HomeMy WebLinkAboutPermit Building 1984-4-25
I IrlSPECTlOrI L1r1E
726-3769
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CITY UF SPRINGFIELD
COMBlrlATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
.
INFORlIATlON UNc
726-3753
Sq. Ftg, '-lain
~q. Ftg. Access,
Sq, Ftg. Other
New Add Alter Rep,
--Fence Demo Change/Use
Other- -
Legal
34<; 7'i/0JJ) cSt.
Oescription\ I)fJ~::b ~ I \ 9 ()[;()
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Range
Job Address
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uJ i I--.!-f\ s.1,
11
ValuJ of Hork: au
.:J11 ~OO.
BUiloinb Permit Info:
Familv nesidence With
kQ_-~
r f\ >^II .rI\ 0A.l' ~O
Owner S. /2 .
Address ;::) 7 ;)..
constructi~~~~
Phone ft;~toq~r;; ,
Describe Work(i.e., Build Single
Attached Garaae)
Address
DESIGN TEAH
Phone
{address}
(lies. no.)
(exoires)
{name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS (namel
I ) Q/u'I
(address)
(lies. no.)
(exo;res)
now~
-<<
iY
Genera 1
Plumbina
Electrical
~1echanical
PLUJ.lBI NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE Nn
r~r r~ARr,r NO_
Each single fixture
Residence of
furnace/burner to
BTU's
SQ. FT,
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath I
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
SDac~ h~atpr ~nd vpnt
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from
heat;no or A.C.
Mechanical exhaust
hond and dud.
Temporary Construction
Change in existing
rpc;. j ~PJ1r:P
multifamily, COITlT1. or
Industrial
Of ampsj
ICOMfI./INO. FEEOERS I
IInstall/alter/relocate I
d;c;.trih. fpprlprc;.
10f amps.1
I I
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ISSUANCE OE PERliIT
TOTAL CHARGES
,later service
Sewer
Storm Sewer
Wood stove/heater
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done by an':Electr;cal Contractor, the electrical portion .of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFUllY EXAt1INED the completed application for permit, and do hereby certify that all information hereon ;strue
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 OCCUPAilCY 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 ;n full force and f t as requ~'red y ORS 7 .055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and emr;: es who 1;J.n? omp1ia/ e with OPS 7Q1.0SS will be used on this project, I L,
IlAHE(please .'., 7f;-!~ ~_ . SIGNATURE If ,C).rr i.Gcuu.'l.,() DATE <. J..J2sM
\' EOR OEFICE USE miL Y
Type/Const. Units Sq. Ftg. f1ain
Bedrooms Occy Load Sq. Ftn. Access
Stories Occy Group Sq. Ftg. Other
Zone
x
Value
Value
Value
Fi re Zone
x
Flood Plain
x
TOTAL VALUATION
BUILDING PERfllT
Charges and
Surcharges
/0 00 Plan Ck.
__JD...<.______ 6S%/Rldo
7. 'I Plan Ck.
, <"./, 30%/BI do
Fence
Systems Development
Charoe 0.5%) .,
CorrrnlInd
Ppr Fpe
R"es
Per Fee
PLUt1BING PERMIT
Charges and
Surcharges
I Oemo
I Sidewalk
------------1 AIC Paving
I Curb Cut
I
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I TOTAL
I g , 1;)
ELECTRICAL PERIIlT
Cha rges and
Surcharges
ITotal Comb. Permit
11ECHANICAL PERMIT
Cha rges and
Surcharges
{ohone
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D
~
I~
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no, \
(ohane nn.
H~ rI-lARr,~ ~
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
I. Applicant to furnish
A. Job Address
B. Legal Description
I, example- Tax Lot 100, Lane County Map Reference
1/ oj 43
2. example- Lot I, Block 3, 2nd Addition to
sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air qas
2. examyle- waterheater/electr;cal/or solar
E. Square footage or valuation, etc.
1, example- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examyle - conve~~ single family resjdence 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. 10 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. ---
Applicant to Sign and date
Whenever possible, the initial application will b~ 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.
U :;)11 :f
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V, FOR OFFICE USE ONLY
Permi t Cl erk
C~ciLU
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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.
PLANS REVIEWED BY:
name
signature
date