HomeMy WebLinkAboutPermit Building 1987-10-12
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I HISPECTIOff LINE
726-3769
CITY OF SPRINGFIELD
COMBIIIATlON APPl-ICATlON/PERMIT
f :.... ,(. -/~ E'IERGY SOURCES
LVAA 11 O/Yl nA 0.1/ Heat
legal Oe'cnptlon 17-C:>;r<?S-~", a.s7~ Ilater Heater
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Owner ~C&YLJ~ 0/' ~tuL~
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INFORllATlON liNt
726-3753
Sq Ftq fiaTn
~q r:tg Access
Sq Ftg Other
New Add Al~er oep
--Fence Demo Change/Use
-Other -- -
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Job Address
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Addre~s
Phone
Ranqe
ValuE ofJJ1~t971
BUllr1ndlPernnt'Info Descnbe lIork(l e . BUIld Slngle
Farn'v ~es,dence li,th P.ttached Garaoe)
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(11es no) (eXOlres) (ohone no
ConstructIon lender
Address
UES lliN HAIti
(name)
Phone
(address)
Pnmary h1/c:::::#~~ ~H /lEr /H~/.<::S'..R 'i
Structural
El ectn co: 1
11echanlcal
COf!TRACTO~S (name)
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Genera 1
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PlumblnCl
C; i!e/h-/;____
E1 ectn cal
~1echanlcal
PlQlI1BHI~
ELECTRICAL
MECHANICAL
NO I
:3
Eac~ ~nn~le fixaur~
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7-5'" 22".:2:
NO I
Res1dence of
I t-"l="l=" I CI-IARf,l=" NO I
11="1="1=" I Cl-UI.Rf,1="
SO FT
furnace/burner to
BTU' 5
RelOUltM bi;,Jt,og
(new fi~~ ~rl~~t1ona]>>
~ New C1rCU1ts a1ts
or extenslOns ."'D":-
'7 L>JE::. /YJPr>""
SERVICES
Z?SZ
Floor furnace
and vent
S F R'E'S~I<<ff!fl.cE'
11 ba~~)
Duplex (1 ho~.l eac"
Recessed wall
SOnc.e heot~r anrl vent
Sewer
I StOrfil Sewer
1
Of
amps
Apo11ance vent
seaa rn tf'
Stat10narv evao
cooler J
Vent fan w1th
s1na1e duct
Vent syste~ apart from
heat1nQ or A c
Mechan1cal exhaust
hood nnd duct
\Iood stove/heater
Add11.HJnal :ba"lLh
Temporary Constructlon
Change 1n eX1st1ng
rpsldpncp
mult1fam1ly. co~ or
Tnrlustnal
~Ia ter sEruit:~
C0I111 II NO FEEDERS
Install/alter/relocate
rl, stn h fpprlprs
Of
amps.
1
TOTAL CHPPJ;I<; '27 - 50 TOTAL CHARGES
WHERE STATE UII ~QUlllfS that the Electncal work be done by an
shall not he wali1 ~nt~l the label has been s1gned by an Electr1cal
ISSUANCF OF PFRllIT
~_~~ TOTAL CHARGES
[lectr1cal Contractor, the electr1cal portlon of th1S perm1t
Superv1sor and returned to the BU1ld1ng 01v1s1on
I HAVE rAREnLLl~ [~~!NED t1e completed apnllcat10n for perm1t. and do hereby cert1fy that all 1nformat1on hereon lS true
and correct~ a~~ [ ~rthPr cert1fy that any and all work performed shall be do accordance w1th the Ord1nances of the C1ty
of Spnngflf'ld arnd the Lall!5 of the State of Ore~on oertalnlOg to the work de nb here1n, and that rw OCCUPAtKY w1ll be made
of any struc~re ~thout ~he perm1ss10n of the 8ul1d1ng 01v1S1on I furth cert}fy th y eqlstratlon w1th the BUllder's
Board 1S 1~ f~11 force and effect as requ1red by ORS 701 055, that lf exe t the bas x mpt10 1S noted hereon, and that
only subc~~~ractors ~nd ~loyees who are 1n comol1ance w1th OPS tnl 055 wlll b s a on th DrOJ t
BUlLDING PERNIT
Charges and
Surcharges
I
U5E CO{:)E#&:Z '-/
, ~ I Plan Ck
___L"?-$_?_'e_ 65%1BJda
1'/ I Plan Ck
6 7 ~ 30%/BldQ
22_e-c::::> I Fence
------T~3-1 06mo
"2'2 -52? 1 Sldewalk
------------
TYl>e/Const
Bedrooms
Ston es
S-/IJ,R'
Um ts
SIr,NATURF
FO" OFFICE ~~F ~\ IV U . '11 Value
Sq Ft~ Access~ x Value
'/il-Z Sq Ftg Other3.c-M""~ value.iZ.$97 ~.
