HomeMy WebLinkAboutPermit Building 1986-3-26
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1 INSPECTION LINE CITY OF SPRINGfIELD
726-3769 COMBINATION APPLICATION/PERMIT
Job Address / 7!f'c:1 ~-k/f/"A/'I/rj 5J; . ~~;~GY SOURCES
Legal De'Crlptlon J;O ~ ;::)"'i 7l/ 6"?AoO Hater Heater
Ranqe
INfORlIATION LINt
726-3753
Sq Ftq Ila,n ~I') <p
~q Ftg Access
Sq Ftg Other
New Add Alter 'ep
-Fence Demo Change/Use
-Other - -
~
I'
I~
Owner /1~ ~'/ /rVVeS~t?A"f,
Address :J.3,j tl (J".,)("" d'JI/ 1 ~y ~/uCi?,vi!A./' Phone l7 ~J '
v~ UE. of \lark t7d
:J..fS-c:J ~
BUllrilno Permlt Info Descrlbe Work(l e . BUlld Slngle
FaMl1y nesldence Hlth ,lIttached Garaoe)
iPeJ?t'<7/ (/',;- )C)fIs!t;....? C:~"7Me .-?C>,,,.j
bl/I I/, ~c,.
Constructlon Lender
Address
UtS1GN TtAr~
(name)
Phone
(address)
(llCS no 1
(exo, res 1
(ohone no
Pnmary
Structural
Electncal
;;;
Mechanlcal ~
CONTRACTORS (name I (address \
General ?c-o,z'd/6' 2?oy..,f /?~/:,W;:; L.,;; "Y''t'rf<)"ftJ";",,..5!:
(11es no
fdM:J..
(exn1 res)
t ,2,'7" li-t.
(ohane no )
7:< .: -.:J"7.?.<
Plumblno
El ectrlCa 1
~lechanlcal
l
PLUIIBING
ELECTRICAL
MECHANICAL
NO
Each slngle flxture
FEE CHARr,E Nn I
Resldence of
I ~I="I=" I rI-lARr,1= NO I
I FFF I r\-1AQr,F
furnace/burner to
SQ FT BTU's
Relocated bUl1dlng
(new flX add,tlonal)
Is F Pesldence
(] bath)
IDuPlex (1 bath) each
New Clrcults alts
or extenslOns
Floor furnace
and vent
ISERVICES
I
Recessed wall
SnACP hPntpr nnn vpnt
I
ITemporary Constructlon
IChange 1n eXlstlng
rpc:.Hjpnrp
Imultlfaml1y, camm or
Tnnu<;trlil.l
10f
I COMIl II NO FEEDERS
I Install/alter/relocate
rl,c:.tr,h fpprlprc:.
10f amp,,1
I
I
I I
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L JU~ REQUIRES that the Electncal work be done by an Electncal Contractor, the electncal portlon of thlS perlillt J
shall not be val,j untll the label has been slgned by an Electrlcal Supervlsor and returned to the BUlldlng O,vlslon
Sewer
amps I
Apollance vent
seoarate
Statlonary evao
cooler
I Vent fan wlth
51nole duct
I Vent systel"'1 apart
heatlna or A C
I Mechanlcal exhaust
hood and duct
I ~Jood stove/heater
I
I
I
from
Add1t1onal bath
~Iater serv1Ce
Sewer
Storm
I
I
I
I
I
I
I SSUANC, OF PFP'11T
TOTAL CHARGES
I HAVE CAREFULLY EXMlINEO t1e completed appllcatlon for permlt, and do hereby certlfy that all lnformatlon hereon lS true
and correct, and I further certlfy that any and all work oerformed shall be done ln accordance w1th the Ordlnances of the Clty
of Spnngfleld and the laws of the State of Oregon oertalOlng to the work descnbed hereln, and that fW OCCUPAltCY wlll be made
of any structure wlthout the perm1SS10n of the BUlldlng Olvlslon I further certlfy that my req1stratlon w1th the BUllder's
Board 15 1n full force and effect as requlred by ons 701 055, that lf exempt the basls for exemptlon 15 noted hereon, and that
only subcontractors and e~ployees who are In compllance wlth OPS 7nl 055 w1l1 be used on thlS proJect
Zone
Fue Zone
Flood Plaln
Tyoe/Const
Bedrooms
Stones
UOl ts
Occy load
OCCY Group
SIGNATURE~
Fon OFFICE USE O,IL y
So Fto rial"
