HomeMy WebLinkAboutPermit Building 1982-03-23CITY OF SPRINGFIELD
COMBI IIAii ON APPL ICATION/PERHIT
Job Address EIIERGY SOURCES
tlater Heater
. Ftq . I'la i n-
Sq. Ftg, Access._
Sq. Ftg, Other-
llew Add Al ter P.eP '
-fence-Oemo Cha-nge/Use
-other--
c!)I
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Lesal Descriotion 11-02 -35-"a o / llto
Value of l,lork:- --
", \L\u ar)Owner
Add16ss Phone Builcii
Fami 'l y
no-Tetmi t' Residence
Info:- Descri be Work ii,e., Build Si ngl etlith Attached Gara qe )
Constructi on n c - -'\()f)1
Address Phone
DES I iN TEAI.I name address I CS. n0.exo res ohone no.
Primary
Structura i
El ectri ca l
l,lechani ca I
CONTRACTORS name address'tcs. no.FXnt req ohone no.
El ectri ca I
l.lechan i cal
PLUIIB I NG ELECTR I CAL MECHAN I CAL
FEE CHARGF NO FTF CHARGF NO FFF CHARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' S
Relocated building
(new fi x. add i ti ona l )
New circuits alts
or extensions
SERV I CES
Floor furnace
and vent
S.F. Residence(l bath)
Recessed wall
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
sPna ra te
$later service Change
res i de
in existing
nce
Stati onar,v evap
cool er
Sewer multifamily, cofin. or
I ndrr <tri a I
Vent fan with
s inole duct
Storm Sewer 0f Vent systern apart from
heatino or A.C.
COI,II.I. / IND. FEEDERS
Mechanical exhaust
hood and duct
Instal I /al ter/re1 ocate
dictrih. feeders llood stove/heater
0f amPs.
ISSUANCE OF PFRTIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAl,l REQUIRES that the Electrical work be done by an
shalI not be valid untii the label has been signed by an Electrical
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
L t comp e ted a pp I c t on Derml t a nd do he reby cert t a I 1 I forma ti on he reon s true
Ci ty
made
rts
that
correct, and I further certify
Springfield and the Laws of the
any structure without the permi
rd is in full force and effecty subcontractors and ernployees
that any
State of
and al 'I work performed shal| be done in accorda nce wl th t he 0rd 'I na nces o f the
o f 0regon oe
the Buildi
rta 'I n 'I n to the work d escrl bed here i n and tha t NC OCCUPAI,ICY wl I I be
o f ss 1 of ng Di vl s t on I furtherf exempt
.055 wi l l
certi fy that my regi s tra t 'I on vn th the Bui 'I de
Boa a5 requ '|red by ORS 701 0 55 tha t 1 the bas 'I s for exempt 'I o n I S no ted hereon and
on I who are I n c0mc I 'I ance w1 th 0r?s 7oL be u n s proj ect
llAt'lE (p1 ease pri nt )IGNA
Zone__________Type/Cons t.t Ftg . t'lai n Val
Fire Zone Bedrooms 0ccY
Flood Plain Stories Occy
Ftg. Acces Value
Group Sq Val
TOTAL VALUATION-
Ftg 0ther
BUILDING PERI-IIT
Charges and
Surcharges
n ard)(\)u-'/./g
Plan Ck. Corrn/Ind
65r,'iBldo Per Fee
S y s tenls
Charoe
Deve(1.57 opme'nt
Plan Ck. Res
30%/Bldq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
Fence
Demo I
ELECTRICAL PERI.!IT
Charges and
Surcha rges
Stdewal k
A/C Paving Total Conb. Permit
HECHANICAL PERHIT
Charges and
Surcharges
Curb Cut
TOTAL "pra\
NE T.N
FOI1 OFFIC
ue
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legai Description
l. e&!ple- Tax Lot 100, Lane County Map Referenc
17 03 432. example- Lot 1. Block 3, 2nd Addition to
SDilnsiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sourcesl. example- heat/electrical ceilinq/or forced air?. example- waterheater/elect[ic I/or soiarE. SquaiE-Tootage or valuation;-EtE-
l. example- 1250 sq. foot house, 500 sq. foot gar2. example- if new project, check new - if additi
EhEFI-dd, etc.F. Building permit information:1. example - construct single family house with a
attached garage
2. example - remodel existing garage into family3. example - convert single family residence intc
restaurant (change of use)G. Value of work as defined in Section 303 (a) of the
Struciural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS
To avoid design or construction delays, Buiiding
Division Staff must be able to contact appropriatr
persons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchddulA. Except where blank spaces occur in the descriptior. portion of the Mechanical and Electrical Schedule:
the applicant need fill-in only the No. Boxes adjrto the appropriate item(s) to be installedB. FulI P'l umbing, l'lechanicai, and Electrical Schedult
are available at the Building Divisionl. To conserve space on the permit form the schet
have been abbreviated2. If the item(s) to be installed are not covere(
the abbreviated schedules you should consult:fuI I schedulesC. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES ANI
CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered.electrical contractor for signature by his electr.supervisor. The general contractor is not authorto sign the electrical label ('
App'licant-to sign and date \
llhenever possibie, the initial app'lication wilI be us,l= -._a worksheet only. lJhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual 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 will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
FOR OFFICE USE ONLY
CITY OF SPRINGFI EtD
ciry xoil
Springfleld, Oregon
Deporfment of public Works
OFFICIAL RECEIPT
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Rece For
Amount
SIGNAYURE
aucEtE Ot ttaot
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v Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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