HomeMy WebLinkAboutPermit Building 1984-3-14 (3)
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COMBINATION APPLICATION/PERMIT (CAP)
1.' Applicant to furnish
'A:' .Job Address
B.. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. examp1e- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examp1e- 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'.~nformation or job~'~ite "
corrections, etc.' '
I!. 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 electrica'l label. -
III. Applicant to sign and date
Whenever possible, the initial application will be, used as
a worksheet only. Where possible, Building Division Staff
wi 11 prepa re 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.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFI.ED BEFORE OCCUPANCY:
6;Z>c:t:::/ A~ /Ns riEC-L/e:>h
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2-#~
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, .Addi ti,ona 1 Project In'formati on:
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PLANS REVIEWED BY:
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PERMIT VALIDATION
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JVP'
Pennit Cl erk ~
name~RNc ;P~~eze
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Signature~"LW~ ..,.".
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date
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,Y'-9-8 CY
CITY OF SPRINGFIELD .". - INFORt1ATION LlNb. J
COMBINATION APPLICATION/PERMIT 726-3753
ENERGY SOURCES: Sq. Ftg. Main I
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
New Add Alter Rep.
Range Fence Demo_Change/Use II
V~ue. of Work: ~Other~M.?Yc7~ . \
f! 85 ~o ' tM/,t' ~ N
Builoinql Permit Info: Describe Work(i,e., Build Single ~
Family rlesidence \~ith ,A,ttached Garaqel
~('JlOQ~at: If ~6 (\f}~{~~
C::Y_M~r-O..l'll!-L - . 0..../ Uo
Address Phone J It .$ t, 9 ,t)/. y:t'. I'
DESIGN TEAr4 (name) (address) (lics. no.l (exoires) rJ tbhone no.)
Primary ..R:U/'-I.. &'~/.NE"~.N~_ ZB3~ .s;tliP"A Uv';~~CWC 3Y'Y- 9//€
Structural
>-.
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- .~.....= -
I INSPECTION LINE .'
726-3769 -'
Job Add~essJ7(J() (~~~ ~~J
Legal Description 1]-<J2."~)-/< ~ dC)";>\
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Owner , (fu' ~ try-- &~ (ti,A J 1,;:1 LJJ ~
- - I
Address 37 8-0 ~ . , ~ I ....,~ Ph~.:"I .
constru(t!:rl::er cP,' CJ / 97 ((7 '7
Electrical
Mechanical
CONTRACTORS (name)
General ~'1..h~ (J,,~. &.
I
(address)
f,O. txt's-r 9 -J/~
. /f/
(ohone no. )
.. -?f.'t ~ 2. $/2 G,
Plumbinq
(lies. no.) (exoires)
/ 3~77~ ,51'7/~<I
Electrical
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i.~ ~_/N~~. /2 j.y~r Q tS7:,~7)9'~._,
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7Y.7-6~35
~lechani ca 1
PLUf1BING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
Each single fixture
Residence of
Relocated building
(new fix.' additional)
FFF r.HARGE-HQ.
FIT- CHARGE I
SQ. FT.
furnace/burner to
BTU's
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<
New circuits alts.
or extensions
Floor furnace
and vent
Temporary Construction
Change in existing
residene!"
multifamily, comm. or
Industrial
Of 2S'~
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
~Iater servi ce
Sewer
Storm Sewer
I
Recessed wall
Soace heatpr and vpnt
amps.
3~
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater I
(~l
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COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
ISSUANCE OF PFR!1IT
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TOTAL CHARGES . TOTAL CHARGES 5$", TOTAL CHARGES
. WHERE STATE L\l~ REQUIRES that the Electrical work be done by an.:Electrical Contractor, 'theelectrical portion'of this permit
shall not be vali,j until the label has been' signed ,by an Electr..ical ;Supervisor and returned to the Building Division ,:; ',. .
" . ... .. . . .~ ., ,- ...... . . '"
I HAVE CAREFULLY EXN1INED the completed application for permit, and do hereby certify that all information h~reon is true
and correct, and I further certify-;th~t .any al'1d .~llwork' oer.fqrmed" sha'll be: done in accordance; with the, 0rdinances of tlie. 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 with the Builder's
Board is.in ,f.ul.l for:ce andeffec,t"as required by ons 7.01'.055,. that if..exempt the basis for 'exemption is' noted hereon,and that'
FOP. OFFICE USE OlfL Y .
Sq. Ftg. f1ain X' Value
Sq. Ftg. Access x Value
Sq. Ftg. Other~ 1th ~~1' Value..ss;~".
. l\Y'f{~Z ~-lq(1)J TO L VALUATION '
. ,6,// t': "2 ,_--p~systems Development' .1 ~ ~
~~,~~ Charge (1.5%) . ~~.
Of
Zone M#
Type/Cons t.
Bedrooms
Units
Occy Load
Oecy Group )';J... 2
Fi re Zone
Flood Plain
Stories
BUILDING PER~1IT
Charges and
Surcharges
, 2~--
_____Ml_7.
/ l? .76
CommlInd
Per Fee
Res
Per Fee
, Plan Ck.
65%/Blda
Plan Ck.
30%/Bldq
PLU!4BING PERMIT
Charges and
Surcharges'
Fence
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I ?5:c,p
___~_J" ·
I.Yt>
Demo'
ELECTRICAL PERfm
Charges and
SurCharges ,
..., ....., .'. 1".
'Sidewal k
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AlC Paving
" 001,.
.....,
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MECHANItAL PERMiT
Charges and
Surcharges
Curb Cut
amps.
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Total Comb. Permit
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I TOTAL
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