HomeMy WebLinkAboutPermit Building 1986-12-1
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CITY Uf SPRINGFIELD 1IIt
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES,
Heat
-,,-.,"" ("')1""11:\ liater Heater
~T'.
Address
Phone
INfOR/tAT/DN UN<
726-3753
Sq. Ftg. 14ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Range Fence_Demo_Change/Use
ValuE t{aS <t, ~ ~ I _Other
Bui16inQ Permit Info: Describe Work{i.e..
Family nesidence With Attached GaraQel
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Build Single ~
4 p~ 'J\
I INSPECT/ON LINE
726-3769
Job Address
'14\
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Legal Description ~Y::>II? ,\ J.. ) (......1=-1 \,:::,....(')
Owner.
-"DA (" .Ie'
p\ I..1r=r_r-lt;J.
Address
DES I GN T EA/4
(name)
Phone
{address}
'TI-JC>.((>,. (")FP _ ~-l'2.-.n~ l~llThI
\~~l.,~ of
3. \ l\.:).e- ,(o...:>E~<; -CVR./olIIl6-J.
no.) (exnires') (ohone no. I
C'/Ap St.l.A!T
CAi'S~ '. J::\"
flies.
Construction lender
Primary
~
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address)
(1 ir:c;,. no. l
(pxoirpc;,) (ohonp nn. l
General
."'n~ RA")/'"'ja.I~)(_
1..\,\ f) '1 '-\ CR..."'.LO .e.o
ICU(..,{::"uE. C'\~.
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~'-l-O'l...A."I
Plumbino
Electrical
~'echanical
PLUf.lBING
~
ELECTRICAL
rH.G,lli,! NO
MECHANICAL
NO.
FF.F'..... CHARGE Nn.
...
...
rHARG.E.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BrU. s
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
~D~~P hp~tpr ~nrl vpnt
Storm Sewer
Of
CO~4./IND. FEEDERS
Install/alter/relocate
dhtrih. fppdpro:o
'imps,
Appliance vent
o:oeoaratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and durt
~Iater service
Temporary Construction
Change in existing
rp,; j dJ'Jl(~p
multifamily, comm. or
Industrial
Sewer
Wood stove/heater
Of
<imps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
TOTAL CHARGES
ISSUANC, OF PFRrllT
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
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 NO OCCUPA'~CY will 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.
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Zone
Fire Zone
Flood Plain
TVDe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGNATURE
FOR OfFICE USE OIIL Y 1 \
Sq. Ftg. 11!uJ
Sq. Ftg. Access
Sq. Ftg. Other
DATE~
::r'M
(;.:>""--:::'
NM4E(please print)
x
Value
Value
x
x
Value
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges ~
...-:;0 cO PI an Ck. COIIJn/!nd
______?_O~~~ .12!/Bldo Pj'r Fpp
I S7'r Plan Ck. Res
, . 'T 30%IBl do Per Fee
Fence
Systems Development
Charoe tl.5~) .
PLur~BING PERMIT
Charges and
Surcharges
DOAlO
I
I
ELECTRICAL PERIHT
Charges and
~ Surcharges
\MECHANICAL PERMIT
(:harges and
~urcharges
\
~
'Sidewalk
A/C Paving
___________J Curb Cut
I
Total Comb. Permit
I TOTAL
I tj(),O 1/
r-- ,
.
..
COMBINATION APPLICATION/PERMIT (CAP)
l. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II oj 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. examole- 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,
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. 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 TEAfI 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. ---
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:
.
PERMIT VALIDATION
gt1130
((-20~f6
Permit Clerk Cc --'
Permit applicant exempt, from registration with the Builder's .Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
"
date