HomeMy WebLinkAboutPermit Building 1984-8-20
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I INSPECTION LINE
726-3769
Job Address
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CITY Uf SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
INFDRt1ATlON LINt
, 726-3753
So. Fto, 1,lain
~q. ftg. Access.
Sq, Ft9, Other
Uew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
f'.,
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legal De5cr;ption
Owne r .
nr~
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~rJU4-'-'-U7 j(
[) Phone
Address
Construction lender
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Address
DESIGN TEAI1
(name)
Phone
(address)
flies. no.)
(exoi res)
; Primary
Structura 1
Electrical
Mechanical
CONTRACTORS (name) D I addre<<)
Gerteral (;),,UJ'YfA.J A2,.."MZ._j 4M-v fl(J(JJ1.VOcIJ
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Pl umb; no
(1;("0;.. no. \ (pynir",,,-'
~ Oli41 ,-c. e,/;r!i::-
{nrn-;'~ M _ '
7n'7_~-::J4f:
Electrical
~lechan;cal
PLUIIBING
ELECTRICAL
MECHANICAL
NO, I
I~ach single fixture
IRelocated building
(new fix. additional)
IS.F. Residence
(1 bathl
IDuplex (1 bath) each
IAdditional bath
I ~Iater service
I Sewer
Istorm Sewer
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I FEF I r:HARhf
NO I
Residence of
I n'~ I n.jllIU~~ NO I
I t:'t:'t:'
I rUAQ(::t:'
SQ, FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall I
c;n,;lrl:l hp:.to," ,;Inrf IIpnt
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ITempOrary Construction
IChange in existing
rl'>~.i df'nc:e
Imultifamily, COrll!1. or
Tnrlll~triil.l
IOf amps.1
ICOffi1,/IND. FEEDERS
I Install/alter/relocate
rl;~trih fppdpr~
Of amps.1
Appliance vent
o:;eoaratp
Stationary evao.
rnnlpr'" .
Vent -'fan with
dnl'11p rfllrt.
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and dud
Wood stove/heater
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ISSUANCf OF PFR!IlT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed apfllication 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 OCCUPAfKY 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 employ~s who are,in compliance with OP.S 7nl.055 will be used on this project.
Po..." ; do -J L..) ,,-l!< e '"
UA/,1E(pIease print) l3u:)J.,.., ~ClCl t,'".. Set' SIGlIATVRE JJ~ Q W~
.. ,- FO~ OFF I CE US'. 0111 Y ,
DATE
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Zone
Fire Zone
Flood Plain
BUILDING PERIIIT
Charges and
Surcharges
Units Sq. Ftg. r1ain x Value
Occy load Sq. Ftg. Access x Value
Dccy Group Sq. Ftg. Other x Value
A!UJT tJSt:- t'tP,t= QI-~II-/QtvJ.)J7 t1JJ7il;ftJrr;t'_f
' Plan Ck. Comm/Inct I shs~ems Development
____________ 65%1B1do ppr <p,,-_ C aroe (J.5~) ,
Plan Ck, Res I fH'
30%lBl do Per Fee ---;;'/0 -
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Tyoe/ConsL
Bedrooms
Stories
/.2%
PLUI1BING PERMIT
Charges and
Surcha rges
Fence
ELECTR I CAL 'PERI:IT
Charges and
Surcharges
DIIRlO
I Sidewalk
I A/C Pavi ng
I Curb Cut
I ~ j)1N>i2
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ITotal Comb. Permit
liECHANICAL PERMIT
Charges and
Surcharges
:Sa. ()-C)
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I TOTAL
3'3. C1J
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8<!os-97
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
#::-~ ? '/ 10
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I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2, example- Lot I, Block 3, 2nd Addition to
>pringtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. exam~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I, examDle- 1250 sq, foot house, 500 sq, foot garage
2. examp'le- 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. example - remodel existing garage into family room
3. exa~le - 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. 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 OOT 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. ---
Ill. 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
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 DNLY
Permit Clerk () ~ _
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exemp.t from registration with the Builder'.s Boar~ because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date