HomeMy WebLinkAboutPermit Building 1991-1-16
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jlNSPECTION LINE
726-3769
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CITY Uf SPRINGfIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ilater Heater
Range
-6.
IHFOffilATION LINt
726-3753
Sq. Ftg. 14aln
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add A Her Pep.
-Fence Demo Change/Use
-Other- --
Owner' 0-1 5 U;J'//~~.;iPc::.
Address~",....., Uu.,.;i.-4 -~ ~
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Construction lender . ~
Phone
I ValuE of Work:
9'5"c:;e>. -
BuildinQ Permit Info: Descr.be Work(i.e.,
Familv nesidence With Attached Garaaei
BulId Single
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Job Address I~ /.:3 / ~ ,~II ~..,..
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Legal Oe,cr;pt;on / 7...t!JB-'2 ?-A:) -....,?':2.~
Address
DESIGN TEAr4
(namel
i
Phone
(address\
E/4L'I'-"'=' ~~~"z::~~:?-
~.:..cTVA'~ 17571 ~L
~~3~~ .
llics. no.'
(exnires1
(ohone no. \
")</7-97/,41)
Primary
Structural
Electrical
Mechani ca 1
CONTRACTORS (name)
~",nera 1 /)W JfACA- .
{addrpss~
(1 ics. no. \
(exnires1 (nhonp no. \
Plumbino
*
Electrical
~'echanical
PLUI,IBING
ELECTRICAL
MECHANICAL
NO. '
Nn
. FH
r:JAllliE Nn
ere
'ru~
FFF
rARGF
Residence of
Each single fixture
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
() hath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snacp heater and ~pnt
amps.
Appliance vent
c;eDarate
Stationary evap.
cooler
Vent fan wi th
'i:in!;Jle d.!-1ct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re.s. j rteJ'lc~
multifamily, comm. or
Industrial
Water service
Storm Sewer
Of
COMM./INO. FEEOERS
Install/alter/relocate
di stri h. ~ppders
Of
amps.
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I SSUANCE OF PFRliIT
TOTAL CHARGES , TOTAL CHARGES I TOTAL CHARGES
, WHERE STATE UII REQUIRES that ti,e Electrical work be done by an,'Electrical Contractor, the electrical portion of this pennit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINEO 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 NO OCCUPAIKY will be made
o( 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 ate in compliance with ORS 701.055 will be used on this project.
NAfIE{please print)
VI, L \.. .J<:::>rnR,....J
SIGN^TURdiJ, ~.-<V-.~
FOr. OFFICE USE ONLY
Sq. Ftg. 11ain
Sq. Ftg.
.Sq. Ftg.
DAif "'-11-
Zone /.JY7 /
Fire Zo~e
Flood Plain
Type/Const. ~~/'
Bedrooms
Stories /
. Units
Occy Load
Occy Group ~~
Access
Other~/~~
x . Value
x Value:
x~t1J Value
TOTAL VALUATION
~:S-a::::>_ --
BUILDING PER~1lT
Charges and
Surcharges
__2<?.S~~__
, 7_ ..,.-'3
IIJ .Jf5.1{) :it IfsCtC,~
Plan Ck. Corrm/lnd Systems. Development
65%/Blda p.pr Fpp '3':2.8"3 Charqe tL5~l, . '..
Plan Ck. Res
30%/Blda Per Fee
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PLUMBING PERMIT
Charges and
Surcharges
Fence
D~mo
ELECTRICAL PERllIT 'Sidewa 1 k
Charges and ------------
Surcharges Ale Paving
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
7? t73
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COMBINATION APPLICATiON/PERMIT (CAP)
PERMIT W:u DATION
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I. Applicant to. furnish
A. Jo.b Address
B. Legal Oescription
I, example- Tax Lot 100, Lane County Map Reference
17 oj 43
2. example- Lo.t 1. Block 3, 2nd Additio.n to
. sprlngtield Estates . .
C. Name, etc. of 'owner and c'onstruct::ion'lender .
O. EnergySour.ces ..... ..
1. exam~le- heat/electrical ceiling/or forcea:air Qas
2. examyle- waterheater/electr'cal/o~.solar
E. Square fbotage or valuation, 'etc. --..0. , ,
1. example- 1250 sq. foo.t house, 500 sq. fo.ot garage
2. example- if new project, check-new - if addition,
Check add, etc.
F. Building 'permit information:
1. example - construct single family house with an
attached garllge
2. example - remodel existing garage into family room
3. examJPle - convert single family residence into
restaurant (change of use)
G. Value of wo.rk as defined in Sectio.n 303 (a) o.f the
. Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division 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 n~ed 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 Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to. be installed are not co.vered o.n
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 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 I
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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registrati~n with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
name L.c>R#E ~~~Signatur~~~. date /-//-9/
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