HomeMy WebLinkAboutPermit Building 1989-09-266l=3Ea J
0li NE CITY OF SPRINGFIELD
COMBI NATI ON RPPI. ICRTIOII/PERMIT tl3DJob Address
Legal Di-.scri ption
Ran.le_
llater Heater
EIIERGY SOURCES
Hea t
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'flB, r-=8 -Val ue of#
Sq. Ftg. l'1ain_
Sq. Ftg. Accesil--
Sq. Fto. Other__
_l,lew_Add-Al ter_Rep.
_Fence_Demo_C han gel U se
0ther
0wne r s(>NlJ OrJt-t
Bui I cii n
Fami I y
q Pernlit Info: Describe Work('
ltesidence llith Attached Garaqe
.e., Bui ld Single
Tlhl?- cFF 1 -l q E -r Q-rlQso,F rr tTtJ
oo1":' t LLs cr:Gr:taG rer)' pt'o'" tltr5-
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Construc uion Lender S-R-r.l trIOIP-G\.DSS eAP ShJEg.-
r--t3Addre s s Phone
DES I Gi,i TEAM name addre s s l ics. no.exD l res ohone no.
Primary
St.iuctura I
F:l ectri ca I
Hechani ca l
name a ddrps s lics- no-'l exDt res ohone no.
t
trDf-'{t-UDPl umbi no
9l'{ ot-El ectri ca I
I'lec ha n i ca I
PLUI.IBI NG ELECTRI CAL MECHAN I CAL
FEE CHARGE NO.FFF CHARGF NO FFF CHARGF
Each singie fixture Residence of
sQ. FT.
furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New circuits aits
or extensions
Floor furnace
and vent
S. F. Residence
( I harh)SERV I CES
Recessed wal I
Snacp hpatpr and vpnt
Duplex (l bath) each
Additional bath Apol i ance vent
seDa rate
[^later serv ice Change in existing
rps i dence
Stati onar-v evap
cool er
multifamily, comm. or
Jndrrstrial
Vent fan with
s'inole ductSewer
Storm Sewer 0f s.Vent systern apart from
heatinq or A.C.
c0Mr.1./rND. FEEDERS
Mechanical exhaust
hood and drrct
Instal I /al ter/re l ocate
di stri h- feeders l,Jood stove/heater
0f S.
ISSUANCF OF PFRI1IT
TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES
WHERE STATE LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali'l until the label has been signed by an E)ectrical Supervisor and returned to the Building Division
oertaining to the work described herein, and that N0 OCCUPANCY will be
lding Division. I further certify that m.y registration vlith the Builder's
only subcontractors and ernployees who are in comcliance with 0l?S 701.
I'lAt'lE( pl ease print)S I GNATURE
Ci ty
made' 0reqon
the Buit the permi
and effect exemp
055 wi
DE,foany
of
I HAVE CAREFULLY EXAI1INED the completed application for rmit, and do hereb.y certify that all information hereon is true
and correct, and I further certify that and al I work per rmed shall be done in accordance with the 0rdinances of theof Springfield and the Laws of the Stateof any structure withou ssion of
Board is in full force as required by ORS 701.055, that if t the basis for exemption is noted hereon, and that
'I I be used on t ect.
Srs\ Qr>ss
FF E
Fire Zone Bedrooms 0ccy Load Sq, Ftg. Access x Value_
TOTAL VALUATION--
Ftq . l'la i
Ftg 0ther
X
x
Zone________Tyoe/ Con s t Val ueUni ts
Val ueFlood Plain Stories.
Plan Ck. Conrn/Ind
65'/,,/Bldo Ppr Fpp 5tBUILDING PERI.lIT
Charges and
Surcharges Plan Ck. Res
30%/B1dq Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges Dgmo
Sidewal kELECTRICA.L PERtlIT
Charges and
Surcha rges A/C Paving Total Comb. Permit
Curb Cut \Ra.@\ GratgS
NECHAI'II CAL PERMIT
Charges and
Surc ha rges TOTAL
Temporary Constructi on
COMBINATION APPLICATION/PERMIT (CAP)
L Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
-w'$
I
1. exampl e-2. examp'l e-E. Square footag
heat,/electrical ceil in or forced air qas
wa ea e ec tr Ld or sol ar
e or valuation,
II
l. example- 1250 sq. foot house, 500 sq. foot garage2. 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 room3. example - convert single family residence intorestaurant (change 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, Bui)ding
Division Staff must be ab'le to contact appropriate
persons regarding design information or job sitecorrections, etC.
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only 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 schedu'les
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF HILL 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 generai contractor is not authorizedto sign the electrical label
Applicant to sign and date
Whenever possible, the initiai application will be used asa worksheet only. Where possible, Bu'ilding Division Staffwill 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
P'lan 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
III.
IV.?
V Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
PLANS REVIEWED BY
name sig nature date,F €97
bqk
Additional Project Information :