HomeMy WebLinkAboutPermit Miscellaneous 1987-11-5
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INFORlIATION L1No
726-3753
Sq. Ftq. I"ain
~q. Ftg. Access.
Sq. Ftg. Other
I~ew Add Alter Rep.
-Fence Demo Change/Use
Other- -
I INSPECTION LINE
726-3769
CITY UF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Job Address
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legal Description
Owner
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E, rI7~ Phone1V1
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Range
Valu, of Hork:
Address
BuiltiinQ Permit Info: Describe Work(i.e., Build Single
Familv ~es;dence W;th~Attached Garaqe)
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Construction Lender
L-
Address
OESIGN TEAll
Phone
(address)
(namel
(1 ics. no.)
(exDires)
Primary'
Structural
Electrical
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,.,-.../"l..
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Mechanical
CONTRACTORS
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(address)
(lir_~. no.)
(p'fn;res)
Genera 1
Plumbina
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MECHANICAL il"
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Electrical
t>lechani ca 1
l'lllnlIltG
ELECTRICAL
NO. I
, HF I r.HARriE
Nn '
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Irl-l'iRG.E~1
Each single fixture
Residence of
furnace/burner to
BTU's
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
I ~Iater servire
I Sewer
IStorm Sewer
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SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl v~nt
lTempOrary Construction
IChange in existing
res j d~J'lr('
Imultifamily. comm. or
Industrial
IOf amps.
ICOffi1./IND. FEEOERS
I Install/alter/relocate
didrih. fppdprc;.
Appliance vent
c;eni\r:ttp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.r..
Mechanical exhaust
hood and durt
Wood stove/heater
Of
amps.
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'7'
ISSUANcr OF PFRIIIT
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(ohone no.)
(ohon,:l no )
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TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'U~ REQUIRES that the Electrical work be done by an"E1ectrica1 Contractor, the electrical rortion of this permit
shall not be valid until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed application for permit, and do hereby certify that all info'rlf'ittion hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Orpinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described here' and that rw OC UPAHCY will be made
of any structure without the permission of the Building Division. I furt e' t t m registrati m ith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exe pt t e basl e emption is no ed hereon, and thit
only subcontractors and employees who are in comoliance with ORS 7nl.055 ill e used nth, 'ect. ~
\ \~.oWlQS l1V\11m ax n + lmrlATURE I
FOr. OFFICE USE OI~L Y
HAl1E(please print)
v
Zone Tvpe/Canst. Units Sq. Ftg. t1ain
Fi re Zone Bedrooms Occy Load Sq. Ftl). Access
Flood Plain Stories Occy Group Sq. Ftg. Other
BUILOING PERNIT Plan Ck. Conm/! nd
Charges anc ----------- 65%/Bldo Ppr Fpe
Surcharges Plan Ck. Res
30%lBldo Per Fee
PLU!~BING PERMIT 1 S 0-0 Fence
Charges and <' ----- -_!...._--
Surcha rges .75 0","0
ELECTRICAL PERIHT I.Sidewalk
Charges and ------------ I A/C Pavi ng
Surcharges
MECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
x Value
x Value
x Value
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TOTAL VALUATION
Systems Development
Charoe t1.5~)
Total Comb. Permit
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I TOTAL
lS.7~
J1s,?\7
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
II OJ 43
2. examole- Lot 1. Block 3, 2nd Addition to
,pr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinqlor forced air Qas
2. examyle- waterheater/electrical/or SOlar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
cheCk add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examyle - 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 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 ~ivision 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.
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V. FOR OFFICE USE ONLY
Permit Clerk'
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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