HomeMy WebLinkAboutPermit Building 1988-10-19
I INSPECTION LINE
726-3769
.
CITY Of SPRINGfiELD . INfDRllATIDN UNt
COMBINATION APPLICATIDN/PERMIT 726-3753
E!lERGY SOURCES: Sq. Ftg. I.'ain '
Heat ~q. Ftg. Access.
Hater Heater Sq. ft9. Other
New Add Alter Pep.
Range -Fence Demo Change/Use
Val UE of Hark: tj rJ-f) I1J Other - -
Builtiinq Permit Info: Describe Work{i.e., Build Single
Familv ,~idence \Hth Attached Garaae)
.Iff i:JiJ d1:' ~ 0f //11 :. ~
IXJ7()(
Job Address
--1 fJ SS- /Yl12.1~
/1 0 ~ -:s 5" 30
legal Description
Address
Phone
~
~
Cl\
~
Owner
~ {Il/l~
;V~
Construction Lender
Address
Ut~j{jN TEAI~
(name)
Phone
r address)
flics. no.)
(exn;res)
(ohane no.-
Primary
Electrical
'JJ~
\I~~
Ii
~L
pf
Structural
Mechanical
CONTRACTORS
Inamel /
fY1 J ) f1fJ'ul
(address)
(lico::. nn.)
(pxnires\
(ohnn,:. nn. \
Genera 1
v --
\,:>/)N!
Plumbina
Electrical
~1echanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
Each single fixture
FFF rHARr,E Nr"J.....J ~~T rlfAB.G.E.. NO.
Res i dence of furnace/burner to
SQ. fT. BTU's
H~ rl-l.;RG"L
Relocated building
(new fix. additional)
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~~p np~tpr ~n~ vpnt
Storm Sewer
Of
amps.
Appliance vent
5eOari'l.tp
Stationary evap.
cooler
Vent fan with
",inole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re<;.jqPJ1C':p'
multifamily, comm. or
Tndll<::trial
~Jater service
COMM./IND. fEEDERS
[Install/alter/relocate
d;<;.trih. fppnprc;;
\01
IOf
I
I
I
amps.
ISSUANCE OF PfR'lIT
TOTAL CHARGES TOTAL CHARGES 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 valij until the 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 NO OCCUPAr~CY 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 7Ql.055 will be used on this project.
~ELs'o0 SIGNATURE>?d~/J.1O-.-( Y1~ATE/CJ-I7' -fo'-
fOr. Off I CE USE OIlL Y
Sq. ftg. 11ain
Sq. ftg. Access
Sq. ftg. Other
IW1E(p1ease print) \)otvA MA \::
Zone
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
Fire Zone
x
Flood Plain
x
TOTAL V ALUA TI Or!
BUILDING PERHIT
Charges and ~.
Surcharges 0'
t I - 'l) 0 PI an Ck. COlllllflnd
______'e_a___ ~{Rldo P.fr FpF!
;1 Plan Ck. Res
...- , In'i 30%lB1 do Per Fpp
Fence
syste.rns Development
Charoe tl.5~) .
PLUI~BING PERMIT
Charges and......
Surcha rges
I DURIO
______ ___ __-'Sidewalk
I A/C Pavi n9
___________J Curb Cut
I
Irotal Comb. Permit
I
I TOTAL
/~< 0(-- ~
ELECTRICAL PERIHT
Charges and
Surcharges
"
MECHANICAL PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. App1 icant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. examp1e- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
I. examp1e- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check-new - if addition,
checl< add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garllge
2. exam~le - remodel existing garage into family room
3. exarnyle - 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 OIVI5ION 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. ---
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.
/ ~& Z -V
( 0 ~ ( q -d
V. FOR OfFICE USE ONLY
Permit Clerk
('C-/
.
]
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