HomeMy WebLinkAboutPermit Building 1987-06-12II
69
L INEi
_ TITYIF SPRINGFIELD
COMBI IIATI ON APPL I CATION/PERMIT 726-3753
Job Address EIIERGY SOURCES:
Heat
l,later Heater
Ran
tq. l.1ain-.-_
Sq. Ftg. Access._
Sq. Ftg. Other__
_f,lew_Add_A1 te2\!e p .
_Fence_Demo Change/Use
0ther
$
D
t^l
$
W
l-ega1 Descri ption
Value of tlork:
2.ra_o->Owner
Addres s Buil cii n'ly q Pernrit Info: Describe Work(
Residence l,lith Attached GaraqeFami
,e., Build Single
122.---7a3-e-<- .4g>.+ s 7o
Constructi on Lender e Z*,.- D4?r.:2*. .3F^
Addre s s Phone
name address I ics. no.exoi res ohone no.
Pri ma ry
St ructura I
E I ectri ca I
Mec han i ca I
C n ame a ddres s (lics. no.'exDt res ohone no-
U
EI ectri ca l
l''lechani ca I
PLUI.lB I NG ELECTR I CAL 14ECHAN I CAL
FEE CHARGF NN FFF CHARG F NO FFF CHA RG F
Each single fixture Residence of
SQ. FT
furnace/burner to
BTLI' s
Relocated building
(new fix. additional )
New ci rcui ts al ts
or extensions
Fl oor furnace
and vent
S. F. Residence(l bath)S ERV I CES Recessed wai l
Soace heater and vent
Duplex (l bath) each
Add i ti onal bath Temporary Construction Apol iance vent
seoa rate
l,Jater service Change in existing
resi dence
Stati onary evap
cool er
Sewer multifami ly, comrn. or
T ndrrstria I
Vent fan with
sinole duct
Storm Sewer 0f Vent systern apart from
heatinq or A.C.
lD c0r4r'1./IND. FEEDERS Mechan'ical exhaust
hood and duct
\4 Instal I /al ter/rel ocate
distrih. feeders l'lood stove/heater
0f
ISSUANCF OF PFRI{IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LAt.l REQUIRES that the Electrical work be doneshall not be vaii.l until the label has been signed by an Elec
by an Electrical Contractor, the electrical portion of this permittrical Supervisor and returned to the Building Division
EX AM I NED comp a pl-)I 'I c a t 'l o n fo r De rm 'I t a n d do he re b.y C e rt I f v th a t a n rma t I 0n h reon 'i s true
the City
be made
and
of
of
Boa
onl
nd I fucorrecta rt he r cer t 'I fy t ha t any a nd a l I WO rk e rfo rme d s ha I I be do ne I n a cc ordan ce th t he 0rdi na nc CS 0 f
So r I ng f 'I I d a nd the Laws of the S ta te of 0re qon DC rta i n I n g to th e wor k de sc r ,l bed h ere 'I n and th a t ilc OCCUPAI.IC 1
.I Ianystructurewlthoutthepermtss'I n of the Bu .I I d 'I ng D 'l I s on I furtherf exempt
.055 vii'l I
cert i I v th a t m.y req 'I s tra t 'l 0n l,/ l th t he B U 'I I de r srd is in full force and effey subcontractors and empl
ct as required by ORS 701.055, that i L he b as 'I s f o r ex emp ti 0n 1 s noted hereon and th atoyees who are in comcliance with ORS 70 be u s ed 0n th I s P ro,j tsL
t'lAl'1E ( pl ease pri nt)L S IGi{ATURE DATE
F
Zone 1-oel Cons t Uni ts (n Ftg. t'lain x Value
Fi re Zone Bed rooms Occy Load Sq. Ftg. Access x Val ue
Flood Plain Stories }ccy eroup F*2 Sq. Ftg. 0the r.lue 2rO ,
-e.-
ToTAL VALUATT0N--_--
BUILDING PERIIIT
Charges anC
Surcharges J --/a-_Sq_a
Plan Ck. Conrn/tna-T
65%/81dq Per Fee 2/3 s teris ve
Eqe1 u4Plan Ck. Re
30%/81dq Pe
srF ee
PLUI4BING PERMIT
Char:ges and
Surcha rges
Fence
Dgmo
ELECTRICAL PERIlIT
Charges and
Surc harges
Sidewa l k
A/C Paving Total Comb. Permit
I,IECHANICAL PERMIT
Charges and
Surc ha rges
Curb Cut
TOTAL 2//..r/
.tORs
opment
coMBINATI0N APPLTCATToN/PERMIT (CAp)
I. Applicant to furnishA. Job AddressB. Lega'l Description1. example- Tax Lot 100, Lane County Map Reference
17 03 43?. example- Lot 1. Block 3, 2nd Addition to
Springfield EstatesC. Name, etc. of owner and constructjon IenderD. Energy Sources
exampl e-
exampl e-
re foota
hea t/air gas
2.water
E. Squa ge or1. 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 singie family house rvith an
attached garage
2, example - remodel existing garage into family room
3. example - convert single family residence into
rEs-taurant (change of use)G. Value of work as defined in Section 303 (a) of the
Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropniate
persons regarding design informat'ion or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. 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 instaI ledB. Full Plumbing, Mechanical, and Electrical Schedules
are 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 on
the abbreviated scheduies you should consult the
ful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractoris not authorized
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where 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
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the t'ime 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.
II
III
IV
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
Aat'{q,g'blL'gl
Perm'it Cl erk LO
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
permit applicant exempt from registrat'ion w'ith the Builder's Board because:
Additional Proiect Information :
PLANS REVIEWED BY:
name s'l g na tu re date