Sq Ft9 Access
Sq Ftg Other
~
om 3 -~,.;yt
NAllE(please pnnt)~A/'e /:"S!;"f
x
x
Value
Value
Value
x
TOTAL VALUATION
BUILDING PERflIT
Charges anC:
Surcharges
3~~
----/57-
Plan Ck Comm/lnd
65%/Blda Per Fee
Pl an Ck Res
30%/Bldq Per Fee
Fence
'Systems Development
Charoe (J 5%)
PLU'1BING PERMIT
Charges and
Surcharges
O~RlO
ELECTRICPl PERI'IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
S1dewalk
AIC Pav,ng
~u----7----1 Curb Cut
Total Comb Permlt
TOTAL
I~~~
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,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
Appl1cant to furnlsh
A Job Address
B Legal Descrlptlon
1 example- Tax Lot 100, Lane County Map Reference
II 63 43
2 example- lot 1 Block 3, 2nd Addltlon to
Sprlngtleld Estates
C Name, etc of owner and constructlon lender
o Energy Sources
1 example- heat/electrlcal cel11nq/or forced alr qas
2 examyle- waterheater/electrlcal/or solar
E Square footage or valuatlon, etc ------
1 examole- 1250 sq foot house, 500 sq foot garage
2 example~ 1fInew proJect, check-nfw - If addltlon.
check add. etc
F BU11dlng permlt lnformatlon
1 example - construct slngle famlly house wlth an
attached garage
2 exam~le - remodel eXlstlng garage lnto famlly room
3 examyle - convert 51ngle famlly resldence lnto
restaurant (change of use)
G Value of work as deflned ln Sectlon 303 (a) of the
Structural $pec1alty Code
H OESIGN TEAM AND CONTRACTORS
To aV01d des1gn or construct1on delays, BUlld1ng
01v1slon Staff must be able to contact appropr1ate
persons regard1ng des1gn 1nformat1on or Job slte
correctlons. etc
II Abbrevlated Plumblng. Mechan1cal, & Electr1cal Schedules
A Except where blank spaces occur 1n the descr1pt1on
portlon of the Mechanlcal and Electrlcal Schedules,
the appllcant need f111-1n only the No Boxes adJacent
to the approprlate ltem(s) to be 1nstalled
8 Full Plumb1ng. Mechan1cal. and Electr1cal Schedules
are ava11able at the BU11d1ng 01V1S1on
1 To conserve space on the perm1t form the schedules
have been abbrev1ated
2 If the 1tem(s) to be lnstalled are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
D As noted on the CAP, the label must be deIlyered to the
electrlcal contractor for slgnature by hlS electrlcal
supervlsor The general contractor 1S not authorlzed
to s19n the electncal label -
III Appllcant to slgn and date
Whenever posslble. the ln1t1al appl1catlon wll1 be used as
a worksheet only Where poss1ble, BU1ld1ng 01vls1on Staff
wlll prepare a type wr1tten copy and return lt to the
appl1cant at the t1me the actual permlt 15 lssued for hlS
slgnature
IV Fees and Charges
Plan check fees are due and payable at the tlme of the
appllcat10n. and no plans w11l be processed untll these
fees are pald All other fees and charges are due and
payable when the perm1t 15 lssued
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V FOR OFFICE USE ONLY
Permlt Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY'
Permlt applIcant exempt from reglstratlon wlth the BUIlder's Board because
AddItIonal ProJect InformatIon
PLANS REVIEWED BY
name
SIgnature
date