HomeMy WebLinkAboutPermit Building 1990-7-19
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CITY UF SPRINGFIELD
CDMBIIIATION APPLICATION/PERMIT
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INFORftATlON LINE
726-3753
So' Ftg, I,lain qf,o;:,
~q. Ftg. Acce~
So' Ftg, Other
New Add Alter Rep,
-Fence Demo Change/Use
Other- -
{name}
Phone
{address 1
EilERGY SOURC!;.S: I
Heatl?lec... ~.'LL""'''
Hater Heater .,yJ It-
Range y.j I ",.
ValUE of I-lark:
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BU11riina Permit Info: Descr,be Work(i.e..
Family Residence With Attached Garaae~
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Build Single
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Constructlon Lender
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Address
UI:.~i(iN ltAH
(exoires)
(ohone no.)
Electrical
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(namel (address1 (lir:s,. no.) (exoires) (phone np_)
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f'i"i;;;ary
Structura 1
Electrical
Mechanical
CONTRACTORS
Genera 1
PlumbinQ
~1echanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO,
FFE 'CHARGE Nn
. ~FF r.H~F NO_
~FF . rHJ1RG.E..
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
11 bath \
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snac~ hpatpr nnd vent
amps.
App 1 i ance. vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hea t i no or A. c.
Mechanical exhaust
hood ilnd r1ur:t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res i (leflce
mUltifamily. comm. or
Industrii'll
~Iater service
Storm Sewer
Of
COffi1,/IND, FEEDERS
Install/alter/relocate
dic:trib. fppdprs
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAlJ REQUIRES that the Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
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L~ - TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
ISSUANCE OF PFRIHT
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon is ~rue
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 pertaining to the work described herein; and that rm OCCUPAUCY 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 ons 701.055. that if exempt the basis for ex em i n is noted hereon, and that
only subcontractors and employees who a~e in compliance with ORS 7nl.055 will be used on thi r ect.
1lAf.IE(please print) t....>~O e- c>...ra.C~IUe:r
om 7-19-91
Fi re Zone
Flood Plain
FOr. OFFICE USE miL Y
Type/Const. ~A7 Units Sq. Ftg.
Bedrooms Occy Load ~15 Sg, FtlJ.
Stories. I Occy Group ~? _So' Ftg,
__I2-S~n
.BS
Plan Ck,
65%/Bldo
Plan Ck,
30%JBldo
Fence
ConmlI nd
Per Fee
ROes
Per Fee
"ain.~x?w"7"Valu. Yd/:;' ~
Access x Value.
Other /"2Jv~~N'...>9 Value /~ cS>--<:>
.:i4. TOTAL VALUAJIOrl
>'6-' g~~<!> I't\ //'7~
Systems Development ///''- ....
Charoe (I,5~) ~, ;:>. ~
Zone Z? l. .
BUILDING PERHIT
Charges anc
Surcharges
/I_~B
PLUt1BING PERMIT
Charges and
Surcha rges
,""~."<I?r"~
~-= '2f~_~
/'30.--
ELECTRICAL PERIIIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Demo
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__LL-C;:-" Sidewalk
( . .. //~:) A/C Pa~!~g
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,z.~~/?95::>
TOTAL
/~g,78
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.
Total Comb... Permit
Curb Cut
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" II,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100. Lane County Map Re~erence
11 U3 4j
2, exam~le- Lot ], Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction' lender
D. ,Energy Sources _' . ,
1. example. heat/electrical ceilinq/or forced air qas
2. examele- waterheater/electrical/or solar
E. Square footage or valuation, etc.
], examole- ]250 sq, foot house, 500 sq, foot garage
2. example. i\ new project, check-new - 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. 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,mus't be able to ,ontact.appropriate
\ 'persons 'regarding design information or jo~ site
correct ions, 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
8. Full Plumbing. Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have bee~ abbreviated
2, .. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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
e 1 ectrica 1 contractor for signa ture by hi s e 1 ectri ca 1
supervisor. The general contractor is.not authorized
to sign the electrical label. ---
Ill. 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
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PROJECT CONDITIONS TO BE SATISF,IED BEFORE OCCUPANCY:
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PERMIT.VALIDATION
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. "Permit
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, 'Permit applicantexempf'from registra,tion with the Builder's Board because:
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Additional Project I,nformation:
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PLANS REVIEWED BY:
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'-nam~'~Rk<E?L~~
signature
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date -?-?J/-.~