HomeMy WebLinkAboutPermit Building 1985-06-20uA,^
I NSPECT I ON
725-37 69
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CITY OF SPRINGFIELD
COHEI HATI ON APPL I CATION/PERI.IIT
N
EIIERGY
Hea t
t,ater Heater
Ranqe
I a
7*
l2fu
Legal Description
Job Address
ow"e' (rJoail t ' 6tr.n C-*-lu-* rl ?F /)*,
uu3 of l.lork:oo
Sq. Ftg. Access._
Sq. Ftg. 0ther
.Ftg.
Address i JqO-O Farni'l At
scr
ched Gara
.e., Build Single
Ailil;t; "/ E"h,*,n
{torEConstruction Lender a (J,I
x
Address Phone 0/
Nrh
o
bDo
TEAI,I name address 'I ics. no.pxoi res phone no.
Pri ma ry
Structura I
EI ectri ca l
Hechani ca l
name addrFc s lics- no-exnires)nhonp nn
General 'fr- t.a a 2
Pl umbi nq
E l ectri cal
Itlechani cal
PLUI,lBI NG ELECTR I CAL HECHANICAL
N0-FFF CHARGF NO FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
FTSQ
furnace/burner to
BTU'S
Relocated bui lding
(new fix. additional)/
New circuits alts.
or extensions /a-Floor furnace
and vent
S. F. P.esidence(l bath)SERV I CES Recessed wal l
Snaae hoatpr and vpnt
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
cpna ra tp
Change in existing
rcc i dpncp
Stationary evap.
cool erl.later servi ce
Indrr<tria l
multifamily, conn. orSewer Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
COMI.I./IND. FEEDERS
Mechanicai exhaust
hood and duct
Instal I /al ter/rel ocate
di ctri h- fFedPrs l'lood stove/heater
0f
ISSUANCE OF PFRI{IT
TOTAL CHARGES TOTAL CHARGES /4a TOTAL CHARGES
WHERE STATE Llll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI'IINED the completed application for oermit, and do hereb,y certify that all information hereon is true
and correct, and I further certify that any and all work Derformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of Oreoon oertaining to the work described herein, and that NC OCCUPAI'ICY wil'l be madeof any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in 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 0l1S 701.055 wi'll be used on this oroject.
LatlAtlE (p'lease pri nt DATEIGIATuRE D,r E,r)r^-
Fire Zone Bedrooms 0ccy Load Sq. Ftg. Acce
Flood Plain Stories 0ccy erouptl 2./ sq. Fts. otn"rl/6284-€ vatue ?f,tD,-
x
x
ValFtg. l'laiits So
Value
* 8c</731 ToTAL VALUATI0N_
Plan Ck. Corm/Ind
6\1"lB1tto Ppr Fee fits. t"o o)l opment 9?*
u
BUILDING PERI.IIT
Charges and
Surcharges
___?/-_:_Plan Ck. Res
30%/BIdq Per Fee
Fence
Demo
PLUi,IEING PERMIT
Charges and
Surcha rges
Sldewa l k
A/C Paving Total Comb. Fermit 7rr. zELECTRICAL PERIIIT
Charges and
Surcha rges
____/a_?__
Curb Cut
7?'.'%TOTAL
HECHANICAL PERHIT
Charges and
Surc harges
f.
.I (}RS
+ B 6'rkLt
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legal Descriptionl. gIgElS: Tax Lot 100, Lane County Map Reference
17 03 432, example- Lot l. Block 3, 2nd Addition toSF?inTiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
F. Building permit information:l. example - construct single family house with anattached garage
?. example - remodel exist.ing garage into family roomJ. exampte _ convert single family residence intorestaurant (chanqe of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contatt appropriitepersons.regarding design information or job iitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & E.lectrica.l SchedulesA. Except where blink spaces occui in the a;;.;i;;i;;--portion of the Mechanical and Electricat Scnebuiei,the applicant need fill-in only the No. soiei-ajjii"nt_ !o_!hg appropriate item(s) to Le instailedB. FuIl Plumbing, Mechanical, and-E.lectrica.l Schedulesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be insta.l.ted are not covered onthe abbreviated schedules you should .onirit-tteful I schedulesC. BUILDING DIVISION STAFF I,JILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de.livered to theelectrical contractor for signature by his "i"ii"ii.i
-
supervisor. The generai coniractor ii not irtt,o.iiea- _to sign the electrical labelllr. Apptrcant to sign and date
l'lhenever possibie' the initiar apprication wiil be used asa-worksheet oniy. Hhere possibti, euitaing oiviiio;-i;.;;wut prepare a typg written copy and return it to theapplicant at the time the actuai permit i, isirea io" tiss i gna ture.IV. Fees and Charges
Plan check fees are due and payab.le at the time of theapplication, and_no plans wiil-be processed until theiefees are paid. All other fees and .ni"g.s are due andpayable when the perm.it is issued.
V. FOR OFFICE USE ONLY
l. example- 1250 sq. foot2. examEle- Jffiew project
check add, etc.
I
?ter
on
forced air qas
house, 500 sq. foot garage, check new - if addition,
or solarec
e l ectrica l
valuatE. Squa
PERMIT VALIDATION
r>
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builter's Board because:
Additional Project Information :
PLANS REVIEWED BY:
datenamer 1./'?.a<'s't g nature