HomeMy WebLinkAboutPermit Building 1984-5-25
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CITY UF SPRINGFIElD
CmlBINATION APPUCATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
INFDRl1ATION liNt
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq, Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
I INSPECTION UIIE
726-3769
Job Address 3'1" 4a.furJ lL, 'Klilld
legal Description 11-0?_,;.?0 -en ,<1\4
Owner 1Dh.t.-l5C2.ll
Address ~<l-
q
. .L Val~ of Hork, 00
IDh, "\..stU ~ 2, 000. ~
rb" . eN' , BuilGinQ Pennit Info: Oeser be Work(Le.,
Phone "UJ..yn ~ Family rlesidence \Hth Attached GaraQe)
'K, ~")rh r ,<\l::ruc...-tu.aL
, r\nmage,
Build Single
~
.l:
o
W
.J::.
I(J)
Construction lender
Address
Ut~ lliN HAt.'
(name)
Phone
(address 1
(lies.no.1
(exoires)
(ohane no.'
Mechanical
CONTRACTORS
(name)
(address)
llir:s.no.'
~
f\\
(pxoirpc;.)
(nhnnp nn.1
Primary
Structural
Electrical
Genera 1
nw A"wR..
Plumbin<]
Electrical
Mechanical
PlUflB I NG
ElECTRICAl
MECHANICAl
NO,'
Each single fixture
, FEE I CHARr,E Ij(l I
Residence of
I r:E.L1~ NO.'
furnace/burner to
SQ. FT. BTU's
IFFLI~
I
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath I
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~~P hp~tpr ~nrl vent
Storm Sewer
Of
amps,
Appliance vent
S~Darate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Wa ter serv; ce
Temporary Construction
Change in existing
fPC;;J dJ'.nce
multifamily, camm. or
Inr1ustrial
Sewer
COffi1,{IND. FEEDERS
Install/alter/relocate
di~trih_ fppderc;;
Of
amps.
TOTAl CHARGES
WHERE STATE l~H REQUIRES
shall not be vali1 until the
TOTAl CHARGES
ISSUANCe OF PFRlllT
TOTAl CHARGES
that the Electrical work be done by an.:Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
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 performed 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 UO OCCUPAUCY 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 ons 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.
SIr,II^TVREt1Q<:vtA>~J::J-LDATE 5h5~
flAI.IE(please print>-l1:!!..I~a." IrDTwh " Ts: "'- LI
\)
Tyoe/Const. U-W
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Bed rooms
Fon OFFICE
USE Olll Y
Sq. Ftg.
Sq. Ftg.
Sq, Ftg.
A .
Hain .. (.. ,~.~ Value
Access \ ~- ,-; Value
Other$' x Value
TOTAl V AlUA TI ON
/
Zone
Mf.I
Units
Fi re Zone
Flood Plain
Stories
Occy load
Occy Group ~ - :\
BUIlOING PERHIT 2D,-OO Plan Ck, Comm/Ind It:'\m
Charges and 65%/Bldo Per Fee
Surcharges .80 Plan Ck. Res I
30%/Bldo Per Fee
PlU'~BING PERMIT Fence I
Charges and ------------ I
Surcha rges Dljl!lo
ElECTRICAl PERI~IT Sidewalk I
Cha rges and - --- -- --- --- I
Surcharges A/C Paving
MECHANICAl PERMIT Curb Cut I
Charges and ------------ I
Surcharges
Systems Development
Char~e (1.5~) .
I
Total Comb. Permit I
TOTAl ~33.80 ~
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
1. Applicant to furn'ish
A, Job Address
B. Legal Description
1, example. Tax Lot 100, Lane County Map Reference
11 03 43
2, example- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin...q/or forced air qas
2. exa~le- ~aterheater/electr;cal/or ~
E. Square footage or valuation. etc.
1. examole- 1250 SQ. foot house, 500 SQ. foot garage
2. exam~le- if new project. check:ruew - if addition,
cneck. add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. exam~le -:remodel existing garage into family room
3. example -_conver~ single family resjdence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM1 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.
11. 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 appropciate 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
Pennit C1 erk
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I
PROJECT CONDITIO~S TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registration with the Builder's Board because':
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date