HomeMy WebLinkAboutPermit Building 1987-10-13
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I INSPECTION LINE
726-3769
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INFORIlATION LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
Job Address
l.:>L'L<Z;
~\ IV s.r.
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Meat
l~ater Meater
Range
t-^vQ.K..e)JC.A G: ~\-X)~ ~S.
Owner ().oQ.. ~~ ~1v~10
Address C'>D V->...,X co I l~UOPIP~hone :iA."3~
r. . \ c:::>l-U -I () \.D { V1 \...L.A<'..,..(~ .3 \ q.,
ValUE of Work: (j
&2...'5,3>'60" .
BuildinQ Permit Info: Descr1be Work(i.e.,
Familv nesidence With Attached GaraQe)
Build Single
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VI
Legal De~cription
~POR.X , 0'<<--. ,q 1~11 ~
Address
Ut~IGN ItAl1
(name)
Phone
(address)
~ Cf'F..-~ L~\\.Q\)c:,.<;'J~
d" U:O '" w(Th\ :1>- M fH~Ji:lU\'S.S. ~IS,. -
c"RAlII.:lC.r ~ ~ ~1...U w.,",- .
flies. no.) (exo;res)
(ohone no. I
Construction lender.
Primary
Structural
Electrical
, (db I
ll~~
Mechanical
CONTRACTORS
(name)
(address)
(lics. no.l
(pxnirpc;.)
(nhnnp nn_ )
rGenerall f)y-,{5. QN...,C:,Ur~ '1J{~ ~ R..O
Plumbino CLlc...e ISE
Electrical Ci.4\,.') 1.
'tt\~}~
\\141 '6''1 :J4\.Hlll nC\
I
,-;, /VII{
~'echanical
PLur.IBING
ELECTRICAL
MECMANICAL
NO.
FFF rHARr,E Nn,-
... r"~ J:Jll......
~1='1=' rlffi.RG..E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
<;.poaratp
Stationary evap.
cooler
Vent fan with
s;n91e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt.
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp~ i rtp}lrp
multifamily. camm. or
Industrial
Water service
?>
'6
\C\
COMM./IND. FEEDERS
Install/alter/relocate
rl;~tr;n fpprlpr~
Of
amps.
TOTAL CHARGES
. WHERE STATE LAW REQUIRES
shall not be vali1 until the
ISSUANCE OF PFR/HT
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an.:Electr;cal Contractor, the electrical portion of this pemit
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 oerforTlled 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 110 OCCUPAIlCY 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 ORS 701.055 ;;ill be used ~:.project. '\
NAI.1E(please print) ..:\\ IJu 'R.AJ~...& SIGNATUREA^~l ~ ~
FD~ OFFICE USE OIILf \
ZonE' Type/Canst. Units Sq. Ftg\ua.;.h
Fire Zone Bedrooms Oeey load Sq. Ftg. Access
Flood Plain Stories Oecy Group Sq. Ftg. Other
DATE 10/ /3/ ~'1
x
Value
Value
Value
TOTAL VALUATIOtl
x
x
.0
\
BUILOING PERf1IT
Charges and -"\
Surcharges d-
!..:::__~'n~~oZ>::
,:~.R;rj5
Plan Ck. Comm/lnd
65't/Bldo PJ'r Fpe
Plan Ck. Res
30%/Bldo Per Fe.
Fence
Systems Development
Charqe (I.5~) ".
PLur~BING PERMIT
Charges and
Surcharges
D_
'Sldewa 1 k
ELECTRICAL PERI11T
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
A/C Pavi ng
I Curb Cut
------------
I
Total Comb. Permit
TOTAL
It g3. of
r
i
..
..;- -...~..
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
11 oj 43
2. exa~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates ,
C. Name. etc. of owner and construction lender
D. Energy Sources
.1. examEle. heat/electrical ceilinq/or forced air Qas
2. examyle- waterheater/eiectrical/or solar
E. Square footage or valuation, etc. -----
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if ~ddition.
check add, -etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
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. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to cont~~J approR~t~te
persons regarding design information~or job-sl~e .
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
l2. 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 SCHEOULES _
O. 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.
I033f
/0- I )-g 1
V. FOR OFFICE USE ONLY
Permit Clerk
cc
1
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
.