HomeMy WebLinkAboutPermit Building 1986-10-7
I IrISPECT 1011 LINE
726-3769
.
~@,
CITY UF SPRINGFIELD . INFORlIATION LltOl
COMBIIIATION APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: Sq. Ftq. I"ain
Heat ~q. Ftg. Access.
Ilater Heater Sq. Ftq. Other
Ilew Add A I ter Pep.
Ranqe . -Fence Demo Change/Use
;t505'~. I-Other--
Builriina Pernlit Info: Describe Work(i.e., Build Single
Familv nesidence With Attar.hpd G~raop)
~()II ) f?nr-.~'~ ,-
- ('j
L 1 a... \ 9,7-(, S~
Job Address
f?"(O 25
maJAu
Owner
ih~i7J0tw \.lk.fJ ~
1f7~ 3'
Jd/J ~
Phone 1cJ 1
5371/
CXl
b
~
~
UJ
legal Description
Address
Construction lender
Address
Ut~Jl.iH ltm,
(namel
Phone
(address)
(1 ics. no.l
fexoirfl's)
(ohone no.l
Primary
Structura 1
E1 ectri Cd 1
Mechanical
CONTRACTORS Inamel
General (DODO OL I6D'--IC,
(address)
(lire; no.)
(pxo;rpc:)
lohnnp no. \
~(JFI AJ c..,
Plumbina
1\._
~
Electrical
~'echan;cal
PLUIIB I NG '
ELECTRICAL
MECHANICAL
NO, FEE
Each single fixture
CHARGF
Nn I
I Res i dence of
SQ. FT.
INew circu~ts alts.
or extenslons
1 SERVICES
1
~~~ I r~ARr.~ NO
furnace/burner to
STU' s
1 ~~~
r~ARr.~
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
11 bath)
IOuPIex (1 bath) each
Additional bath
Recessed wall
~n~rp hp~tpr ~nrl vpnt
~Iater service
ITempOrary Construction
Change in existing
rpc;.;rlpnrp
multifamily, comm. or
Tnrluc;.tr;al
Storm Sewer
Of
amps.1
Appliance vent
spoarat.~
Stationary evap.
cooler
Vent fan with
sinale duct.
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct.
Wood stove/heater
Sewer :
1
1
,I
I
I
COMM./IND, FEEDERS
Install/alter/relocate
rl;c;.tr;h_ fpprlprc;.
Of
amps.1
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valid until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCf OF PFR!IIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 oerfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Orel]on pertaining to..the work described herein, and that f~O OCCUPAIKY 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 com51iance with ORS 7Dl.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Groun
SIGIIATURE~
FOr. OFFICE USE miL Y
Sq. Ftg. riain
Sq. Ftn. Access
Sq. Ftq, Other
~
OATEltl'7- rj,
NA/,'E(p1ease print)keHe
/;51;,;,1'1"
x
Value
Value
Value
x
,x
TOTAL VALUATION
BUILDIIlG PERIIIT
Charges and
Surchargesj
tr::f '--'" Plan Ck.
01o.~ 65%IRldo
-------c:?~~-~ ~b~~Bi~~
Fence
Conmll nd
Pf>r Fpp
Res
Per Fee
Systems Development
Charqe (J.5~)
PLU'1BING PERMIT
Charges ana
Surcha rges!
ELECTRICALi PERI~IT
Cha rges an(l
I
Surcha rges!
MECHANICAL! PERMIT
Charges and
Surcharges ;.
Demo
Sidewalk
A/e Paving
Total Comb. rermit
Curb Cut
TOTAL
S~ ,r-; to
.
.
.'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description ...
1. example- Tax lot 100. Lane County Map Reference
II 03 43
2. exampJe- Lot I. Block 3, 2nd Addition to
Spnngtield Estates.
C'. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
12. exampJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot hOus€;,SOO sq. foot garage
2. examole- if new project. check-new-- if addition,
check add, etc.
F; Building permit information:
1. example - construct single family house with an
a ttached garage
2. exam~le - remodel existing garage into family room
3. exa~le - 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 apprapriate
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
wi:ll 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
~6dJ 225:
t 0- / - g 0
Permit Cl erk
Q2/
,
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
I
date