HomeMy WebLinkAboutPermit Board of Appeals 1990-5-8
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'CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Meat
l~ater Heater
-
Job Address
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INFDRlIATlON LINt
726-3753
Sq. Ftg. Jlain.
~Q. Ftg. Access.
S,. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
jINSPECTION LINE
726-3769
(name)
Phone
(address)
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Build Single ~
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(exni res 1
Range_
ValuE O~iOr~~
BUilclin~ ~eMn't Info: Describp. \~ork.( Le. t
Family nesidence With Attached Garaae'
legal Description
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owner:TF\\1l\ f-11 (\ ~ /~u.j~ B {(Q
Addres~ ../T -1 9.:: t)... f-.{ aJJ Phone I
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Construe Q 4"11
Address
DES I GN TEAr'1
{lies. no.)
(ohane no. ;
Primary
Mechanical
CONTRACTORS
(name)
{addressl
(1ic~. no.l
~
(exDiresY (ohnnp no. \
Structura 1
Electrical
Genera 1
Plumbina
Electrical "\
~1echanl~al\<\('\S\ \ (\ \ \l ,,~tC\\ 1)1\f)
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PLUrlBING
ELECTRICAL
MECHANICAL
NO.
FFF r.HAR~F Nn
c:f.L '.cHARliE .Jill
:EL .cJJARliE.
SQ. FT.
furnace/burner to
BrU. s
Each single fixture
Residence of
Relocated building -
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p hp~tpr ~nrl wpnt
Storm Sewer
Of
amps.
Appl lance' vent
~~Daratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hnod and duct
Sewer
Temporary Construction
Change in existing
r~<; j 1r.nc~
multifamily, comm. or
Industrial
Water service
CO~1./IND. FEEDERS
Install/alter/relocate
distrib. fppdprs
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vall1 until the
TOTAL CHARGES
that the Electrical work be done by an,
label has been signed by an Electrical
ISSUANCE OF PFRrllT
, TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all infnrmation 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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i oi ng to the work descri bed herei n, and that rID OCCUPAllCY will be made
of any structUfp. without the permission of the Building Division. I further.certify that my registration with the Bui1der1s
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 701.055 will be used on this project.
rW1E (p 1 ease prh..t I Jo~V\ t. Rice. SIGIlATURE
/ ',-, FC~ OFFICE USE OIlLY
Zone Tyoe/Const. Units Sq. Ftg.
Fire Zone Bedrooms O,ccy Load Sq. Ftg.
Flood Plain Stories Occy Group Sq. Ftg.
tfkll\
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~u
DATE
'5.6.'10
x
Value
Value
Value
r1ain
Access
Other
x
x
TOTAL V ALUA TI Ot!
BUILDING PERHIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Pffr Fpp
Plan Ck. Res
30%/Bldq Per Fee
Fence
'Systems Development
Charqe (1.5~)
PLUt1BING PERMIT
Charges and
Surcharges
Demo
'Sidewalk
ELECTRICAL PERIHT
Charges and
Surcharges
AIC Pav; ng
--Lb...~-- Curb Cut
J)~
Total. Comb. Permit
r1ECHANICAL PERMIT,
Charges and
Surcharges
TOTAL
( ~. 'lS
.
e
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II uj 4j
2. example- Lot 1. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ!or forced air Qas
2. examYle. waterheater/electrlcal/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,
cned add. etc.
F. Building pennit information:
1. example - construct single family house with an
attacned garage
2. examele - remodel existing garage into family foom
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 Cnde
H. DESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design infonmation or job site
corrections, etc.
11. Abbreviated Pl~mbing. 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permi t
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Permit appl icant exempt from regi strati on with the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date