HomeMy WebLinkAboutPermit Signage 1990-5-17
J INSPECTION LINE .
726-3769
, Job Address I C( fJR IY JD Jl C!(){fl )
CllY Uf SPRtNGflELD . tNfURlIATlON uNt
COMBIIIATlON APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: Sq. Ftg. 1,Iain
Heat ~q. Ftg. Access.
legal De5cription Water Heater ~ Sq. Ftg. Other
Ranoe ---.:-__+- ~{ew_Add_Alter-,qep.
Owner (')1. fI n <. { vl1.Ltru'X"J /di/1 JJL ValuE offt1: ~ ~~~~~_oemO_Change/Use
\....sfJ( )Yl n .0 ~ ( U,^I\^ f"l) ,,?:z 1/1/1, 1M ->>U11",no P~mlt Info: Describe Horkl1.e., Build Single
. U/ 1 JlL: M VN IL{...-( 1/ _ "r::P'J' U VI/I Famllv nesldence Hlth Attached Garaoel
~.~~~:. ~":;omClIU"Jkp;/)rtt(lJy 1 ( >J qn. )
Address Phone
Ut~luN flAM (name) {addressl
..D
B
~
~
(lies. no.)
(exn;res)
(ohane no.l
Electrical
.~
Primary
Structural
Mechanical
CONTRACTORS
{name I
(address1
(1 ics. no.)
(exnirps)
(nhone no. \
Genera 1
PlumbinQ
P)Lu~\d_d.- ':; .a IJ8 Y) ~r1_U ~ r 1.1'5 'd- 34?r-1'2..Cf7
(y~ //.~--.,l;*- ~<;d-O -5 \,J Vr IO/Cf/)
/PLUI1BING ,ELECTRICAL MECHANICAL
Electrical
.... . .I"~;'
NO.
FEf CHARGE Nn
F'F~..c.H.ARG..E.. NO.
I='n' r~~
SQ. FT.
furnace/burner to
BTUI s
Each single fixture
Residence of
Relocated building ~
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
II bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
rli"trih. fpprlprs
amps.
Appliance vent
S~Daratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hnnd and duct
Wood stove/heater
from I
I
Sewer
Temporary Construction
Change in existing
resJ g~.nce
multifamily, corrrn. or
Industrial
\llater service
Of
amps.
l ~srn
ISSUANCf OF PFRmT
l-::S ,oJ TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this penoit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
TOTAL CHARGES
TOTAL CHARGES
I HAVE CAREFULLY EXM,INED 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
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that 1m OCCUPA1KY 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.
Units
Occy Load
Occy Group
SIG:lATURE
FOP. OffICE USE DilLY
So. Ftg.
Sq. Ftg.
Sq. Ftg.
DATE
1lAJ.IE(please print)
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories'
t1ain
Access
Other
x Value
x Value.
x Value
TOTAL VALUATION
BUtLDING PERfllT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Blda P~r Fpp
------------ Plan Ck. Res
3D%/Bldo Per Fee
Fence
Systems Development
Charoe (I.5~)
PLUI~BtNG PERMIT
Charges and
Surcha rges
D!1R1o
_ _l~....S?;2,__Sidewalk
, I ~ A/C Paving
Curb Cut
Total Comb. rermit
ELECTRICAL PERliIT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
\~."}S
.
.
COMBINATION APPLICATION/PERMIT (CAP)
J. Applicant to furnish
A. Job Address
B. Legal Description
1. exa~le- Tax Lot 100, Lane County Map Reference
17 03 43
2. ~xample. Lot 1. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
2. examole- waterheaterlelectrlcal/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-nfw - if addition,
checl< add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~le - 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 DOT ALL FEES AND
CHARGES ON THE SCHEDOLES
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
..:J
PERMIT VALIDATION
o
Pennit Cl erk
'.,
- {7~qO
/ 7 ()q()
C7<~
/
I
--
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date
,I