HomeMy WebLinkAboutPermit Building 1987-9-25
I INSPECTION LINE
726-3769
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Job Address I 01 S l~rw'A~ vJaJ.
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Legal Dmription / r-r O,~ I.CJ t'J 0 () () (( () (
CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Range
ValuE of I-Iork:
INFDRllATlON LINt
726-3753
Sq. Ftg. "la i n
~q. F'tg. Access.
Sq. Ftg. Other
Hew Add Alter Rep.
--Fence Demo Change/Use
-Other - --
Owner,1kwr.; 4:,~
Address 0
Phone
Builriina Permit Info: Describe Work(;~e..
Familv ~es;dence liith Attached Garaae)
~~vt ~lliA~\~~"'''d
1(" 'X:> CMV)lL- '-(CAN' dh
flies. no. r (exo;res)
Build Single
rfl
-:J
o
..j
~
--i:>
Construction lender
Address
Ut~lliN H.AH
(name I
Phone
(addressl
,
1
(ohone no. 1
Primary
Electrical
/21 /.. Q C1'-!,''''()
. v (, I v
Structural
Mechanical
CONTRACTORS
In...,)
(address)
(1 ic:s. no.)
(pxoirpc;)
(ohnnp no_ )
Genera 1
Plumbino
(AI"'P'
IJ. F
Electrical
~lechan;cal
PlIlllilIIl1i
ELECTRICAL
MECHANICAL
NO.
FFF r.HAR(;E Nfl
~~~ rHA~r,~ Nn_
~I='I=' rI-lAQr,1='
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU. s
Relocated building
(new fix. ad~itional)
IS.F. Residence
11 bathl
Duplex (1 bach) each
Additi anal bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
Temporary Construction
Change in existing
rps; ctp.nrp
multifamily, comn. or
Inrluc;trial
Of amps.1
CO~1./IND. FEEDERS I
Install/alter/relocate I
rli~trih fpprlpr"
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heat;no or A.C.
Mechanical exhaust
hood and r1urt
Wood stove/heater
~Ia ter service
I Sewer
Of
amps.1
".''1
lV-
,0\
I SSUANCf OF PFRIH T
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\lI REQUIRES that tile Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
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 performed 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 IlO OCCUPAUCY will be made
of any stru~ture without the permission of the Building Division. I further certify that my registration with the Builder's
Board is ;~ 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 compliance with ORS 701.055 will be used on this project.
IW!E(please print) I-I-tl.)~'f ~-rAl-\C1(.. SIr,IIAT)J~.tA/fAilJ! ~ DATEc?'j2-5/S7
FOr. o~u;r Us{ DriLY ~
Zone Type/Const. Units Sq. Ftg. f1ainl / x Value
Fire Zone Bedrooms Occy Load Sq. Ft9. Acce\s/ x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERIlIT
Charges and
Surcharges
Plan Ck. Comrn/lnd
____________ ~/Rldo PJ'r Fpp
Plan Ck. Res
3D%/Blda Per Fee
Fence
Systems Development
Cha rqe (I. 5%)
PLU'1BING PERMIT
Charges and
Surcharges
D~mo
'SIdewalk
AlC Paving I
Curb Cut 11.'..
G..K:~~ I llog.
I
ITotal
I
I TOTAL
Comb. Permit
ELECTRICAL PERI~IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
t\o
Jrog',OO
J
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.
,.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
1/ OJ 43
2. examEle- Lot 1. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
"I. example- heat'telectrical ceilin....Qjor.forced air Qas
2. examole- waterheater/electrlcal/or sola~
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, SOO sq. foot garage
2. examole- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. example - 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 SCHEOULES
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
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.
!{);)0t/
0-;)5 -~ '/
V. FOR OFFICE USE ONLY
Permi t Cl erk
cc/a!l1
/
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date