HomeMy WebLinkAboutPermit Miscellaneous 1983-5-25
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COMBINATION APPLICATIO~/PERMIT (CAP)
" :;, ~ .~. PERMIT VALIDATION
III.
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I. Applicant to furnish
A. Job Address
B, Legal Description
1. example- Tax Lot 100, Lane Countj,Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield 'Estates -
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqjor forced air gas
2. example- wat~rheater/electrical/or solar
E. Square footage or valuation, etc,
1. 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 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
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are 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. ---
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 SATI~FIED BEFORE OCCUPANCY:
llLld P~NJ~r /.< /~~I.J~D #~BJE~? ~ A CON/?LT'A>ArA-L t,/sE ~':1'b'"
~c:>y.,.c. ~ ~ "M~~E ~~ ~r-~~ ~~tlTJ/1".JP~_rAt(/~/71'?
"A-~~r'';LG? ,7~/c.E7" .~~ ~~.&> ~'JIpiH~ 7#E" ..a,~/M- ",
~~,,~p .&:>$L:.~c.U:.7'~.N .r~rA-Rr~P/.udr 70 cG~&n> ~~):),,~
Permit applicant exempt from registration with the BuilderlsBoard because~
,
Additional Project Information:
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signatur
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Job Address S 3~:< c?~/?7-?7 <{if/a- / 5~ 5,;/ ~'7l}e/cI '
Legal Description 17.t:):z.-~/.:Z1" ttJt1tBC>C>
iJeq.se~ /) , /1 /J
''''Ref'', f1;t!.../'.J-,/-. IY/m JlCl/'diOt!70cl.s.
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Address 1/ 77S ..:5 tV./ ~tl /' /7 ~ lle/e
-r: <' a< r C/, c:J r q?'.;;?;r 3
/1//,1
'IINSPECTION LINE
726-3769
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Construction Lender
Address
DES I GN TEAr1
(name)
Primary
I(/Jh e.v f '..J
....sa n? ~
SQ;P~
0CtA?7 ~
(name)
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CITY OF SPRINGFIELD'"
C0/1BINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
l~ater Heater
.
INFORl1ATION UN!: I
726-3753
Sq. Ftg. r,lain
~q. Ftg. Access.
Sq. Ftg. Other
~lew--^dd__Alter~~ep.
Fence Demo Change/Use
--Other -- --
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Range
ValuE of Hork:
7r7 (!,,- a. f ~~. CO .
Phone/D~~~/~~ BuiloinQ Permit Info: Describe Work(i.e., Build Single
~7~vJ~ Family nesidence With Attached Garaae)
/e!( I'/:J()/~od/e .::5~~m///-/-b' PJ/',::Jt:~/U(!e
1'/; !-e..!jes (CZo/? I-s) Q 1401 t/7J I,' "lI'S h@c/
J..L/;nb~ -F~Q4T~ ~N(,Y
(lies, no,) (exoires)
Phone
(address)
.
(ohone no.
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/(1(2 f./ rJtJ Jd.5
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Structural
Electrical
Mechanical
CONTRACTORS
?t.:{oS aJ.,., /?,/~;"'/l /0"1,,,;
C7 /: 9? c:J07
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(address)
&B;? er-~/ In,'/ / L~/7 s7'-rL((J
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~~~ TOTAL CHARGES
WHERE STATE L'I(REQUIRES that the Electrical work be done by an,Electrical Contractor, the electrical portionqof this, permit
shall not be valiJ until the label has been signed by an E~ectrical Supervisor and returned to the BuildingDivi~ion' '.
General
7""ClrAel-
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Ae'V k E/eLl-r" c.
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Plumbina
Electrical
~lechani ca 1
PLUllBI NG
NO,1
"/ Each
Relocated building
(new fix~ additional)
FEE
CHARGE
single fixture
6:~
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"" S;'F. .Res,idence..:,::'",
, '(T bath)
Duplex (1 bath) each
Additional bath
/
Water service
II).~
Sewer
Storm Sewer
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(lies, no,)
(exoires)
(ohone no.)
f/oYl 1PI79~/tt:I/7q .Lker"l'/1etJv. 97//t71/
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3 CJcPS ~/j-kt/lo/ /Pd. ~/e/??
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ELECTRICAL
MECHANICAL
NO.
fHAR(.;F NO,
FFF
FH
fHAR(.;F
Res i dence of
furnace/burner to
BTU's
,
/
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Soace heater and vent
Temporary Construction
Change in existing
residence
Imultifamily, comm. or
Industrial
10f
ICOMM./IND. FEEDERS
'I Install/alter/relocate
" dic;trib: feederc;
10f .$C;~
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Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
s i nol e dur.t.
Vent system apart from I
.heating or A.C.
Mechanical exhaust
hood and duct
amps.
Wood stove/heater
amps.
ISSUANCE OF pF.Rrm
TOTAL CHARGES
,15:00 TOTAL CHARGES
I HAVE CAREFULLY EXAMINED the completed application ,for permit, and do hereby certify that all information hereon is true
and, correct, and; I.further, certify that any and all work oerformed shall be' donei n accordance wi th the Ordi nancesof the City
of Springfield and the Laws of the State of Oregon'pertaining to the work described herein, and that NO OCCUPArlCY will be'made
of any structure without the permission of the Building Division. I further certify that my registration ~lith ,the Builder's __'_
Board is in full force and effect as requi.red by ORS 701.055, that if exempt the basis for exemption is n'oted hereon, and that
only subcontractors and employees who are in compliance withORS 701.055 will be ed on this project.
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rW'lE(please print) )( 6-et2/0tt? #t<> /f( /11,1/ t:l~ 1"1 SIGNATURE
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~ FOP. OFFICE USE
Units Sq,
Occy Load Sq.
Occy Group Sq.
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Zone
);)-11
Tyoe/Const.
Bedrooms
Fire Zone
Flood Plain
Stori es
J? c.. 7f € VIi! W 11'-9"3 - ~
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2.~O
BUILDING PER~1IT
Charges and
Surcharges
PLUr~BING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERfHT
Cha rges and
Surchilrges
t1ECHANICAL PERMIT
Charges and
Surcharges
'D/I.Tt)(~o?b-J' .3
t1ain x Value
Access x Value
Other ~~T~X~4 'L-Va lueA ~~. -0
TOTAL VALUATION
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Plan Ck.
65%/Bldo
Plan Ck,
30%lBl da
Fence '
Comm/Ind
Per Fee
Res
Per Fee
~5~~ '31. ~~
Systems Development
Charge t1.5%) ."
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D6ffiO
ISidewal k
lAIC Paving
r Curb Cut
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I, /3]./2
To~al Comb. Permit
~B,q FeE:
TOTAL W~Kk 1JvI$'
e~.N ~e'
39;;,~?
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