 pertaining to the work described herein, and that NO OCCUPAr~CY 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.
rW.1E(please print).D kiU v11 e."t IV"! vie ~ SIGNATURE ~ ~k
FOR OFFICE USE or~L Y /
Type/Const.5'.....tt. -6~ Units So. Ftg. t1ain~PL~
,
Bedrooms Occy Load~~ Sq. Ftg. Access x
Occy Group t:3.,. 2. Sq. Ftg. Other x
.. fi) f/ ~X r1
Corrnn/Ind- It,-P--? 'L~ U_,"~_",-l-S-yste,mSDeYelOpment
Per Fee :J~' ~~ -, ~ CWtharge (1.5%)
Res I I
Per Fee
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iNSPECTI/1N LINE.
726-3769
Job Address
Pri ma ry
Structural
Electrical
Mechanical
CONTRACTORS (name) . (address)
:::::::, ~i2~:Jf.Ljl~~ :
Electrical ~_/}
~lechaniCa\~ ~fU1A~ g~1' rf/iJ];);
PLUMBING ELECTRICAL
(] ics. no.)
NO.
FEE CHARGE NO
FFF rHARr,F NO.
5
Each single fixture
Residence of
~~ ;1.?C~
SQ. FT.
Relocated building
(new fix. additional)
Zone C c:::::
Fire Zone
Flood Plain
/
Stori es
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck.
--_~~~t:?___ 65%/Bldo
Plan Ck.
~ 0$ 30%/Bl dq
___..l?:...~~__-' Fence
I .~8 I D6mo',
____~~___'sidewalk
'~"pp I A/C Paving
,/S.6-:'" I CU~b Cut
---- ---,-76'--1
?
PLur~B ING PERMIT
Charges and ~
Surcharges :)
ELECTRICAL PERMIT
Cha rges and Y
Surcharges
INFORl1ATION UN!:'
726-3753
Sq. FtC). r.1ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
~
8
w
~,
. '-D
(/\1r~ ~
't> \S I
-- /)
.s ~ ov
(exoires)
(ohone no. )
~/-2gy/
MECHANICAL
FFF rHARf,F
~
furnace/burner to
~~. BTlI's
,G..- a..~
Floor furnace
and vent
Recessed wall
Soace heatpr and vpnt
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~-~.~
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I App 1 i ance vent
seoarate
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart from,
heatinq or A.C.
I. Mechanical exhaust I
hood and duct
Il'JOOd stove/heater I
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DATES -( {-8Q'
Value /~,-~.-
Value
Value
TOTAL VALUATION
##"
ITo~a' Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
~
TOTAL
--::?d~8/J
-~ -- -- ---",- ",' < '
('I
....,.
.. ",'.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I 1.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 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 ceiling/or forced air qas
2. example- waterheater/electrical/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
a ttached 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, 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 schedule~ you should consult the
full schedul es
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. -
Applicant to sign and date
Whenever possible, the initial application will be used as
,a worksheet only. Where possible, Building Division Staff
wi 11 prepa re a type wri tten copy and return it to the '."
appl icant at the time the 9ctual'perrhit 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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IV.
V. FOR OFFICE USE ONLY
Permit Cl erk
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__. PROJECT CONDITIONS TO' BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exem~t from regi~tration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
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da te 5" :?-$8
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name-'-&>?i~t!F: .~~ ~~
signature
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