HomeMy WebLinkAboutPermit Building 1987-7-14
I INSPECTION LINE
726-3769
.
CI1Y Uf SPRINGfIELD
COMBIIIATION APPLICATION/PERMIT
I EIIERGY SOURCES:
I Heat
I Hater Heater
Ranqe
.
INFORIIATION UNt
726-3753
Sq, Ftg, I-Ia;n
~q. Ftg. Access.
Sq, Ftg, Other
flew Add Alter Rep.
-Fence Demo Change/Use
Other - -
00
-..:J
o
I~
I.
,--.J
Job Address
;I
30fD
SJUd:h, A
legal Description
fJ~:-' /15T -'
Owne; fe..:; JAA .JO~/>RA.r
Address Q5cs- _ '; ~ ;e:;
Phone 7 'fh
10(p(o
ValUE of 1~:
.0.000
Builriino Permit Info: Oeser,be Work(i~e.. Build Single
Familv Residence l'lith JI..ttached Garage)
?avhf?~ t7A1d ~
If
Construction Lender
Address
DES I GN TEArI
(name)
Phone
(address)
(lies. no.)
(exo; res)
(ohane no.)
Primary
Electrical
1"1 JJ...
"",
\ ";l'Atl
Structural
f1echani ca 1
CONTRACTORS
(name)
(address)
(l ir,,_ nn,)
(exoirp<:;)
(nhnnp M_)
Genera 1
Plumbino
/;'
t'- 'ft P
Electrical
~1echanical
NO,
PLUlIBING \J \ t\..-
FFF l CHARGF
ELECTRICAL
\JIb..-
~H' . r~.Q.Q~~
MECHANICAL
\ )c~~"'
NO
NO.
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
SERVICES
Recessed wall
SDacp hpatpr nnn vpnt
Storm Sewer
Of
amps.
I Appl iance vent
separate
I Stationary evap.
cooler
I Vent fan with
sinale duct
I Vent system apart
hea t i nq or A. C.
Mechanical exhaust
hoor! nnn r!uct
from
Additional bath
Sewer
Temporary Construction
Change in existing
res,i n_ence
multifamily, comm. or
Tnr!ustrial
~Jater servi ce
\
C0I11-1, II NO, FEEDERS
Install/alter/relocate
distrib. feeners
Wood stove/heater
Of
amps.
~\
,.. / "\' ~
(\IV= 'PQ""'~l'
010
ISSUANCE OF PFRlIlT
TOTAL CHARGES . TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an "Electrical Contractor, the electrical portion of this pelT.1it
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed ap["llication for permit, and do hereby certify that all infonnation 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 rw OCCUPAIKY 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 req~red by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are i~ compliance with OP.S 701.055 will be used on this project.
PlUtIBING PERMIT
Char..ges and
Surcharges
I Plan Ck.
65%1Bl de
Plan Ck.
30%/Blde
Fence
Corrm/lnd
Ppr Fpp
Res
Per Fee
SIGrIA~ ~f/1/t1J~
FO~ OFF I CE PSVOilL Y __
S{ Ftg, rlain (x ~
Sq. Ftc]. Access x Value
Sq. Ftg. Other x Value
~ TOT^L VALUATION
\ , \ 1\ -\\ \. Systems Devel~pmeot I '" h. ,<-.J-.-J
\----/ t+ Charae (1.5%) ~ I \.J
v I
I
I
I
OATE
7-" 1(,--/;;:7
/lAI,IE(please print) &l+fJ P.
MAl. UL-.o L-lVb
)
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Uni ts
Occy Load
Occy Group
BUILDING PERmT
Charges and ......L
Surcharges r
--
ti. ),\Y0
-- -'0'2::--
r;>,
--
I~
,5,00
ELECTRICAL PERI~IT
Cha rges and
Surcharges
O~mo
I Sidewalk
I A/e Pavi ng
I Curb Cut
I
ITotal
I
I TOTAL
\~~~'2- ,
Comb. rermit
IIECHANICAl PERMIT
Charges and
Surcharges
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II oj 43
2. example- Lot 1. Block 3, 2nd Addition to ~
Springfield Estates
~'l C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/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. examp-le - remodel existing garage into family room
3. examyle - 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 'rega rd i ng des i gn i nforma t i on or job sHe
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 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
I."
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
Permit Clerk
1(0
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
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