HomeMy WebLinkAboutPermit Building 1987-12-28NSPECTION LINE CITY OF SPRINGFIELD-. ._26.3769 COHBINATION APPLICATION/PERMIT -3
Job Address /40V o I L,EIIERGY SOURCES
Hea t
t,later Heater
Sq. Ftg. I'lai n_
sq. Ftg. Acceil-
Sq. Ftg. other_
-l'lewJddJlter-P.eP._Change/ Use
(>f)
-\O
--5
l-egal Description f 0 e5
tr{lalue of llork:'LzlaoOwner-S-
Addres s Phone rn'l t
Farni I
l^lork .e., Build Singie
I
tCP
Construction Lender
Addre s s Phone
U
DES I GN TEAI{name address lics. no.exD l res ohone no.
Pri ma -Lrrt A/2<tZ'>-9)
Structura I
El ectri cal
Mechan i ca I
CONTRACTORS name a ddrps s (lics- no-)pxnr rpq nhone no- )
General .-L n,r'^ e,--l,tnt Orrtl {
\
Pl umbi nq 'r^*.{erJ
I'lechanical
PLU14BI NG ELECTR I CAL MECHAN I CAL
FEE CHARGE NO FFF fin FFF r:HARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional)
New circuits alts
or extensions
Floor furnace
and vent
S. F. P.esidence
( I bath)SERV I CES
Recessed wal I
Snaap heatpr and vpnt
Duplex (l bath) each
Additional bath Apol iance vent
seoa rate
Llater service C hang
rpqi d
e in existing
e naP
Stati onar,v evap
coo l er
Sewer multifamily, comm 0r
Indrrstrial
Vent fan with
sinole duct
Storm Sewer 0f amps,Vent systern apart from
heatino or A.C.
COMI'I./IND. FEEDERS
Mechan i cal exhaust
hood and duct
Instal I /al ter/rel ocate
distrib. feeders I'lood stove/heater
0f amp s.
ISSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAtl REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
t comp appl i c
and al
0reqon
the Bui
at 'I o n fo r Derm 'I t and do here b.y certi fy tha t a t 'I n hereon 'l s tru
and and I fu rther c ert I ty tha t any
te of
I w0 r k 0e rfo rme d s ha I I be do ne I n a cc orda nce wl t h the 0 rd 1 n an ces f the City
be madeSpri ng
any strd isy subc
fi e I d and t he L aws of the Sta 0e rtai
ngD
701.
nl ng to rh wor k descr 1 bed h ere I n and th at N c 0cc UPAI,I CY wl I I
ru ctu re without the permiss
force and effect as
I 0n f I d ,l I '|s 'I 0 I further certf exempt the
.055 will be
'I fy th at m.y reg 'I s tra t 'I on VJI th the B ul 1 der s
Boa 1 n fu I I requ 'I red by ORS 05 5 tha t 'I ba s 'I s for exemp ti on 'I s noted hereon and th at
0 n I on trac tors an d ernr)I oyees who a re 'I n comD I 'I a nce wl h 0t?s 7rl used on th 'I s proj ec t
l8'{+t'lAl''tE( pl ease pri nt)IGNATURE
D
Zone t. Uni ts So Vrt
. Ftg
. Ftg
l'la i x Value
Fire Zone Bedrooms Load lq . Access x Value
. 0ther x ValueFlood Plain Stories Occ.y Gro up sq
TOTAL VALUATION-
BUILDING PERI'IIT
Charges and
Surcharges
I
,7i
Plan Ck. Cornm/Ind
65"/./B1do Per Fee
of3l-
Svsterirs Deve
charqe (1.57 opment
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
D6mo
ELECTRICA.L PERIIIT
Charges and
Surcharges
lrtoF
4e
Sidewalk
A/C Pavi ng Total Comb. Permit
IIECHANICAL PERMIT
Charges and
Surc harges
Curb Cut
TOTAL 661
I
Temporary Constructi on
correct,
ISF IIIJI Y
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
1250 sq. foot house, 500 sq. foot garageif new project, check new - if addition,
F. Building permit informatjon:1. example - construct single family house with an
attached garage2. example - remodel existing garage into family room3. example - convert singie family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electrical label.Applicant to sign and date
Whenever possible, the initial applicat.ion will be used asa.worksheet only. Where possib)e, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of theapplication, and no plans wiII be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
exampl e-
exampl e-
check add
II
III
IV
E
V
examol e-
examp I e-
rre footag
ea e ecWA
or forced air gas
ua
heat/electrical cei
e or valuation,
l.
2.
Sql.
2.
or solar
PERMIT VALIDATION
ly->tr -t 1
Permi t Cl erk &
rc72r
latzr
PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registrati on with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name date '-''ori;s'l g na tu re