HomeMy WebLinkAboutPermit Building 1988-6-27
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I. INSPECTION LINE
726- 37 69
"'h,
CITY OF SPRINGFIELD -
COMBINATION 'APPLICATION/PERMIT
ENERGY SOURCES:
Heat
t1ater Heater
Range
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INFORflATION liNt.
726-3753
Sq. Ftc). f'lain
:q. Ftg. Access.
Sq. FtC), Other
Ne\~ Add Alter Rep,
--Fence Demo Change/Use
--Other -- --
".i.,;,I/', /'?:~.'/AL?/"' "........ ValuE: of Hork:
JdWtU /r//rrJ-t:.."'?c--' f5'~VZ;:;~/~ -:2 O~. ere>
Address . . . Buildinq Permit Info: Describe Work(i.e.,
::t;/~c> ?'XZ?~ iPq-'7- ~_.,._'?~ Family Residence ~vith Attached Garaoe)
eC/h~z-/c;ff. ~~~L WC87;; ~./?
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Build Single
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Job Address 5' ~3 Ji/'- 6/9/ e:.A"~,At-L
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Legal Description /?~3""2. /-'Y3; 0 s-8"c:>6
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Construction Lender
Address
DES I GN TEAt,1
(name)
Phone
(address)
(1 ics. no,)
(expires)
(phone no.')
Primary
Structural
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Electrical
Mechanical
CONTRACTORS {~arne}
,..- ~
General /E/f/~~r:
Plumbinq
(address)
(1 i cs. no.)
(expires)
(phone no.)
, Electrical
~'echani ca 1
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V C/ .
!P'ILIUIitlUBIIl1!4>,
ELECTRICAL
MECHANICAL
NO.
FEf CHARGE NO.
FFF CHARGE NO.
FFF CHARGF
Each ~i~~]e fixt~re
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocate~ ooi~.d'i!lg
(new fix. a.drllitiiornaH
S.F. Residenu
(1 bath~
Dup 1 ex n ~1:h) Bacilli
Additional !bath
New circuits alts.
or extensions
Floor fu rnace
and vent
SERVICES
Recessed wall
Space heater and vent
~later serviice
ITempOrary Construction
IChange in existing
residence
multifamily, comm. or
Industrial
Of
Appliance vent
separate
Stationarv evap.
cooler" ,
Vent fan with
sinole duct
Vent system apart from I
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Storm SeWEr
amps.1
COMM./IND. FEEDERS I
Install/alter/relocate I
distrib. feeders
IOf
I
I
I
amps.]
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ISSUANCE OF PFRtlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE l?\W REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion 'of this permit
shall not be v~]i~ ~~tjl the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CARfIHUIU...U iEJ<NlINED the completed app.l ication for permit, and do hereby certify that all information hereon is true
and correct, a~rll 1 f~rther certify that any and all work performed shall be done in accordance with the Ordinances of the City
,of Springfielld amd the Laws of the State of Oregpn pertaining to the work described herein, and that NO OCCUPAr~CY will be made
of any strllct'Uf'e IlInitho'J;lt the permission of the Building Division. I further certify that my registration ~Iith the Builder's
Board is, in full] fo~e and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontracwlTs a:llliJIemployees who are in compliance with ORS 701.055 will be used on this project.
fW'IE(please iJ1rl1nd MO\..I"'9 () S\~U q ,~f-e..r SIGNI\TURE ??1~ ~
FOR OFFICE USE Oi~L Y (; . ' ~'
Sa. Ftg. r1ain
Sq. Ftg. Access
Sq. Ftg. Oth.er..li~~
D/I.TE~J/Py
Zone C c...
Fire Zone
Type/Const. ~~~Units
Bedrooms Occy Load
Stari es / Occy Group
67
73-2
x Value
x Value
Rp~ Value
TOTAL VALUATION
-::<c::ere>. ~
Flood Plain
BUILDING PER~1IT
Charges and """"'-
Surcharges ,.
___~3:~~__
/.~3
Plan Ck. Comm/Ind
65%/Blda Per Fee
Plan Ck. Res
30%/Bl dq Per Fee
Fence
Systems. Development
Charge \1.5%) .
PLUf1BING PERMIT
Charges and
Surcharges
ELECTRIC/l,L PERrm
Cha rges and
Surcha r,ges
------------
1 Domo
ISidewal k
------------1 Ale'Paving
Curb Cut
I.
I Tota 1 C~TDb. Permit
I
I TOTAL
37r/3
I
MECHANICAL PERMIT
Charges and
Surcharges
, ,-,
.
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COMBINATION APPLICATION/PERMIT (CAP)
" PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp 1 e- Tax Lot 100, Lane County Map 'Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
_ Springfi.eld Estates . '
C. 'Name, etc. of' owner and construction 'fender
D. Energy Sources .
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electricalior 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
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, 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. -
Applica~t 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.
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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III.
V, FOR OFFICE USE ONLY
'12QEl Pr 118c>~ .
Permit Clerk ~. ..o",,--,t(:~J\.
- '0' G::, -.!f< 7 - ~ '8'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicanf-exe,mPt from registration with the Builder's Board because:
~.. ~ J
., -.~d.di.tjonal Project,:,\Inf,ormat.i.on,;
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PLANS REVIEWED BY:
name
0.ffAY<5' ?0<;:~
Signature~--?
date (;...-::?? '8~
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