HomeMy WebLinkAboutPermit Building 1990-06-14N
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L CITY OF SPRINGFIELD
CO}{BI NATI ON APPL ICATION/PERMIT
the completed apnlication
and correct, and I further certify that any and all work pe
of Spri ng fi
s tru
eld and the Laws of the State of
726-3753
t, and do hereb.y certify that all in on hereon s true
shall be done in accordance with the 0rdinances of the
r
Ci ty
made
cture wi thout
s in full force a
the permi
nd effect
0regon oertaining
the Building Divisssion of
to the work described herein, and that NC 0CCUPAHCY will be'ion. I further certify that my registration vrith the Builder'sof any
Board i
only subcontractors and employees who are in comp Iiance with 0l1S 701.055 wilI be used on this oroiect
tlAtlE(please print h^I GNATURi
as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
DAIE 6.'1 -?t
Job Address
l-egal Description
Ran
Hea
EIIERGY SOURCES
llater Heater
""\dlilDo*Owner
L
Sq. Ftg. Access.
Sq. Ftq. 0ther_
_l,lew____,Add1 I te r_Rep .
_Fence_Demo Change/Use
0ther
. Ftg n
r Phone Builciinq Permit Info: Describe t,lork(i.e., Build Single
Family Residence liith Atiached Garaqe)
. \ e er.n[
Address
r}IConstructr
I4\*/td
Addre s s Phone
ICS- nO-resDE5I GN TEAI,I name address exD
Pri mary
Structura I
EI ectri cal
Mechan i ca I
address 1ics. no.exot res ohone no.CONTRACTORS name drt rfir \Ai IC \?3
\Pl umbi nq
E l ectri ca I
l,lechani ca l
MECHAN I CALELECTR I CALPLUI{B I NG
FFF l^ HA PGF Nr FFF CHARGFFEECHARGENO
furnace/burner to
BTU' sEach single fixture Residence of
FTSQ
New circuits alts.
or extensions
Floor furnace
and vent
Relocated building
(new fix. additional)
Recessed wal l
Snace heater and vFntSERV I CESS. F. Residence(l bath)
Duplex (l bath) each
Temporary Constructi on Apol iance vent
seDarateAdditionaI bath
ge in existing
dence
Chan
rFsl
Stationary evap.
coo I ertlater service
mul ti fami 1 y,
Tndrrstrial
comm. or Vent fan with
sinqle ductSewer
Vent systern apart from
heatino or A.C.0f s.Storm Sewer
Mechanical exhaust
hood and duct-c0Mr.1./IND. FEEDERS
I n stal I /a l ter/ re l ocate
dicfrih- fepders lrJood stove/heater
0f amps.
ISSUANCF 0F pFRtlIT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
WHERE STATE LAI,I REQUIRES that the Electrical work be done
shall not be valiC until the label has been signed by an Elec
bytri an Electrical Contractor, the electrical portion of this permit
ca1 Supervisor and returned to the Building Division
ToTAL VALUATI0N_
x
x. 0ther I
Acces s
l'la i n 'I u
Ftg
Group Sq. Ftg
Const. Uni ts Sq. l-tg
Flood Plain Stories
Zone
Fire Zone Bedrooms Occy Load Val ue
opmentPlan Ck. Corrn/Ind
65%/81do Per Fee
Svstems Deve
Charqe (1.5q
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERMIT
Charges and
Surcharges
Fence
D6mo
PLUI,IBING PERMIT
Charges and
Surcha rges
SldewaIk
Tota'l Comb. lrermitA/C Paving
ELECTRICAL PERI1IT
Charges and
Surcharges
Curb Cut CTOTAL
T,IECHANICAL PERMIT
Charges and
Surc harges
tld
t't,
Jni
Ir lnne nn
-.{i.tr"---
COMEINATION APPLICATIONiPERMIT (CAP)
i Applicant to furnishA. Job AddressB. Legal DescriptionI' example- Tax Lot 100, Lane County l'lap Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
SFTin:-fteta EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
l. exampl e-2. exampl e-
E. Square footag
hea t/el tri 0 r forced air gas
sol arwateeae
e or valuation, e1. example- 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. example - construct single family house with an
attached garage
2. example - 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
Structurai 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 site
corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installedB. FulI P'lumbing, Mechanical, and Electrical Schedules
are avai lable at the Building Division1. To conserve space on the permit form the schedu'les
..'have been abbreviated2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
ful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de]ivered to theelectrical contractor for signature by his electrical
supervisor. The general contractor is not authorizedto sign the electrical iabel.III. Applicant to sign and date
lJhenever possible, the initial application will be used as
a worksheet only. Hhere possible, Building Division Staffwill 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
P'lan 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
PERMIT VALIDATION
# NE6U
("-14--qo
Permit Cler
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name sig nature date