HomeMy WebLinkAboutPermit Building 1984-8-2
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Construction Lender
Range
ValuE of l'lork: /.16.1\
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. Buildinq Permit Info: Describe Work(i,e., Build Single
Family nesidence .1'lith ,A,ttached Garaa~) . . /.
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1NFORliATION UN!:.
726-3753
Sq. Ftg. r'1a in
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter P.ep.
-Fence Demo Change/Use
-Other - -
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I INSPECTION LINE
726-3769
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Legal Description \1[)~QJ.oA{4 \t-\~D[)
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CITY OF. SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
.Heat
I~ater Heater
Job Address
. -
~::::" ~.~~)P~7q771
<<J-
Address
DES I GN TEAt-i
(name)
Phone
(address)
(1 ;cs. no.)
(exoires)
(ohone no .'\
P.r.imary
Structura 1.:
: El ectri ca 1
: r1echani ca 1
;. CONTRACTORS
. Genera 1
(name)
r~"
(address)
(lics. 'no.)
. (exoires)
(ohone no. )
. Plumbinq
. Electrical
i ~iechani ca l'
PLUf1B I NG
ELECTRICAL
MECHANICAL
NO.1
Each single fi!<ture,.
FEE
CHARGE.j NO,
FFF
f:HAR(;F NO.
f'Ff'
f:HAR(;F .
Residence of
SQ. FT. '
furnace/burner to
BTlI's'
Relocated building
(new fix. additional)'
New ci~cuits alts.'
or extensions
Floor fu rnace
and vent
S.F. Residence
(1 bath) .
'DuPlex (1 bath) each - I"
IAddi~ional bat~"
I ~la.ter servi ce
1 Sewer I'
I Storm Sewer 1
I:
"
I
SERVICES
I
Recessed wall
'Soace heat~r and v~nt
Of
amps~
Appliance vent
seoarate
Stationarv evao.
cooler - ,
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
:1
.:1
Temporary Construction .:
, Change in existing'
residence
ImultifamilY, comm. or
Industrial
I
. COMM./IND. FEEDERS
. ..Install/alter/relocate
distrib. feeders
Of
amps;1
I
:1
,
ISSUANCE OF PF.Rt1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
l
WHERE STATE L!I,\~ REQUIRES that the Electrical work be done by an, Electrical .Contractor, the electrical portion of this permit
shall not be val H until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA11INED 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 oerformed 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, arid that NOOCCUPAHCY will be made
of .any structure without the permission of the Building Division. I further certify that my registration ~Jith 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 \1ho are in camp 1 i ance with OP.S 701. 055 will be used on th is proj ect.
lm-iE (p 1 ease print)~-1 k. ]Lv kt" i .' S IGrMTURE !!O~% A~ DATE g:. ~ g'4
FOP. OFFICE USE ONLY
Zone Tyoe/Const. Units Sq. Ftg. t1ain x Value
Fire Zone Bedrooms . Occy Load Sq. Ftc]. Access x Value
Flood Plain Stori es Occy Group Sq. Ftg. Other x Value
. TOTAL VALUATION
BUILDING PER~1IT __-c--_l9.:.~ Plan Ck. CommlInd
Charges and. 65%/Blda Per Fee
Surcharges LIt) Plan Ck. Res
30%/Bldq Per Fee
PLU'1BING PERMIT Fence
Charges and ------------
Surcharges Di1mo
ELECTRICAL PERr~IT Sidewalk
Charges and ------------
SuX'cha rges A/C Paving
MECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
Systems. Development
Charge 0.51,) .
Total Comb. Permit
I
I TO~AL
I tJ ,2/0
, ~ . .
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COMBINATION APPLICATION/PERMIT (CAP)'
PERMIT VALIDATION
I. '. Applicant to furnish.
A.Job Address
B. Legal' Description
. 1. examp 1 e- Tax Lot roo, Lane County Milp Reference
. 17 0343 .
2. examp 1 e-. Lot 1. Block 3, 2nd Add ltionto
'. Springfield Estates, .
. C. Name, etc.' of owner and con'struction lender
. D. . Energy Sources
'1.. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electricalJor sblar .
E. Square footage or valuation, etc.
. .1. example- 1250 sq. foot house, 500. sq. foot garage
2. .example- if new project, check-n€w - 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 ~he
Structural Specialty' Code
H; DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
.. Division Staff'must be.ab1e to. ~ontact appropriate
persons regarding design information or job site
.' corrections, etc. . ; .
II~ Abbreviated Plumbing, Mechanical, I E~ectrica1 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 a~allable at the Building Division.
1. To 'conserve. space on the permit form the schedules
have been abbreviated, .
2. If.the item(s) to be in'sta11ed. 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 tottie
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 initia.1' 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 i~ 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.
'/
$ 6 ~?> o~ .
&JcV-uJ q
3-:~-J?
,.
V. FOR OFFICE USE ONLY
Permit Clerk().~r?1~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
i
Permit appl i cant e:xempt from reg'j,strati on with the Buil dt;r I s Board' becq.use:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date