HomeMy WebLinkAboutPermit Building 1989-10-25
I INSPECTION LINE
726-3769
.
.
INF0R11ATION LINE
726-3753
Sq. Ftq, I.'ain
~q. Ftg, Access.
Sq, Ftg, Other
rlew Add A 1ter P.ep,
-Fence Oemo Change/Use
Other- -
Job Address ,
437
'(Vld~
CITY Uf SPRINGfIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hor~ .
<lPSOO.OO
. t". :',BuildlnQ Penn'ft info::'Oescr beWork{he~~ Build S(ingle
. . "':.~ ::~ ...~:. "\ ',: Ph9~~.~' .~f. . I ,Famil v nesidence.Hi thAttached_Gara~e 1 '. ~ ~.... p+. ,j
..""..,'.."..'......->' .., ';: r~\i'p: .""e xi'&-fr'~ ' <::,j'~ ~_ .
re..O /,Q,e.tJ . LI J;~ JA 0.1, 1 ".
Legal Oe,eription
Owner (~5 r3~
Address. L~ .P. ;:'" ::":',
4 . '" .:..,....... .l.' .~~,_
....'1.
Construction lender
Address
UES I GN I EAl1
... {namel
Phone
(addressl
fl ics. no.l
{exniresl
(ohone no.l
Primary
Structura 1
Electrical
Ii
i
Mechanical
CONTRACTORS
(namel
laddresc;1
l1ics.no.\
(pxnires\
fohnne no. \
Genera 1
Po, iSox f)::J...{ Bu.-cJ../)~,
PfTto~
Q-5c.... to/C;O
.?x2-2.182
PLUIIB I NG
ELECTRICAL
MECHANICAL
NO,
FEE CIlIiBYL ~n
FFF rHq&G[ Nn,
F F F . J:lJARliE.
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(( bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~n~rp hPAtpr Ann vpnt
Storm Sewer
Of
COMfI,/INO. FEEOERS
Install/alter/relocate
di~trib. fppdpr~
amps.
Appliance vent
SE!oaratp
Stationary evap.
cooler
Vent fan wi th
sinalf! duct
Vent system apart from
hf!atino or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
~/i.,
14lf
Sewer
Temporary Construction
Change in existing
resJ (te.nc~
multifamily, comm. or
rnduc;trial
~Iater service
Of
amps.
"
TOTAL CHARGES
WIIERE STATE L~H REQUIRES
shall not be vali1 until the
TOTAL CHARGES
I SSUANCF nF PFRlm
TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical rortion of this permit
label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXM11NED the completed aprlication 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 110 OCCUPAIICY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
rlAl-tE(please print)
Zone
Fire Zone
Flood Plain
Type/Const,
Bedrooms
Stories
Units
Occy" Load
Occy Group
SI"IlATURF.
FOP. OFF I CE USE OIIL Y
Sq, Ftg, Itain
Sq, Ftg, Access
Sq, Ftg, Other
OATE
x
x
x
Value
Value
Value
TOTAL VALUATlOII
BUILOING PWHT
Charges and
Surcharges
Plan Ck, Comm/lnd
__ _______ ___ ~/Blda P.f~r Fee
Plan Ck. Res
30%/Bldo Per Fee
Fence
Systems Development
Charo. (1.5~)
.-
PLUr1BING PERMIT
Charges and
Surcha rges
O~mo
__~~..:~___ Sidewalk
'IS A/C Paving
Curb Cut
Total Comb. rermit
ELECTRICAL PERIHT
Cha rges and
Surcharges
"~l
..~
,~ .
.1'
11ECIIANICAl PERMIT
Charges and
Surcharges
TOTAL
I \~,')~
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B. Legal Description
J, example- Tax Lot JOO, Lane County Map Reference
Jl 03 43
2, example- Lot J, Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check new - if addition.
cnecK add, etc,
F. Building permit information:
I, example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam!?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
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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
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 penmit is issued.
to .~ca.81
~\Sd\5
,
~~~.
V, FOR OFFICE USE ONLY
Permit Clerk
~~
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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
signature
date