HomeMy WebLinkAboutPermit Signage 1988-7-12
I INSPECTION LINE
726-3769
Job Address 5'125
.
CITY Uf SPRINGFIELO
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work.:
.
INFORltATION UNl
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
/YL~
Legal Description
,
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BuildinQ Permit Info: Oescribe Work(i-.e.. Build Single ............
Familv R.esidence l~ith...P.ttached Garaael , ~
~ ~AfiJ\;)'
~ / ~
Owner lll~
Address . "5"9;;- .,
f
~~
~
Phone
Construction Lender
Address
DESIGN TEAll
(name)
Phone
(address)
(1 ics. no.l
(exoiresl
I
,
I
no. )
(ahOM
Primary
Mechanical
CONTRACTORS
(.....,1
(address)
flics.no.)
(pxnires)
~L
~y
{",hOOP nn
Structural
__,...- $300
...,.,.~ \
Electrical
Genera 1
Electrical
/
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Plumbina
~lechan;cal
PlmBIIlG
ELECTRICAL
MECHANICAL
NO.
FEF rHARr,F Nn
rrr r~~Rr.r Nn
rr~ ~ rl-ldQr..~ ~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Storm Sewer
I
I
I
I
I
I
Of
amps.
Appliance vent
~POi'lrate
Stationary evap.
cooler
Vent fan with
<;;nolf:\ rluct
Vent system apart from I
h':'':ltinq 0f A.r
Mechanical exhaust
hood and rluc-t
Sewer
Temporary Construction
Change in existing
rpc;iQ.ent:p
multifamily, corrrn. or
Tnrlu<;triitl
~Iater service
~I
~ f) ()d
\/1
I
I
COMM./INO. FEEDERS
Install/alter/relocate
c1i c:;tritL fpprlprc;
Wood stove/heater
Of
amps.!
TOTAL CHARGES
WHERE STATE l~U REQUIRES
shall not be vali-J until the
TOTAL CHARGES
ISSUANCE OF PFR!lIT
TOTAL CHARGES
that the Electrical work be done by an"Electrical Contrac ,or, the electrical portion of this perrilit
label has been signed by an Electrical Surervisor 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 rm OCCUPArKY 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 O~S 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.
IWIE(please print) K.11/fE.N J ':bONNER.....>
SIr,!IATUR~tJrn.~
... ..---- . -- --- -.- .----
FO~ orFI CE USE O1~L Y
DATELg/lJJ./f
v v
Zone
Fire ZonE'
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERNIT
Charges an~
Surcharges
Plan Ck. Comm/lnd
65%/Blda Ppr Fpe
------------PTan Ck. Res
30%/Blda Per Fee
Fence
Systems Development
Charoe (1.5%) .
PLU'1BING PERMIT
Charges and
Surcharges
I OeRlO
15, Cf'D I Sidewalk
--------~75-1 A/C Pavin9
I Curb Cut
leaU!
I
I
I ")'"
(EO( ~
I
I
ELECTRICAL PERI:IT
Charges and ~
Surcha rges 1,
.1ECHANICAL PERMIT
Charges and
Surcharges
ITotal Comb. Permit
-~
(.5 - r~
I
--uD I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
II UJ 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air aas
2. examyle- waterheaterlelectrical/or solar
E. Square footage or valuation, etc. ,
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check:ruew - if addition,
checl< add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3, exa~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 TEM~ 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 OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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.
rr(j; 7{
1-17/--11(
V: FOR OFFICE USE ONLY
Permit Clerk
CfJ
.
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