HomeMy WebLinkAboutPermit Building 1985-8-16
I.
COMBINATION APPLICATION/PERMIT (CAP)
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I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
, Spr.ingfield 'Estates '. , ~. \', - ':: '
C. Name, etc. of owner and construction lender
D. Ener:gy ~ources ,':-:" ' ,~. . .
1. example- heat/electrical ceilinq/or for.cedair qas
2. example- waterheater/el'ectri'cal/o'r 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 ~f 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 instalied are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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
wi 11 prepare a type wri tten 'copy and return it to ttie",
applicant at the time the actual permit is issued for his
signature.
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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III.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE 'SATIS~lED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permit Clerk
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Permit applicant exempt from registration with the Builderls Board because:
'Add,i ti ona l:ProJeCt'. Informat-i on:
PLANS REVIEWED BY:
name L4'nN# 11.1!iif;~::.rJ
signature d
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I HlsPECTION LINE
726-3769
Job Address 6 3 d.. ~,
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INFORlIATION UNt:.
726-3753
Sq. Ftq. f.lain
~q. !"tg. Access.
Sq. Ftg. Other
New Add Alter Rep.
~Fence Oemo Change/Use
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
\~ater Heater
Ranqe
Legal Description
Owner J)OIV' D~.r; 1~j-orV
Address~s",~ ~-&l1 ~f,
c:/Y' '- .
Phone
ValuE of Hork:
S-~_ ....
Buildinq Permit Info:
Family nesidence With
Descrlbe Work(i,e., Build Single
IIttached Garaae)
V/P~~
Conttruction Lender
/'-I?- 761':1....
Address
DESIGN TEAr~
(name)
Phone
(address)
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nics, no.)
~c.E'c./r:r/~c. ~~<'~
~"'/'A?~~E
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(exoires)
4
(ohone no.)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(lies. no,)
(exoires)
(ohone no, )
General
P1umbinq
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Electrical
~Iechani ca 1
t
PLUt,!B I NG
ELECTRICAL
MECHANICAL
NO.
FEE
CHARGE
NO
1'1'1'
rI-4ARr::[NO.
I EFF
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I rHARGE
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Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
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Relocated building
(new fix. additional)
New circuits alts,
or extensions
Floor furnace
and vent
s.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Soac.e heatpr nnd vpnt
Storm Sewer
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Temporary Construction
Change in existing
residence
multifamily, camm. or
Industrial
Of .-::2 est::> amps.
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
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Appliance vent
seoarate
stationary.evap.
cooler
Vent fan with
sinale'duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
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~Ia ter servi ce
Sewer
Of
amps.
ISSUANCE OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES ::< o:~ TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
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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 done in accordance with the Ordinances of the City
IOf Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY 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 full force and effect as 'required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
"only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
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SIGNATURE_,,t:? ~
FOR OFFICE USE ONLY , I /
DATE
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Zone .NJ AI .
Type/Const.
Bedrooms
stori es
Units
Occy Load
Occy Group
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Fire Zone
Flood Plain
Sq.
Sq.
Sq.
Ftg.
Ftg.
Ftg.
rlain
Access
OtherCG!=C.I':
x Value
x Value
~,..<:.e:: Va 1 ue
TOTAL VALUATION
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BUILDING PER~1IT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________ 65%/Bldo Per Fee
Plan CL Res
30%/Bldq Per Fee
Fence I
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D6mo I
'2 ~ .., Side~alk I
-------/~....-IA/C Paving I
A . ~"'~ ,- I CU~b~ c'ut' '0" , I
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ISystems Development '
Charqe ('1.51,)
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ITotal Comb, Permit
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PLur~B ING PERMIT
Charges and
Surcharges
ELECTRICJ!.L PERtHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL.
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