TOTAL VALUATION
omJJ" , 9Jn
I~AIIE(pleas. ~nntl---.DA.,', ..l
I
lA );1,,>"'"
Zone.J? ~
F1re Zone
Occy Load
OcCy Group
Flood Plaln
Comm/l nd
Ppr Fpp
Res
Per Fee
10-(2-\$ 1
100 r3 ~^?'7'7 Systecs Development
o ::l ,c:> 'Iu'O>::>L.- CharQe (J 5~)
1-/.4
PLUI1BlNG PERMIT
Charges and
Surcharges
ELECTRICPL PERI'IT
Charges and
Surcharges
/./3
A/C Pavl ng
Total Co~b Perm1t
11ECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
1
I TOTAL
1$2 /9
J
.
COMBINATION APPLICATIONIPERMIT (CAP)
Appllcant to furnlsh
A Job Address
B Legal Descrlptlon
1 examDle- Tax lot 100, Lane County Map Reference
11 oj 43
2 example- lot 1 Block 3, 2nd Addltlon to
Sprlngtleld Estates
C Name~ ete of owner and constructlon lender
o Energy Sources
1 example- heat/electrlcal ce,11nQ!or forced alr qas
2 example- waterheater/electrlcal/or solar
E Square footage or valuatlon, ete -----
1 example- 1250 sq foot house. 500 sq foot garage
2 example- If new proJect, check new - If add,tlon,
chee k add, ete .. ~...
F BUlldlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 example - remodel eXlstlng garage lnto faml1y room
3 example - convert 51ngle famlly resldence loto
restaurant (change of use)
G Value of work as def1ned In Sectlon 303 (a) of the
Structural Speclalty Code
-H DESIGN TEAM AND CONTRACTORS
To avold deslgn or construct1on delays, BUlldlng
Olvlslon Staff must be able to contact approprlate
persons regardlng deslgn lnformat10n or Job slte
correctlons, etc
II Abbrev1ated Plumblng, Mechanlcal, & Electrlcal Schedules
A Except where blank spaces occur In the descrlptlon
portlon of the Mechanlcal and Electrlcal Schedules,
the appllcant need f111-ln only the No Boxes adjacent
to the approprlate ltem(s) to be lnstalled
B Full Plumb1ng, Mechanlcal, and Electrlcal Schedules
are avallable at the BUlld1ng Olv1s10n
1 To conserve space on the permlt form the schedules
have been abbrevlated
2 If the ltem(s} to be lnstalled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
o As noted on the CAP, the label must be dellvered to the
electrlcal contractor for slgnature by hlS electrlcal
supervlsor The general contractor 1S not authorlzed
to $lgn the electncal label -
III ~ppllcant to slgn and date
Whenever posslble, the lnltlal appllcat10n w1ll be used as
a worksheet only Where posslble, BUlldlng Olvlslon Staff
wlll prepare a type wrltten copy and return lt to the
appllcant at the tlme the actual permlt lS lssued for hlS
slgnature
IV Fees and Charges
Plan check fees are due and payable at the tlme of the
appllcatlon, and no plans wlll be processed untll these
fees are pald All other fees and charges are due and
payable when the permlt lS lssued
V FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
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PERMIT VALl,DATION
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Permlt Clerk
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Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
Addltlonal ProJect InfQrrnatlOn
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PLANS REVIEWED BY
Lp8.h'&: h!5Z;~Slgnaturv7~~date
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name
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