HomeMy WebLinkAboutPermit Building 1988-01-08COIlB I IT 726-3153
7Job Address
Legal Description
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Ranqe
EIIERGY SOURCES
liater Heater
. Ftg. Access
Sq
Sq
Sq
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Ftg . I'lain
. Ftg . 0ther
vaiue of ,y,43efl
Z t/^rr ,e., Build SingleBuiIciir
Fami ly nq Pelrnit Info: Describe Work(
Residence tlith Attached GaraqeAddress//// /
Construction pnder ,,4 /
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Address Phone
DE5 I GN EAI4 /name \)address exoi res (phone no.
Primary
Structura I ) .ll/),
/' ('El ectri cal
Mechani cal
lics. no-'exDl res ohone no-CONTRACTORS name
ralGe roPlumbinq
El ectri ca i
llechani cal
MECHAN I CALELECTR I CALPLUIIB I NG
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furnace/burner to
BTU' sEach single fixture
Floor furnace
and vent
Relocated building
(new fix. additional)
New circuits alts
or extensions
Recessed wal I
Snacp hpafpr and vpnt
S. F. P.es i dence(1 bath)SERV I CES
Temporary Construction Apol iance vent
seoarateAdditional bath
Change in existing
rps i dpncp
Stationary evap
cool erllater service
Vent fan with
sinole duct-Sewer multifamily, comn, or
I ndu stri a I
0f Vent system apart from
heatinq or A.C.Storm Sewer
coMr'r./rND. FEEDERS
Mechanical exhaust
hood and duct
trlood stove/heateraI nsta l I /a l ter/ re l ocatedistrib. feeders
0fv
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ISSUANCE OF PFRI1IT
TOTAL CHARGESTOTAL CHARGESTOTAL CHARGES
WHERE STATE
shall not be va
LAl,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
li'J unti'l the label has been signed by an Electricai Supervisor and returned to the Building Division
EXAMINED the completed application for oermit, and do hereb.v certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the City
of Springfield and the Laws of the State of 0reqon pertaining to the work described herein, and that N0 0CCUPAI{CY will be made
of any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exempt'ion is noted hereon, and that
only subcontractors and enrployees who are in comoliance with ORS 701.055 will be used on this project.
ItAl.'lE ( pl ease pri nt S I GNATURE
'etsP
I HAVE CAREFULLY
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Val ue
ToTAL VALUATI0IT_
x
x
Load Ftg
Group Sq. FtS
Zone___Type/ Cons t Val ue
Va'l ueAccess
0ther
Fire Zone Bedrooms
Flood Plain Stories
ts So . Ftg . l'la i
PIan Ck. Comm/Ind
65'/,,/B1do Ppr Fpc
opmentDe
1.
stems
rqeBUILDING PERI'IIT
Charges andSurcharges J
I
2.a Plan Ck. Res
3l%/Bldq Per Fee
FencePLU!4BING PERMIT
Charges and
Surcha rges Demo
Sidewalk
Tota'l Comb. PermitA/C Paving
ELECTRICAL PERIlIT
Charges and
Surcha rges
Curb Cut
{C" 75-TOTAL
I,IECHANICAL PERMIT
Charges and
Surc harge s
m
Residence of
sQ. FT.
Duplex (1 bath) each
i
COMBINATION APPLICATION/PERMIT (CAP)
I. 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 Sources1. example- heat,/electrical ceiling/or forced air gas
2 . ex;mplE wa terfiEi-l-e r] eTeE trIZI--a I / o r so=Ta=F-E, Square footage or valuation, etc.
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. examp]e - construct single family house with anattached 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, Bu.ild.ingDivision Staff must be able to contact appropriitepersons regarding design information or job s.itecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanjcal and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate.item(s) to be installedB. Full Plumbing, Mechan.ical, and Electrical Schedulesare 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 onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF hIILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectricai contractor for signature by his electricalsupervisor. The general contractor is not author.izedto sign the electrical iabelIII. Applicant to sign and date
lJhenever possible, the .initial application wilI 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 actual permit is issued for his
s i gna ture.IV. Fees and Charges
Plan check fees are due and payable at the t.ime of theappjication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is .issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
lotTo
l-g-trr
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit app'licant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name signature date