HomeMy WebLinkAboutPermit Building 1989-9-6
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EilERGY SOURCES:
Heat
l~ater Heater
Range
ValuE of flork:
oIlS L,5'l
1'-1 lD BuilriinQ Pennit Info:
Phon",=;., o'J.,- Famil V neS i dence Hith
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INFORlIATlON
726-3753
Sq, Ftq. 1.lain
~q. F'tg. Access.
Sq, Ftq, Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Build Single ~
~NC('. ()
Job Address
~y 'L ~10 Sf'
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("11')(2...0" r-..)
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legal Oe,cription
Owner
Address
Describe Work(;.e..
Attached Garaae)
Address
OES I GN 1 EAI1
(name)
Phone
(address)
~ ~'loa SQ. PI.
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Construction lender
Mechanical
CONTRACTORS
~eneral)
I
I
4<
Primary
Structural
Electrical
(name)
(address) f1ic~_ no. \ (p"lCo;rp<;l (nhnl'lp on ,
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f..:;t)r.....rs~
9,401..>
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Plumbina
Electrical
Hechanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE Nn
~~L...c.liARG.E. NO
~~~ 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
(1 bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp kp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
s.eoarat.p
Sta'tionary evap.
c.ooler
Vent fan with
sinole du~~,
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
Sewer
Temporary Construction
Change in existing
rps j dPflcp
multifamily. COnJll. or
Indu"trial
Water service
CO~1./INO. FEEDERS
Install/alter/relocate
rlh:.trih_ fppdpr<:.
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L'H REQUIRES
shall not be valij until the
TOTAL CHARGES
ISSUANCE OF P~RllIT
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 OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 7nl.055 will be used on this project.
IIAl,IE(please print) .::::rl M.. ~s..s. SI(,IIATURE A\Ml J ~.~
'.L. l' FOr. OFFiCE USE OIIL Y (,
Zone Type/con~ JCof--unitS Sq. Ftg. t1afitJ x
Fire Zone Bedrooms Occy load Sq. Ftg. Access x
Flood Plain Stories Occy Group Sq. Ftg, Other x
OATE
Value
Value
Value
BUILDING PERfIlT
Charges and
Surcharges
,~~ 60 . Plan Ck.
~l.I' 65%/Rldo
----, --(""3- Plan Ck.
, . '"\ 30%/BldQ
Fence
ConmlInd
Ppr Fpp
R"es
Per Fee
'Systems Development
Charoe (1,5~) ,
TOTAL VALUATION
"'-'') . ~
-~
PLUl1BING PERMIT
Charges and
Surcharges
Demo
'Sidewalk
AIC Paving
Total Comb. Permit
ELECTRiCAL PERllIT
Cha rges and
Surcharges
r1ECHANICAL PERMIT
Charges and
Surcharges
TOTAL
:~),u~
.
Curb Cut
I
.~ i' ..
.
COMBINATION APPLICATION/PERMIT (CAP)
",.
H..
I. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100, Lane County Map Reference
11 03 43
2, example- Lot I, Block 3, 2nd Addition to
~pr'ngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilin~/or forced air Qas
2. examyle- waterheater/electrlcal/or sotar
E. Square footage or valuation, etc. ------
I. example- 1250 sq, foot house, 500 sq. foot garage
2. examp.le- if new project. check!ruew - if addition,
check add, etc,
F. Bu"ilding permit information:
1. examole - construct single family house with an
attached garage
2. examgle - 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
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
signa ture.
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:
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Pomit Clock ~if- q! oX-
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS
REV<:IJeB BY:
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