HomeMy WebLinkAboutPermit Building 1988-12-23
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.' CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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EIIERGY SOURCES:
Heat
\~a ter Hea ter
.
INFORl1ATION liNt
726-3753
Sq, Ftq, 1'la;n
~q. Ftg. Access.
Sq, Ftg, Other
flew Add Alter Pep,
-Fence Demo Change/Use
Other- -
Legal Description /?-O"3-'3S-OCJ ~;r-L>P 2==
/" i
Range
ValuE of Hark:
":7..........:...., --
Bull(;inQ Permit Info: Oeser be \~ork(;-.e..
Family nes;dence With Attached Garaoe)
Build Single
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I NSPW.CT:JO N LINE
726-:y.>~ ..
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Owner / S ,...-
f _F_ "::>l,.v~""",/? r-
Address ":2 ~ 5'P-.;:r S-r ~1;.o~&"o;;;:
~.;"'-""'?D. r::>/?,
Construction Lender /
Address
DESIGN TEA"
(name)
Phone
(address 1
L""'~7?i:GrC.r--- ~&/O'P ~~.~_~
1/' ~.H'nc_. ~ h~
fk-.#./.c~___ ~S"&>~~
(lies. no.l (exo~res)
(ohone no. \
Primary
Structura 1
Electrical
1()"1
') ,>0(/
t1echanical
CONTRACTORS
(name 1
(addrf'ss)
(1 les. no.'
(pxoirf's)
(ohonp no.)
Genera 1
Plumbina
()
_ tV
I: V
Electrical
~lechanical
PLUIIBIrIG
ELECTRICAL
MECHAN I CAL
Each single fixture
FEE C:HARr,F NO I
I Residence of
sq, FT,
INew c;rcu~ts alts.
or extenslons
I SERVICES
I
ITemporary Construction
Change in existing
rpsidpncp
multifamily, camm. or
Tnrlustrial
~FF fHARGF NO_
J:"FF fHARGF
NO,
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
(j bath\
Duplex (1 bath) each
Recessed wall
Sn~ce hPrttpf rtnrl vpnt
Storm Sewer
Of
amfls.
Appl iance vent
SPOil ra te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
Additional bath
~Ia ter serv; ce
Sewer
C0I1H, /I ND, FEEDERS
Install/alter/relocate
dic;trih. feeders
Of
amps.
TOTAL CHft.RGES
WHERE STATE l~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES
ISSUANCf Of PFR!lIT
I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed apfl1ication for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Orel'.lOn pertaining to the work described herein. and that lW 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 comoliance with Or.S 7nl.055 will be used on this project.
I
Zone_CC
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stari es
SIr,II.~TURE&A""(;' d./
FO~ OFfICE USE DilLY
~-N Units Sf]. rtg. f1ain
Occy Load Sq, Ft~, Access ~~J<7
Occ'y Group 7$-/ Sq, Ftg, Other ;-
12./1-1-1 aa (D '
/"Q pr "H"'t- 12-"1 t\C) ~ p, j,~
I I Plan Ck. CommlIrtd Systems Development
___2~S:c:?__ fi5%1Rldo P,er Fee ~V3 Charqe (1.5%)
Plan Ck. Res
"? '7.5 3D%/Bl do Per fee
r!~
OftTE
h-2J-'i;f;
r~Af.1E(please print)
x
Value
Value
Value
9~,-
x
I
x
TOTAL VALUATION
;~
BUILDING PERMIT
Charges ane
Surcharges ).
PLUt~BING PERMIT
Charges and
Surcha rges
/~.
.......
?J-
Fence
D~mo
ElECTRICft,L PERf~IT
Charges and
Surcharges
Sidewalk
A/e Paving
Total Comb. Permit
7'8. "23
I1ECHANICAl PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
2/3.73
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B'f legal Description
1. example~ Tax Lot 100. Lane County Map Reference
II 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. example- heat/electrical ceilinqjor forced air qas
2. examp)e- 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. examole ~ construct single family house with an
attached garllge
2. example - remodel existing garage into family room
3. exam~le - 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 OIVISION 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 ~ivision 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.
"
( 2- q cf~
12--23-V(
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V, FOR OFFICE USE ONLY
Permit Clerk
Q()
PRDJECT CDNDITIDNS TD BE SATISFIED BEFDRE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~ ~~~--F r:- ~~
signature 4~'f:!:~r~ date/::?'-=<7-g~
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