HomeMy WebLinkAboutPermit Building 1988-2-22
I INSPECTION LINE
726-376g
-,
CITY Of SPRINGfIELD
COHBINATION APPLICATION/PERMIT
EIIERGY SOORCES:
Heat
Hater Heater
Range
.
INFORlIATION UNE
726-3753
Sq. Ftg. '-lain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
-Fence Demo Change/Use
Other- -
.~
C>
,
-
Job Address
Cl.:L~ rv1~
Legal Description 11 C-'.:IS 3:1
O~c::lOo
ifJ
owner.........-K~h ~.YlJ...~
Address I, ~ LU:' Q: .
~. 0 fL ql.!:tr1
Construct~n Lender
Phone
ValUE of Hork: cD
.It 115..JD -
Bul10ina Permit Info: Describe Work(i.e.,
Familv nesidence With Attached Garaael
Build Single
/.to ..,.
(vL.,,('
1200.(:,";,
/+"... ""'-wy
Address
DESIGN TEAl1
(name)
. Phone
(address)
nics. no.)
(exoires)
r ohane no.-
Primary
Electrical
V"l
7'
t'(,)!,
~NY)
Structural
Mechanical
CONTRAC TORS
(namel
(address)
(l ics. no.l
NO.1
Each single fixture
I FEF I r.HARr.F NO I
tf-Z1dc z.
I r"'"RGJ Nn
(pxoirpc::'
~ -
~
~
CP J.z..., IfX('
,
MECHANICAL
(ahonp nn. 1
Genera 1
Plumbina
Electrical
flechanical 600n tJ\e.. ~l~~~:..!..\ ~..
PLUMBING ELECTRICAL
I ~~~
ICt"~I...c.J:JARG.E
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So",.p hp,,"tp.. ::Inri \/I'.nt
Storm Sewer
Of
amps.
Appliance vent
seoari'lt.p
Stationary evap.
cooler
Vent fan wi th
sino1p. duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood i'lnd duc.t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rPs. i d_PJH~p
multifamily, comm. or
TndIJ,tri<ll
~Iater service
.~ ' .
Of
amps.
He.-r %..~
I
I
I
1.;1/..,6<
I .
I
COMfl./lND. FEEDERS
Install/alter/relocate
ni,trih. fPPrlpr,
\..101
,
. "
(
ISSUANC, nF PFRtIlT
TOTAL CHARGES TOTAL CHMGES TOTAL CHARGES .;;:;,<.:,5<'.'
WHERE STATE L.\\/ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
shall not be valij until the label has been signed by an Electrical 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 fW OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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.
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy load
Occy Group
SIGUATUREffi._ / ~
FO~ OFFIC( OSE DilLY
Sa. Ftg. Ilain
Sq. Ft~. Access
Sq. Ftg. Other
DATE
(}.-;J...)'- fr
nJ
IWIE(please print) C~N'e. rdSt~
x
x
x
Value
Value
Value
TOTAL V ALUA TI ON
BOILDING PERfllT
Charges ant:
Surcharges
Plan Ck.
____________ 65%1Bldo
Plan Ck.
30%lBldo
I Fence
I DfIRlo
I Sidewalk
I A/C Paving
____~~~__I Curb Cut
1.:33 I
Comm/Ind
Ppr F""""
Res
Per Fpp
Systems Development
Charqe (1.5~)
PLU11BING PERMIT
Charges and
Surcha rges
I
I
I
ELECTRICAL PERIIlT
Cha rges and
Surcharges
MECHANICAL PERHIT
Charges and 'n
Surcharges l"
ITota1 Comb. Permit
I
I TOTAL
.;zl ~
~
~
, .
..
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 oj 43
2. example- Lot 1. Block 3, 2nd Addition to
Springtield Estates .
. C. Name, etc. of owner and construction lender
D. Energy Sources
1. examl?le- heat/electrical ceilinqjor forced air qas
2. examole. waterheater/electricalfor solar
E. Square footage or valuation. etc. -----
I. 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. exa~le - 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 (a) of 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 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 Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. I f the item( s) to be ins ta 11 ed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BOILDING 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. ---
III. Applicant to sign and date
Whenever possible, the initial application will b~ 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
signa ture.
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.
dJlL'
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Permit Clerk
V. FOR OFFICE USE ONLY
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additio~al Project Information:
.
PLANS REVIEWED BY:
date
signature
name
,