HomeMy WebLinkAboutPermit Building 1991-3-6
:;-1 INSPECTION LINE
J 726-3769
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CITY Of SPRINGfIELD
COIIBIiIATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE of Hark:
~~.-~
Ph n BuflGinQ Permit Info: Describe Work(i.e., Build Single
~~e ~I Familv nesidence With Attached Garaoel
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I1'FURJIATlON LINt
726-3753
Sq. Ftq. l'lain
~q. Ftg. Access..r:>~
Sq. Ftq. Other
lIe" Add Aller rep.
--Fence Demo Change/Use
Other- -
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Legal Oescription 17-.::1<-.3"'1-:1 J /'''' ~l
Job Address
Owner C::~A"I"'~ ?~ MY'N~
Address 5""::1,~C> MH/H q,7.
~Z;>r~7/, 6A'_
Construction lender ,r
Address
DES I GN TEAI~
(name)
Phone
(address)
(lies. no.l
[exoiresl
{ahane no.
Primary /.:JWd~;ze
A
~
.Y ""
Structural
Electrical
Mechanical
CONTRACTORS
(namel
taddress)
(l iC':C';.. nn.l
(pxlJirpc;,)
(ohnl'lp nn. \
General C>WR~.
Plumbina
Electrical
~'echan;cal
PLUt,IBING
ELECTRICAL
MECHANICAL
....llih FFF
~ Each single fixture II?
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Iater servi ce
~. Sewer
Storm Sewer
CHARGF NO
~~~ r~~ NO
H~ r~~
Residence of
?a.-
SQ. FT.
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp np~tp~ ~nrl vent
Of
amps.
Appliance- vent
seoaratp
Stationary evap.
cooler
/ I Vent fan with ~
. sinale duct ~?
I Vent system apart rom
heatino or A.C.
I Mechanical exhaust I
hood and durt
I tIood stove/heater I
I
I
I
/.e;:"W:
-:4!::-
Temporary Construction
Change in existing
res j rl~nLe
multifamily, COrTm. or
Indllstriid
COMM./IND. FEEOERS
Install/alter/relocate
distrib. feeders
Of
amps.
~ ,="~';A{~ ,2?;,'...?i"/7"'
/q~0~- '
ISSUANcr OF PFRIIIT
/ t9.. -
/'77/ h _ 2').""'f
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
5:5..'P TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
TOTAL CHARGES
Electr,lcal 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 oerformed 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 1m OCCUPAHCY 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.
1lAJ.IE(please pri~ {J/@k .$,,;tT ~M.,_SIr.IIATURE C/I/l/fJF-5 S('o1T ~gESOATE )-&-'7/
r FDn orFICE USE OilL Y
Zone_ /,"'-
Fire Zone
Flood Pla i n
Tyoe/Const. ~ .
Bedrooms
Stories
BUILDING PERfIlT
Charges an~
Surcharges
Plan Ck.
__1?:?.-:St2___ 65%/Rldo
Plan Ck.
e,. I ~ 30%/61 do
_nS5--
'2.75"
Units Sq. Ftg. f1ain x Value
Occy Load Sq. Ft9. Access /2dD x /~/,O Value/~_ 9~~.
Occy Group~-<,.~q. Ftg. Other x Value
";j> / TOTAL VALUATION
I)/.P7 '9//"'7
, 7"'" ....., _"... Sys tems Development
/_t:!F...... .... 7"/ CharDe (1.5~)
COITlll/l nd
Ppr Fp~
Res
Per Fee
PLUt~BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICAL PERIHT
Charges and
Surch,a rges
/IECHANICAL PERMIT
Charges and
Surcharges
Sidew. ik
A/.C Paving
2S:~, Curb Cut
------------
1.25'"
To~tal Comb. -Perm; t _
TOTAL
::2 1;Z ,~'?
,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole. Tax lot 100, lane County Map Reference
II U3 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
~ ,..., .C.' "Name. etc. of owner and construction lender
D. Energy Sources " . . .
1. exam~le- heat/electrical ceilinqlor forced air Qas
2. examyle- waterheaterteJectr;cal/or solar
E. Square footage or valuation, etc.
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
cneel< add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - 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. 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, & Elect~ical 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 ANO
CHARGES ON THE SCHEDULES
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. ---
Ill. 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.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT'VALIDATION
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
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Addltlonal Proj~ct Information:
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PLANS REVIEWED BY:
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name L&>;g~,z= ?c:..,!Z;~ signature +---b--+-- date2-7/-'-'9/
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