HomeMy WebLinkAboutPermit Building 1983-5-26 (3)
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
'i,
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
1703 43
2. example- Lot 1. Block 3. 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources'
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar ~ D ~
E. Square footage or valuation, etc. ~
1. example- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-n€w - if addition,
check add, etc.
F. Building permit information: b?
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence' into
restaurant (change of use) .
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code .
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building ~
Division Staff must be able to contact appropriate ~ \
persons regarding design information or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. 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 installed , 0 ~
B. Full Plumbing, Mechanical, and Electrical Schedules ~r-.
are available at the Building Division '. ,
1. To conserve space on the permit form the schedules
have been abbreviated
. 2. I f the item( s) to be ins ta 11 ed a re not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is ,not authorized
to sign the electrical label. - ,
III. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his,
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
lH../~ ?e~N1/T' /.1'" I$SIc) ~D .~BJt!:<r 7D A CO~DJr~~L ?1st!: ~b""
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?e-/'7~P . (1:)$ ~NS/ /lItc.J~7'A:>N tf~TA;p.rGJP. Aldr 70 6-tt:.tCEZ> ~O:PII ~
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Permit applicant exempt from registration with the Builder's Board because~
Additional Project Information:
t:>Y/~~
PLANS REVIEWED BY:
tJ:io<~e~'!k.;~ .~/o~
7~A?/.r ./CC
6~ ~-;-~ 7~
~~/~/N;~~ 7L. '~~/7:
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n'ame~1f:.NE ?1:~~
signatur
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lega 1 Description /7-(/)2." ~/.;;Z 1# ttJ(7 s.c.o
iJ~r.I/~ 1dl!.J':J:-". ;?i/r1 J1ord/(/??~,cI$,
Address )/.77S S L// ~/~t)//lt..r ~t/t:
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PlUllBING ELECTRICAL
NO, FEE CHARGE NO.
Each single fixture Residence of
/ 6:oe- SQ. FT.
Relocated building New circuits alts.
(new fix. additional) or extensions
I
Temporary Construction I
Chang~ in existing. I
residence
multifamily, comm. or I
Industrial
10f amps. I
ICOMM./IND. FEEDERS I
I Install/alter/relocate I
di~trib. fpeder~
10f .$~~ amps.1 16!'-1
I I I I
I I I I
I I I I . ISSUANCE OF PFRr1IT
TOTAL CHARGES It):oo TOTAL CHARGES ,,{"~l TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES that the Electrical work be done by an 'Electrical' Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed application for permit, and do hereby certify that all information hereon is true I
and correct. and, I, further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPA!ICY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~Iith the Builder's.._.
Board is in full force and effect as required by ORS 701.055, that if exempt the b~sis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7()l.055 will be )fSed on this project. . '".
!IAf'1E(please print) K Ce'CJ/O~;I/~ /r1 //ltl(r:;/?Pl . SIGN^T~RE~ ~~ Ot.-t9~DATOCa:-c:(b-J'3
FOR OFFICE USE NLY t
/?C. 7f€VIt!W fikg:3-"
_____ lfS._~__ ~~~~B~~~ ~~~~~~d
Plan Ck. Res
I. ,,< 30%/BldQ Per Fee
_____Ls: 00_-' Fence;
.6e I D~R1o
I_____~fi. CA. I Sidewalk
2. ~ol A/C Paving
. I C,urb Cut
------------L
lINSPECTION LINE
726-3769
Job Address ..:3 3 ~ .;{
~
Construction Lender
Address
DESIGN TEM
Primary
Structural
Electrical
11echani ca 1
CONTRACTORS
General
PlumbinQ
Electrical
~lechani ca 1
S.F. Residence
(l bath)
Duplex (l bath)
Additional bath
1
Water service
Sewer
Storm Sewer
Zone M.#
Fire Zone
Flood Plain
BUILDING PERNIT
Charges an~
Surcharges
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICJ!.L PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
e
(name)
I?,hey fJ
--Sa n? e
Sc;, m~
CITY OF SPRINGFIELD
CDr1BIilATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
('Iater Heater'
Range
Valu€ of Hork:
Zr'7 ~~ 9, ~ '5C). co
Phone/""/~?/~, BuilriinQ Permit Info: Descrlbe Hork(i.e., Build Single
~7~~Jl, Familv Residence With Attached GaraQe)
/d{ l"'tN'-/l1 J / e ..:5 cochn , ' / / 7'-d /J r t:J d /u e e
f/,1-t!.!J~S ((!O/7f:~) Cl~clL/7J~'~/sh@d'
J.. Lt n? b ~v - r#/J(.JhQ4.T,dh C::>,N(. y
(lics. no,) (exoires)
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INFORtlATION UNI:.
726-3753
Sq. Ftq. I'lain
~q. Ftg. Access.
Sq. Ftg. Other
~lew__Add__Alter~qep.
Fence Demo Change/Use
--Other -- --
~~
W
-...
'-'
~i\i
Phone
(address)
(ohone no:\
1?-et/TltJJclS
'"
t.b.:?CS.tt.J. /"7/~ .4 /0 A.-? C//: 97?'o7
,
I
OCt y.n l"'~
(name)
(address)
C;;en U4/ //),' / / c:?e'/J 5 '/-rft.t (J
(lies. no.)
(exoires)
(ohone no. )
f/CI'7 -r~/79~rt::J/Jq ~k<?-.'/1e {/r: 97//t71/
,
'..-'
,
,.,
3 CJJ?5 lb/rkTJ4 ~c/. cSQ/e/??
t1/:
$ 6J-a??o/1
/
...
MECHANICAL
FFF
I
fHARr,F NO,
fHARFF ~
/,
,. /"
FFF
furnace/burner to
BTU's
Floor furnace
and vent
<
SERVICES
Recessed wall
Soace heatpr and vpnt
each
/(J.~
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heatina or A.C.
I Mechanical exhaust I
hood and duct
I ~Jood stove/heater I
I I
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Tyoe/Const.
Bedrooms
Stori es
Units
Occy Load
Occ,y Group
Sq. Ftg. r1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other.~~T.IONx~Value~~~.-o.
TOTAL VALUATION
1~5~~ g/. ~O
Systems Development
Charqe (1.51) .
IZ6. '1~
ITotal Comb. Permit
I ~QBI..tS" F~e:
TOTAL W..:!>,Rk 1J.4$'
I B.!.~<:'N ~/<!
I~J, 12.
~92.~9
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