HomeMy WebLinkAboutPermit Building 1983-8-10
I INSPECTION LINE
726-3769
.
CITY OF SPRINGFIELD
COMBItIATlON APPLICATION/PERMIT
.
INFDR/1ATlDN llNt
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq, Ftg. Other
!lew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
IU-~' b~/S'2.-q
I
Job Address 4f.n,SS ~-! ~+
Legal Deseription \ I) "~?Je:,",,~ (J \'~()( )
EilERGY SOURCES:
Heat
l~ater Heater
Range
Owner "'T """ LO- \YN> h q 1'-1-'
Address 1\ n,<; n. :;<. rzd Pj)
Construction LenderA rttAJ ,
Phone 7~7.mr;
Val~€ of l'lork:
-b(.,c,S.O'O
BUlldinq Permit Info: Describe Work(i~e.. Build Single
Familv Residence With Attached Garaqel
~e,'t(,.,a-t;,...~. p~+
~
0....
---
N)
Do
Address Phone
Ut~ lliN H.Ar1 (name) (address 1
Primary
Structural
Eleetrieal
Mechanical
CONTRACTORS (name) (addrpss)
Genera 1 ,t:::,,,../.~ ~"'~Q..A) ~pFd}
U
Plumbina
Electrical
~1echan;cal
flies.no.l
(exoiresl
{ohone no ."\
ld
~~,
t"
(1ics.no.)
(exnirec:;)
(ohnnp no. )
PLUlIB ING
uj
ELECTRICAL
MECHANICAL
NO. I
I FEF I CHARGF jJO I
I H~ I nl~ NO. I
I n:~ I rl-lllR!iE.
Each Single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
/
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
n bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
rps- j rlpJ'~p
multifamily, cOnYn. or
TnrllJd.rial
Of amps,l
ICOMI'I./IND. FEEDERS I
IInstall/alter/relocate I
rli,t.rih_ fppnpr,
IOf amps.1
I
I
I
Appliance vent
seoarat.p
Stationary evap.
cooler
Vent fan wi th
sinalp dt.IC::~_
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dud
Wood stove/heater
~Ia ter servi ce
Storm Sewer
ISSUANCE OF PFRlllT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'll REQUIRES that the Eleetrieal work be done by an, Eleetrieal Contraetor, the eleetrieal portion of this permit
shall not be valiJ until the 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 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 UO OCCUPAIKY 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 OP.S 7~1.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Cons t.
Bedrooms
Stories
Units
Oeey Load
Occy Group
SIGllATU~ /~\-r-?~
FOr. OfFICE USE ml~ I
-------
Sq. Ftg. f1ain ,x
Sq. Ftg. Access x
Sq. Ftg. Other x
DAT~/(}-f?")
V
IlAr,IE(please print) '7'i'N \( - )~ 1- r-P (' n
Value
Value
Value
TOTAL VALUATION
BUILDING PER/lIT
Charges an~
Surcharges
c:l Plan Ck.
__ _7...._c:..______ ~IBlda
B Plan Ck.
.~ 30%IBldo
COIlVTl/lnd
PJ'r Fpp
Res
Per Fee
Isystems Development
Cha rqe (1. 5%) ,
PLUI1BING PERMIT
Charges and
Surcha rges
Fence
DeRlo
ELECTRICAL PERI:IT
Cha rges and
Surcharges
'Sidewalk
- --- -- --- ---
I A/C Paving
____________1 Curb Cut
I
I
Irotal Comb. rermit
I
I TOTAL
/I
7- :J. ~
J
11ECHANICAl PERMIT
Charges and
Surcharges
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, lane County Map Reference
1/ 03 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examJPle- heat/electrical ceilin~/or forced air qas
2. example- waterheater/electrlcal/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 addition,
cheek add, ete.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. examele - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Yalue of work as defined in Seetion 303 (a) of the
Struetural Speeialty Code
H. OESIGN TEAM ANO 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, Mechanieal, & Electrical Sehedules
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 penmit fonm the schedules
have been abbreviated
2. If the item{s) to be installed are not eovered on
the abbreviated schedules you should consult the
full schedules
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
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 eleetrieal label. ---
III. Applieant to Sign and date
Whenever possible. the initial application will b~ 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.
Y. FOR OFFICE USE ONLY Permit Clerk
. I
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