HomeMy WebLinkAboutPermit Building 1987-9-15
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IIISPECTIOII L1I1E
726-3769 '
Job Address
Address
Ul:.~IGH TE.Ar]
Primary
Structural
Electrical
r1echanical
CONTRACTORS
(nameJ
1J1~
CITY UF SPRIIIGFIELO
COIfBIIIATlON APPLICATION/PERMIT
E!TERGY SOURCES:
Heat
l'/a ter Hea ter
Ranqe
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INFOR/TAT: .':1 L,;" I
726-375j I
Sa. Ftq. (.lain
~q. !='tl). Access.
SQ. Ftq, Other
Ilel'" . Add Alter ~eo.
--Fence Demo Change/Use
Other - -
Phone
If. f4zJ
Buildncr ermit nfa: Describe Hork(i.e..
Fa~::i~taChed r.aranel
Bui Id Single
Phone
(address)
(lies. no,l
(exnires)
(ohone no. )
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Genera 1
Plumbino
Electrical
'.1echanical
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address
1 ics.
("IJ() 386
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PLUIIBIrIG ELECTRICAL MECHAN I CAL
nO.1 ,- "'.. ..liLt HARGF Nr -H,LI r"ARCF 'In,
_lEach - '" furnace/burner "to
single fixture Residence of
" -- sq, FT, BTlI's
Relocated build-~- INew circuits alts, I I I Floor furnace
'(new fix. additional) or extenSlons and vent
I Install/al ter/relocate
rli~trih. fppdpr~
IOf
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TOTAL CHARGES J TOTAL CHMGES
I.JHEI1E STATE L"I~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical l1ortion of this perl:l1t
shall not be vali1until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINEO the coml1leted aprlication for ~ermit~ and do hereby certify-thatallTnformation her"eon 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 Sor i ng fi e 1 d and the laws of the 5 ta te of Ore <<:ton pe rta i ni ng to the work descri bed here in, and tha t IW OCCUPAflCY \~i 11 be made
of any st~ucture without the permission of the Ouilding Division. I further certify.....t-h;r my r qistration Hith the Builder's
Goard 1S 1n full force and effect as requlred by ORS 701.055, that lf exempt the b~is for mntion 1S not d hereon, and th
only sUbcontra,/a,nd"e,yees "hO;=~~~_)'lOlianc~ with OP.S ~b~use on lS nrDj~~: ~
11AilE(please PrJnt~~y: ~c...,. . \1r,ll^TURF~__ ~ ,,' /) O^T~9:
FO~ OFFICE USE UilU / 7'
S. F. Res i dence
(1 bath I
I Duplex (1 bath)
IAdditional bath
~!ater service
Sewer
Storm Sewer
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.ElL J:W.GL
ISERVICES
I Reces sed wa 11
~~nrp hp~tp~ ~nrl ~pnt
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Temporary Construction
IChange in existing
rpsirl('nre
multifamily, camm. or
Inr1lJ~tr;nl
I Apol iance vent
c;p~ar~tp
I Sfa"tionary evap.
cooler
I Vent fan wi th
s;nolp duct
I Vent system apart from I
hpi'ltino or A_C.
II\lechanical exhaust
. hood and dun
I \-load stove/heater
Of
amps,l
C0I1t,I./lND, FEEDERS
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I TOTAL
CHARGES
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amps.
I SSUANCF OF PFR!1l T
Zone
,
Value
--- --- -, --", -., .. "
BUILDlfJG p~Rr'lIT 1.2 J..5V Plan Ck. Corrm/Ind
Charges an" ;L' -----=-d.-.J!____ 65X1Bldo Ppr Fpp
Surcharges 1_ '7-::> Plan Ck. Res
up. ~ 30%/BldQ Per Fee
PLU~~BING PERMIT I Fence
Charges and ____________
Surcharges I O~mo
,ELECTRICAL PERI:IT I Sidewalk
Charqes and ____________
Surcharges I A/C Paving
I1ECflANICAL PERI1lT I Curb Cut
Charges and ____________
Surcharges J
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
/
Occy Load
Occy Group
x
Value
Value
,
TOTAL VALUATION
Systems Development
Charoe (1.5~)
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Total (omb. rermit
I TOTAL
/11, ;)3
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot lOa, lane County Map Reference
1/ oj 43
2. examole- LDt I, Block 3. 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources '
1. exam~le- heat/electrical Ceiling/or forced air Qas
2. examole- waterheater/electricar/or solar
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,
check add. etc.
F. Building permit information':
1. examole - construct single family house with an
attached garage
2. examole - 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 (al Df 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 II/here 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
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 rees 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
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PERMIT VALIDATION
I 0 to (0
~ --{5 r 9/7
Permit Clerk
Q( ---
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
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date
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