HomeMy WebLinkAboutPermit Building 1990-4-3
CITY Of SPRINGfIELD
CqMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Hp.at
Hater Heater
Ran~e
.
'......
,
INFORllATlON LINt
7?~-,7,1
Sq. Ftg. f;ain-'.
~q. !=t!]. Access.
Sq. Ftg. Other
flew Add Alter P.ep.
--Fence Demo Change/Use
Other- -
ValuEl'lf 1)1[~ ci:)
<. l,r.1.-{ I
Bundin\! Penn1t info: Describe \~ork( Le.,
Fami1 v ~esidence IH th Attached Garaae)
Build Single
c
I~
(J
Address
Ul~lliN rE:.Ar~
(name)
\Z~r
Phone
(address)
I_diDO" rif?
f1 ics. no.l
'''O;"~'""l2f::n.l
Primary
r,~
~N-3
\f?)g. 1\1.\.) O\\Of<ttN
Structural
Electrical
Mechanical
CONTRACTORS lnamel
General R()~ E (,>M At.oI\H~
Plumbina
\ ~ r~~es~, W {)l \/){JlI~r: ~V~t~ N1pxn4Rto9.'L (2:; ~2'y;t
,wr 8,14 jqr
Electrical
~1echanical
PLUlIBI NG
ELECTRICAL
MECHANICAL
NO,
FFF r:HARGF ~n
eEL.tIlAIlliE. NO
t:'n' ru~
Each single fixture
Residence of
SQ. FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits a1t5.
or extensions
Floor fu rnace
and vent
S.F. Residence
(j bath I
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp np~tpr ~nrl u~nt
Storm Sewer
Of
amps.
Appliance- vent
~~oaratp
Stationary evap.
rflfllpr
Vent-fan with
sinole duct.
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hnnd and rtllrt
Sewer
Temporary Construction
Change in existing
I"P~ j d_p)'Irp
multifamily. camm. or
I nrtus tri ill
~!ater servi ce
COMfl,/IND. FEEDERS
Install/alter/relocate
di~trih. fppdpr~
Wood stove/heater
Of
amps.
I SSUANCf OF PFR!1lT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit f'
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 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 UO OCCUPAllCY will be made
of any structure without the permission of tthilding Division. I further certify that my registration with the Builder's
Board is in full ill fr and effect as required y ORS 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractor an ,playees who are in om! liance with OP.S 701.055 will be used on this project.
, ~ Q
IlAlIE(please print. . ,A1V\1\ ~, ~IGfIATURE ~I'\ n\.. \\.'lBA~ DATE..2Lla\ q6
I FOP. OFFICE USE OiILY
I
Type/Canst. Units Sq. Ftg. t1ain x Value
Bedrooms Occy load Sq. Ft~. Access x Value
Stories I Occy Group dIl-"'3 Sq. Ftg, Other #-~/ffi'~ Value 9~,~
U ' TOTAL VALUATIOtl
Zone <<:::: c..
Fire Zone
Flood Plain
BUILDING PERHIT __'5-~_C2!?__ Plan Ck. COIllll!l nd ::2:"5"'..0 ?
Cha rges an':: 65%/Bldn Ppr Fee
Surcharges ~9;3 Plan Ck. R-es
30%/Bldo Per Fee
PLU>~BING PERMIT Fence
Charges and ------------
Surcharges D~mo
{, ELECTRICAL PERI:IT 'n~~~~ Sidewalk
Cha rges and
SurCharges - A/C Paving
-
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charo. (1.5%)
#.~
. Total Comb. rermit
TOTAL
b;5"; Yrb
.
e
~,. _...
.. - .
-- ,
.
COMBINATIG:i APPLICATION/PERMIT (CAP)
-;
I
, PERMIT VAll DATION
~
I. Appl icant to furnish
A. Job Address
B, legal Description
I, example- Tax lot 100, lane County Map Reference
17 D3 43
2. example- lot I. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
L exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I, examole- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
cnecK add, etc.
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. exa~le - 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 (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
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
-*' l (;<;tl(
~
Permit Clerk ~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Pro~ect Information:
.
PLANS REVI EWED BY: '.'
name
, , ~ /"
&gnfF ?~~Signature~../1"~~~ date
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