HomeMy WebLinkAboutPermit Building 1988-1-6
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. INSPECTION LINE
II 726-3769
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INFORllATION LINt
726-3753
Sq. Ftg. 1.la i n
~q. Ftg. Access.
Sq. Ft9. Other
flew Add Alter Rep.
-Fence Demo Change/Use
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater.
Job Address
Legal Description /1fi? -0 <-0 1-~~
,
Owner lI(5e~ ~.
Address'~ -'">. ~6""" ~/~~ Phone
r~.. rV':A /4" c.- 7~~~/./:~
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Construction Lender
Address
Ut~ LGN I tAf~
{nameJ
Phone
(address 1
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name I
(address)
General Dw~
Plumbino
Electrical
~1echanical
PLUIIB I NG
NO.1
-----lEach single fixture
IRelOCa(ed building
(new fix. additional)
IS.F. Residence
(1 bath)
IDuplex (1 bath) each
Additional bath
Range
ValuE: of Hark:
:::< ~ _ .be>
Builtiina Permit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaae)
ffC:?CH-L' e ~ 1!-;z;>,....~ s....4Zr-
E:.ur ,P""""'r?<5' -I /--+"1r-A'~<'" I
Gk77_;':.>~5_'_""S-?~/<"? ~.
(lies. no.) (exoiresl (ohone no. \
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(pxnirpc;)
(ohnnp no.
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ELECTRICAL
MECHANICAL
FEF r.HARGE Ij(l ITL JJiAIlIiE. NO
Residence of furnace/burner to
SQ. FT. BTU's
New circuits alts.
or extensions
SERVICES
~~L-.C.I:iARG.E..
Floor furnace
and vent
Recessed wall
~ni!.l"'P hp~tp~ ~nrl vpnt
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hond and duct
~Iater service
Temporary Construction
Change in existing
re~ j 4CJ'H~p'
multifamily, comm. or
IndlJ~trial
Sewer
Storm Sewer
Of
COffi1./IND. FEEDERS
Install/alter/relocate
dic;.trih_ fppf'lprc:
Of
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TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until (he
TOTAL CHARGES
that the Electrical work be done by an.
label has been signed by an Electrical
Wood stove/heater
amps.
I SSUANCf OF PFRllIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 performed 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 UO 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
SIGNATURE .
FOR OFFICE USE OIIL Y
So. Ftg,
Sq. Ftg.
Sq. Ftg.
NAI.IE(please print)
~C\{oIJ R. \-\lAv'tL.fl) Jf
Zone
Fire Zone
Flood Plain
~A/.
Units
Occy Load
Occ,Y GroupJq- ---
Tvoe/Const.
Bedrooms
Stories
BUILDING PER/lIT
Charges and...~ ,
Surcharges .,;'
10. ~ ~~a~B~~~
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_ Plan Ck.
_ ~ t:> 30l/Bl do
Fence
ConmlI nd
Ppr J:'pp
Res
Per Fee
PLUl1BING PERMIT
Charges and
Surcharges
D/IAlo
'Sidewalk
ELECTRICAL PERI~1T
Cha rges and
Surcharges
11ECMANICAL PERMIT
Charges and
Surcharges
A/C Paving
'., I Curb Cut
__n n nn--I
DATE Ilbld' 8
t1ain x Value
Access x Value
Other~~"x Value OZ<;=-_......
TOTAL VALUATION
Systems Development
Charqe (!.5~)
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Total Comb. Permit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B, Legal Description
1, example- Tax Lot 100, Lane County Map Reference
II U3 43
2, exam~le- Lot I. Block 3, 2nd Addition to
.spnngt.ield ~states. . - ", ,'" ,'"
C. Name, etc. of owner and construction lender
D. . Energy Sources . '\ .. to.
_ 1. example- heat/electrical ceiling/or forced air Qas
2..~ examole- waterheaterjelectrical/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 pennit information:
1. example - construct single family house with an
attached garage
2. examole - 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 (al of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
~ivision 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 ~ivision
1. To conserve space on the penmit fonm 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 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
electrical contractor for signature by his electrical
supervisor. The general contractor is ,not authorized
to sign the electrical label. ---
Applicant to Sign and date
Whenever possible, the initial application will b~ used as
a worksheet only. Where possible, Building Oivision 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.
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V. FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CDNDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board besause:
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'- 'Additional Project Information:
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PLANS REVIEWED BY:
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name / .L73~c;;- ?C~~ Signature/?~__ _.~~~.,..'1a~e /-6-&:E?
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