HomeMy WebLinkAboutPermit Building 1982-1-13
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CITY Of SPRINGFIELD
Cm1BI:IATION APPlICATION/PERMIT
E!lERGY SOORCES:
Heat
(-later Heater
Range
INFORIIATION liNt I
726-3753
Sq, Ftg, 1.lain
~q. Ftg. Access.
5q, Ftg, Other
New Add Alter ~ep,
--Fence Demo Change/Use
Other- -
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I INSPECTION liNE,
726-3769
Job Address
Co II ~n1.ClLn Sh p :; ,f-:
Dmription 17,"~"'S-31 . ~?<'t::d
,
Legal
'D OJ\ C.O,,;''. -te ~-'
Address :~. n. l~nX
~o+Ad .
Construction lender
F,() (()
Phone 740. r;9S~
Valu'.t.P.f Hork: :)"'
lJ 3 nOr) ( U
BUlld;nQ Pennit Info: Describe t~ork(i-.e.. Build Single
Familv ~es;dence With Attached GaraQe\
C-1L>ti~~~.lf')'; \ \.\ A^"__~.l~
M,-rE;;;}/6R 7?~&JEL. "'Z>P
"3 e>rr/~~ tl ~~~,&. t 8.-,
(lies. no.)' (exoiresl
II
no. )
Owner
Address
DESIGN TEAll
(name)
Phone
(address)
(ohone
Electrical
~
Primary
Structural
Mechanical
CONTRACTORS
Genera 1
(name)
N ~(},lljV
(address)
(1ir:~. no.)
(~)[nire!i;)
(ohone no. )
Plumbina
Electrical (VE71IT'7')
~1echan;cal
PLOIIBING
ELECTRICAL
MECHANICAL
NO. .
Each single fixture
FFF . r.HARGF Nn ~r:r: rl-l.Q,Rr.~ NO.
Residence of furnace/burner to
5Q, FT. BTU's
. F'~~ . rHA~r.~
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Relocated building
(new fix, additional)
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New circuits alts.
0:2 ex:,;~o.:%.sn e
SERVICES
IS'"
Floor furnace
and vent
S.F. Residence
(I bath l
Duplex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
IOf
ICO~1,/IND, FEEDERS
Ilnstall/alter/relocate I
l'iic:;trih_ fpprlprc:;
10f -'amps.1
amps.1
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Appliance vent
<;'PDi'lr~tp
Stationary evap.
cooler
Vent fan with
sino1e duct
Vent system_apart from I
heatinq or A.C.
Mechanical exhaust I
hood and duct
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~Iater service
ITemporary Construction
IChange in existing
re<;.idence .
Imultifami1y, comm. or
Inrluc;.tri;11
Sewer
Wood stove/heater
TOTAL CHARGES
. WHERE STATE lAH REQOIRES
shall not be va1i1 until the
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/$":011> TOTAL CHARGES
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
ISSUANCE OF PERlnT
TOTAL CHARGES
I HAVE CAREFULLY EXN1INED 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 oerformed shall be done' ~ordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work des ed herein. and th UO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I furthe certif)V'that my re 'st~ati with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exe t the basis for ption' noted hereon. and that
only suhcontractors and employees who are in compliance with ORS 7nl,05/1"i~1~S~ s / t,
I~AI-IE(please print).]:2.Cfl "! 1? (114 .eft? I'? SIGII^TURE ~d It ,/ 'L DATE/' I J ~F'2... !
FOR OFFICE OSE/Oi~L y--' ,
Sq. Ftg. r1ain
Sq. Ftg. Access
1?- 2. Sq. Ftg. Other.u,T.
~e::.
Tvoe/Const.;tZI:'-A~
Bedrooms
Zone
Fire Zone
Flood Plain
Stori es
I
Units
Occy Load
Occy Group
Comm!l nd
Ppr Ff>p
R-es
Per Fpp
i-//~S :;
't .~
., /':7.!~ 0
x Value
x Value
/.fEH6pEc.. Value
TOTAL VALUATION
~~ '; ,--
;,.,._____ <r ~
BUILDING PERfIIT
Charges and
Surcharges
"-'li _ Plan Ck.
.... T' 65%/Rldo
------------ Plan Ck.
. ~~ 30%/Bldo
{ r, -i_~'?
u..... f......., L~
(lL
Systems Development
Charqe (1.5%)
PL0I1BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICP.L PERlm
Charges and
Surcharges
I~ - I Sidewalk
----- -~'o-I A/C Paving
I Curb Cut
------~.~~~
Total Comb, rermit
'1tP. 56
7"t:'.'5"'~
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IiECHANICAl PERMIT
Charges and
Surcharges
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I TOTAL
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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
11 03 43
Z.example- Lot 1. Block 3,Zrid Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1, examole- lZ50 sq, foot house, 500 sq, foot 9arage
2. examp.le- 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. example - remodel existing garage into family room
3. examyle - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (al of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction~deJ~Ys, ~uilding .
Divis ion Staff must be-"abl'e' to~;ccint'act' 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 OIVISION 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 si9n 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.
diroDz/rJD
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V, FOR OFFICE USE ONLY
Permi t Cl erk
(I~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
. --.
name L.,l'i'g~ ~F<;'~Signature+.--, --Y;;'~ date I-/~~
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