HomeMy WebLinkAboutPermit Miscellaneous 1986-7-3
I IrISPECTION LINE
726-3769 .
.
Job Address
3'41\
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I>.,~l::>.
Legal Description
Owner It-+I;:' \<..\..., 6 :>Fc<u>
'?1WO'-=>L"'t ?
Address
56\~
\M"'''-(.o'-A- ~~
Constructi~n lender
Address
UDllir. I tAl.'
(namel
_ Primary
Structura 1
Electrical
f1echanical
CONTRACTORS
(name)
General ') _
Plumbina &tt'J (~'^ 11M ~~itl
Electrical
'.1echanical
PLUI1B I NG
NO.1
I FEE I r.HARf;F
Each single fixture
Relocated building
(new fix, additional)
S.F. Residence
n bath \
Duplex (1 bath) each
Additional bath
~!a ter servi ce
Sewer CA f'
)500
Storm Sewer
'-!1b
(,,0
,
.
,o~ lJJ
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
,-
EIIERGY SOURCES:
Heat
. tiater' Heater
Ranqe
ValUE: of Hork:
INFOR/iATION liNe
726-37S3
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
--1lew__Add__Alter-"~ep.
__Fence__Oemo__Change/Use
_Other
)\.\
~
~
~;" "".,, ~
.I
(ohone no.)
Un ,
PhQ,,"k_"ibd
Builriino Permit Info:
Familv Ilesidence Hith
~
Describe Work(i~e.,
.d.ttached Garaoe \
CCL.G-/
\5
Phone
(address)
(lfcs. no.)
(eXOlrfl's)
Jj,
--J~.
~
IV~
... "'I
(address)
l1;r:~. no.)
(pxoirp~)
(OhMP no.)
It{ flU,.fA
"-...,)
ELECTRICAL
! MECHANICAL
, rlJARlil: ....!:!Q.....I
furnace/burner to
BTU's
I
. '=F~ . r~J1RG.E.
NO.a-.' I ~~~
Residence of
SQ. FT.
I'New circuits alts.
or extensions
ISERVICES
I
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing
rec;jdr,nr:p
Imultifamily, COlT1T1. or
Ind\J<;tri~l
IOf amps.
ICOMM./INO. FEEDERS
I Install/alter/relocate
rli~tr;h_ fpprlpr~
10f amp",1
I
I
I
Appliance vent
o;,~oari\tP
Stationary evap.
cooler
Vent fan with
sinole duct.
I' Vent system apart from I
heatina or A.C. .
I Mechanical exhaust
hood and dur:t
1 Hood stove/heater
I
I
I
ISSUANCE OF PFR!lIT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
l S .(,,'0 I TOTAL CHARGES TOTAL CHARGES
that the Electrical wor~ be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~1INED 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 wor~ oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Orel]on pertaining to the work described herein, and that rw OCCUPAHCY 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 OP.S 7nl.055 will be used on this project.
SI"II^TURE~ w.Af. ~.
FOr. OFF I CE USE DIlL Y
Sq. Ftg. t1ain x
Sq. Ft~. Access x
Sq. Ftg. Other x
Plan Ck.
65%/Blda
------------ Plan Ck,
30%/Blda
\ S ,~ I Fence
--------.(;0-, Demo
I Sidewalk
I AIC Paving
I Curb Cut
I
WAI.IE(please print)
uJ. \), '\2H",.,..'t>;;.5
Zone
Tvpe/Const.
Bed rooms
Fire Zone
Flood Plain
Stories
"
BUILDING PERf1IT
Charges ant:
Surcharges
PLUI~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
om 7- 3>"Bt-:>
Units
Occy Load
Occy Group
Value
Value
Value
TOTAL V ALUA TI ON
Conm/lnd
Ppr Fpp
R.es
Per Fee
/systems Development
Charae (1.5~)
ITotal Comb. Permit
I
I TOTAL
C5, CoO
.
.
.
01
COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
I!.
Applicant to furnish
A. Job Address
B. legal DescriPtion
1. examp 1 e..; Tax Lot 100, Lane County Map Reference'
'17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name. etc. "of owner and construction lender
~. Energy Sources
1. examole..; heat/electrical ceilinqlor forced air Qas
2. example- waterheater/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.
checl< add. etc.
F. Bu i1 d i n9 pennit i nforma t i on:
1. example - construct single family house with an
attached garage
2. examyle - remodel existing garage into family room
3. examole - 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. OESIGN TEM4 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.
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.
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.
CL----
; ,
'.
5&~ro 11
I I I.
IV.
V.
FOR OFFICE USE ONLY
Permit Clerk
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
.
PLANS REVIEWED BY:
name
signature
date