HomeMy WebLinkAboutPermit Building 1983-8-16
"
11rlSPECTIOrl L1IIE
726-3769
.
.
~ . CITY OF SPRINGfiELD
COMBIIIATION APPLlCATIDN/PERMIT
..L EilERGY SOURCES: ._____'
___..ffif'\ ~- (\ 0A , Heat_____
flSrff) Hat~" eater
]l6ge .:..-
ValuE
INfORllATION UN.
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. ftg. Other
~lew_Add_Alter~p.
fence Oemo Change/Use
Other- -
Job Address t1 \ n
Legal Description \-1l)).;~S4~
, .
Owner liC\~Q rt
Address \ \)
of nl)(~oO
Builriina Permit Info: Oescribe Work(i,e., Build Single
Familv nesidence With Attached Garaoe)
I fi. 0 - "l\ ~I 0 f1VW't'\ 0 \\ lif1 \L,
- - ) P{~~_,
, Y IN II Q, ..l f,.,Q ~-B~ j
- - (lics.no~ (exo;res)
\"('l lAW,," J
\.\
Phone
Construction lender
Address
DESIGrl TEAI1
(name)
Phone
(address )
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS Inamel
General, !) nf,
a
-D
'"'
f
(ahoM no.
Plumbina
~f~hnJ
<9(~()~L\ rl\()h~~~-r: 0 l(;;~QPM ~ fohnnpnn \
-J l 0 ~~4 -C'JP,( all
,
I
I
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
Electrical
~lechanical
PLUIIBI riG
ELECTRICAL
MECHANICAL
NO.
FEF r:HARr.F Nn ~n rJiAB..G.[ NO
Res i dence of furnace/burner to
SQ. fT. BTU's
Each single fixture
Relocated building
(new fix, additional)
,. I
S. F. Res'i dence
(] bath)
Duplex (1 bat~) each
New circuits alts.
or extensions
Floor furnace
and vent
:\
\' I
"-,
-,./-
'~/
Recessed wall
Snarp hpatp~ anti vpnt
SERVICES
, '
Additional bath
ITemporary Construction
/Change in existing
rp~.i rl~n('p
Imultifamily, comm. or
Industrial
10f amps.1
ICOMfI./IND. FEEDERS I
IInstall/alter/relocate I
rlic;t~ih_ fpprlp~c:
10f amp,,1
Appliance vent
~eDa ra tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I'
heatina or A,C.
I Meehan i ca 1 exhaus t
hnod and dud
IloJOOd stove/heater
I
I
I
~-
\folater service
Sewer
I Storm Sewer
I
I
I
I
I
I
ISSUANCE Of PFRIHT
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I~ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
t:"t:"~ r~
/
~p
I
I
I
I
I
I
I
I HAVE CAREFULLY EXN1INED 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 oerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Ore~lOn perta i ni ng to the work descri bed herei n, and that rw OCCUPAr~CY wi 11 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 701.055 will be used on this project.
UAlIE(please print) HICIlIfU A'OV J(O~
SIr,IIAT~..'c.-~/~...........~
FO~ Off! CE lfSE OIIL Y ,
Sq. Ftg. rlain ,x
Sq. ftD. Access x
Sq, ftg. Other x
Value
Value
Value
OATE gp6'/~
Zone
Fire Zone
flood Plain
Type/Cons t.
Bedrooms
S tori es
Units
Occy Load
Occy Group
TOTAL V ALUA TI Or!
BUILOIllG PERI-lIT
Charges an~
Surcharges
/11 CD Plan Ck,
__~-*_______ 65'URldo
J1r> Plan Ck.
'1?"1 30%lBldo
Systems Development
Charae tl.5~) ,
Conm/Ind
Ppr Fpp
Res
Per Fee
PLU'1BING PERMIT
Charges and
Surcharges
Fence
O@mo
ELECTRICAL PER'~IT 'Sidewalk
Charges and ------------
Surcharges A/C Paving
Total Comb. Permit
~,
TOTAL
1~.Y~
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
11 oj 43
2. ,exam~le- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air qas
2. examyle- waterheatertelectrlcal/or ~
E. . Square footage or valuation, etc.
I. examDle- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-nfw - if addition.
check add, etc.
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. examQle - remodel existing garage into family room
3. example - 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. OESIGN TE~~ 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 ANO
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 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:
--"..-
PERMIT VALIDATION
..
~0Jll- QL
~ . {{Q/33 .
{jj{~S8
"-....
Permit
Clerk~(~
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
,I