HomeMy WebLinkAboutPermit Building 1989-11-17
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CITY UF SPRINoFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
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(name)
Phone
(address)
INFOR/lATION LINE
726-3753
Sq, Ftg. '.la i n
~q, Ftg, Access,
Sq, Ftg. Other
New Add Alter pep,
Range -Fence Demo Change/Use
ValuE of Work:.It I t5t:5t:5f Other- -
BuildinQ Permit Info: Describe Workli~e," Build Single
Familv Residence With Attached Garaoel
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Ill.".,. ,JN LINE
726-3/69
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Legal Oescription \ V] () -0 J0 J \ orkXXJ
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e c.xu:) 1-'-6"'-' '5
Owner' GDR-Oow 'i"l-"':1U..d.. F,
r '"1'-_
Address ..::J-l1. tv...r.:u t-.) ~ Phone",.,;.,
Job Address'
Construction lender
Address
DESloN nAM
(11es. no.)
(exoiresl
(ahone no. .
Primary
.~
-i~
FI' .
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss)
(lies. no.l
(pxoirps) (ohnnp no_ \
"'Genera 1 )
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Plumbina
Electrical
Hechanical
PLut.1BING
ELECTRICAL
MECHANICAL
..JJQ.."
FEF rHAPGF Nn
~~L -.C1:fAH.G.E. NO
~H r~~
Each single fixture
Residence of
SQ. FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
C1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
sp-oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dud
Sewer
Temporary Construction
Change in existing
rps i dJIJu"p
multifamily, comm. or
Induc:trial
Water service
COMfI./IND. FEEDERS
Install/alter/relocate
dic:trih. fppdprc:
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
TOTAL CHARGES
ISSUANcr 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 1s true
and correct, and I further certify that any and all work Derformed 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 tlO 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 compliance with ORS 7nl.055 will be used on~ project.
NAf.IE(please print):T'"', U" e.F......~~ SIGNATURE k )~n~ DATE
FOr. OFFICE USE DilLY ( ,
Zone Tvpe/Const. Units Sq. Ftg. rfa.uJ x Value
Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PER~1lT
Charges and
Surcharges
Lf\ ~ r'\ Plan Ck,
___ '_L:...,)'!:""!__ 65%/Bldo
od Plan Ck.
, . 0"1'\ 30%lBlda
COI1lll/lnd
Ppr Fep
Res
Per Fee
Systems Development
Charae t!.5~) ,
PLUMBING PERMIT
Charges and
Surcharges
Fence
------------1
DfllllO
I'Sidewal k
lAIC Pavi ng
I Curb Cut
I ,y
. ,
I
I
I
ITotal Comb. Permit
ELECTRICAL PERIIIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
\ ~'6?J
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
17 oj 43
2. exa~le- Lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. : example~ heat/electrical ceilin...Q/or forced air qas
2. example- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
checl< add, 'etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage ,
2. example - remodel existing garage into family room
3. examole - 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
0, 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 wnen the permit is issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,I
.,',!
date