HomeMy WebLinkAboutPermit Building 1988-3-11
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CITY UF SPRINGFIELD
COMBIHATION APPLICATION/PERMIT
E1IERGY SOURCES:
Heat
Hater Heater
Range
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INFORJIATlON liNt
726-3753
Sq. Ftg. 1'1ain
~q. Ftg. Access.
Sq. Ftg. Other
--1lew__AddJ(Alter--Yep.
Fence Demo Change/Use
-Other - -
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I INSPECTION LINE
726-376g
Job Add'ress /01 <I- Jla. y 10uJ -Road
Legal Description !Jf[;L -r;LJ(. oJ- -;t}.v& S
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Address ~-;;:~ f.~:J t:;! ~")~<,I
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Construction l~der ~~~
Address
DESIGN TEAM inamel
Primary --I?u.fZf.A I-
valu;t35bO ~
BuilciinQ Pennit Info: Descr,be Work(Le., Build Single
Phon"741~~,~~ Familv nesidence With Attached Garaoel
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flies. no.)
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Phone
(ilddre"is)
(exoires)
(ohane no.
Structura 1
Electrical
Meehan; ca 1
CONTRACTORS Inamel
General ~d,-J../ J-
Plumbino 1..4../~O P/uhf6:...... (
Electrical /11'~ P.d.../rJ rP&rJP':7 _
~'echanical
(address)
(1 ics. no.)
(exn;rps)
(ohnnp no. \
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PLUIIBING
ELECTRICAL
MECHANICAL
NO.
HF r.HAR!;F Nn
I-EEL J:liARG.E. NO
~H. r~~
~ Each single fixture
;/ .-yq.-..,~ 4<_0_: '/..5&-72.:>0
Relocated Duilding
(new fix. additional)
Residence of
SQ. FT.
furnace/burner to
BTU' 5
S.F. Residence
(] bath \
Duplex (I bath) each
Additional bath
New circuits alts.
~ or extensions
'2 0;&(' ./'7?=J<T4i'
SERVICES
::?~tx>
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
sro.a ra tp
Stat; onary evap.
coolar
Vent fan with
sinala duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood i1nd durt
,/fi1P. ""i .
Sewer
Temporary Construction
Change in existing
rpc; j <1e!H"p
multifamily. COlTlTl. or
Tnnuc::triill
~Iater service
L, t;P c:>F~ ~/"'7/,<h '"
7.St1:>
CO~1./IND. FEEDERS
Install/alter/relocate
rl;~trih fpprlpr~
./
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
I SSIIANCf OF PFRIIIT
3? ""t> TOTAL CHARGES =<:<. SO TOTAL CHARGES ~/.-<>'. /. 5"- coo
that the Electrical work be done by an,"Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the compJeted application for permit, and do hereby certify that all information hereon is true
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 NO OCCUPAHCY 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 exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.~~sed on this project.
1lAr-IE(please print)bLA~ r~JI:"'Q4Jood SIGNATUR / ~~p OATE3-/I-&P;
FOP. OfFICE USE DIlLY /
Sq. Ftg. 11ain x Value
Sq. Ft9. Access x Value
Sq. Ftg. Other ~67l Value~~_ -
TOTAL VALUATION
Zone .,c" ,-;
Fi re Zone
Type/Const.~Jlt ~~Vnits
Bedrooms Occy load
Stories I' Occy Group
n' - .:?
Flood Plain
BUILDING PERfllT _____~~S-~_ Plan Ck. Conm/lnd
Charges and 65%/Bldo PJ'r FpF!
Surcharges ::c'-':l.3 Plan Ck. Res
30%/Bldo Per Fee
PLUI1BING PERMIT 3c:? ...,. Fence
Charges and ---- _:..._---
Surcharges /-9:> 0/11110
ELECTRICAL PERlm ----~:p~- 'Sidewalk
Cha rges and
Surcharges / ,/3" A/C Pavi ng
MECHANICAL PERMIT __n/a:.~n Curb Cut
Charges and
Surcharges .75"
"K<'{' ..,P~ ~1I10 Lo
....." ('\ "'- .l' [Systems Development
<>/D..~ t1l~Charqe (1.5%)
N.4
I
i
Irotal Comb. Permit
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. example- Tax Lot 100, Lane County Map Reference
I! oj 43
2. examele- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examele~ heat/electrical ceilinqjor forced air qas
2. examole- waterheaterjelectrical/or solar
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house, 500 sq. foot 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 garage
2. examele - remodel existing garage into family room
3. examele - 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. OESIGN TEN1 ANO 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
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. ---
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.
(I ( 49
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V. FOR OFFICE USE ONLY
Permit Clerk
CL
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
PLANS REVIEWED BY:
name ?aR~ n~~
signatur~.
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