HomeMy WebLinkAboutPermit Miscellaneous 1982-4-5
CITY Ur SPRINGFIELD. INFDRlIATlON liNt
.COMBIIIATlON APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftq. i.la i n
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
Ilew Add A Her Rep.
Ranqe --Fence Demo Change/Use
ValuE of HorXJ lA- ptheP)-
BuildinQ Permit .Info: Deser.be Work(Le.. Build Single
Family ~esidence With Attached Garaae)
A
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.. ,
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-ld~ G~ J~fulW~exoire'l ~t\ l;'~ I
INew circuits alts.
or extensions
I SERVICES
Temporary Construction
IChange in existing
resjd_e.nr'p
Imultifamily, camm. or
Induc;trial
IOf amps.1
!COMM./IND. FEEDERS
Install/alter/relocate
di<;trih fpprlprc.
.
J INSPECTION LlIIE
726-3769
Job Address ~C\\..\~ ~ A'('{\. l
Legal De.cription ;7-f)1 ~~Lf- 30
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Address ffi\.\.U I. 1f'f\(\ U\
construct~e~~~ J ~ 0
Owner
Phone
Address
Ut~lbN ItAII
(name)
Phone
(address 1
Primary
Structura 1
Electrical
!1echanical
CONTRACTORS Inamel____
. General l ..\...~ ~ ~ Jl\f'.
Plumbino
Electrical
~1echanical
PLUIIBItIG
NO.
FEE
CHARGE
Nn
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Duplex (1 bath) each
IAdditional bath
Water service
Sewer
Storm Sewer
Of
0.')5' (1. (1..,
lit:::.. '
; 1 f:')1 ,
~
o
~
....J
r
,1<::\/ "/;1)U
D?~ -
(lics. no.l
(exniresl
(Dhone no.l
Ii
I
,
!
-.--."-..-->0.-.......",'
ELECTRICAL
MECHANICAL
...
NO~I
I furnace/burner to
BTU's
I Floor furnace
and vent
I Recessed wall
Sn~rp hp~tpr ~nrl vpnt
~
,:
~
fI-lAIU:~
--- - -
F'F'F' fI-lARr.F'
SQ. 'FT.
amps.
Appliance vent
seoaratp
Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from
heating or A.C.
I Mechanical exhaust
hood and duct
I ~Jood stove/heater
I
I
I
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that tile Electrical work be done by an.
shall not be valid until the label has been signed by an Electrical
I SSUANCf OF PFRllIT
LTOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
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 OCCUPArKY will be made
of any structure without the permission of the'Building Division. I further certify that my registration with the Builder1s
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 OP.S 701.055 will be used on this project.
IW.IE(please print) t /J"""'-~ r-L l)/,l~/..$ SIr,IIATURE~L.,~f&_
FO~ OFFICE USE miL Y
So. Ftg.
Sq. Ftg.
Sq. Ftg.
Zone
Tvpe/Const.
Bedrooms
Units
Occy Load
Occ.y Group
Fi re Zone
Flood Plain
Stor'i.:.~
BUILDIIIG PERflIT
Charges and
Surcharges
. PI an Ck. Conm/lnd
65%/Bldo Pyr Fee
Plan Ck. Res
30l/Bldo Per Fee
Fence
PLUt1BIIIG PERMIT
Charges and
Surcharges
I Demo
I'Sidewalk
I A/C Paving
I Curb Cut
I
ELECTRICAL PERr~lT
Charges and
SurCharges
MECHANICAL PERMfT
Charges and
Surcharges
~
i
~ <:;)....,
DATE </ '- ~ -~ -.,
i
I
I
Haio
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charqe t1.5~) .
I
I \'?\~)
I
I \~.OO
I
I
ITotal Comb. Permit
I
I TOTAL
d~. ~'"
"
.
COMBINATION APPLICATION/PERMIT (CAP)
..'
,
~. .
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name,' etc. of owner and construction lender
D. Energy Sources
"1. example- heat/electrical ceilin9/or forced air qas
2. example- waterheater/electrlcalJor ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add. ete.
F. Building permit information: .
1. examele. construct single family house .with an
attached garage
2. examole - remodel existing garage into family foam
3. example - 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 OUT 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
Tees are paid. All other fees and charges are due and
payable when the permit is issued.
V. FOR OFFICE USE ONLY
(
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,.
..
PERMIT VALIOATION
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Permi t
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
~DG.~ ~,. C\lf\Qt.I..~Qt.. -
PLANS REVIEWEO BY:
name
signature
.
date