HomeMy WebLinkAboutPermit Miscellaneous 1981-7-17
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INSPECTION LINE
726-3769
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-3753
JobAdd".. 46"9~- >>A/;U sn
L.goIO",dp!lon l 00 - 11 () 2. '3 '2 00
ENERGY SOURCES:
Hect
Water Heater
Ran~e
Value of Work:
Sq. Fig. Main
Sq. Fig_ Access.
Sq. fig. Other
_New_Add_Alter_Rep.
_Fence_Damo_Changel Use
_Other
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I Own., 6: 2),e /\/ r
I Add,... 792.4 - '7/I~A!!STCJI\l eo Phon726-S593
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Construction lender
Building Permit Info: Describe Work (i.e.. Build Single
Family Residence With Attached Goroqe1
-Z:;.IST"'l/1 CL~1)Jlr JJLi/t'Y
'J,u ~/1/. S.e<<Le~,
Address
DESIGN TEAM
Phone
(nome)
(oddreu)
(lies. no.)
(expires)
(phone no.)
Primary
lrt
-r
Structural
Elflctricol
Mechanical
CONTRACTORS
(name)
(address)
(lies. no.l
(exoires)
(ohone no.'
General
plumbina
fllo
/
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO. -
FEE
CHARGE NO.
FEE 1 CHARGE NO.'
FEE . CHARGE
Residence of
furnace/burner to
~TU's
Appliance vent
separate
Stationary evop.
cooler
Vent fon with
single duct
Vent system apart from
heoting or A.C.
Mechanical exhoud
hood and duct
Each sin9.le fixture
Relocated building
(new fix. additional)
S.F. Residence
f1 both}
'9' ft.
New circuits, alterations
Dr extensions
SERVICES
Du~lex (l both) each
Temporary Construction
Additionol bath
Amps.
Water service
Sewer
Wood 'fave/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10.000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES A 10 ';'::,e:- E
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES that th. Electrical work be don. by the Eledrical (ontrador, the electrical portion of this permit sholl not be yolid until a
label has been signed by an Eloctrical Controctor and attached to tho olodrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon h true and correct, and I further
certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon
pertoining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further
certJfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption-
NAME (please print) ~ l.-ln~ i-.....
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~~A) L-SIGNATURE _;.S..A~~---' M~ ~,:I-
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DATE '7-J7-CC,'
FOR OFFICE USE ONLY
Zone Type/Conlt. Units Sq. Ftg. Main
Fire Zone A ~drooms occy Load l:._, Ftg, Ac~u
Flood Ploin l:.tori.. Occy Group Sq. Fig. Other
BUILDING PERMIT Plan Ck, Comm/lnd
Charges and 65%/ BldQ Per Fee
Surcharges Plan Ck. Res
30%/ BldR Per Fe.
PLUMBING PERMIT
Charges and Fence
Surcharges
Demo
ELECTRICAL PERMIT
Charges and Sidewalk
Surcharges
AI C Pavina
MECHANICAL PERMIT
Charges and Curb Cut
Surcharges --------
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charae 0,5%)
Total Comb. Permit
TOTAL
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. COMBINATION APPlICATION/PE. (CAP) v-
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.PERMIT VAll-DATION
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I. Applicant to furnish
A. Job Address
B. legal Descriptian
1. example-tax lot 100, lane County Map Reference 17 03 43
2. example-lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example~heat/electrical ceiling/or forced air gas
2. ,example~water heater/electrical/or solar ~
E. Square footage or valuatio.n, etc". .
1. example-1250 sq. foat house, 500 sq. foot garage
2. example-if new project, check new~if addition, check
add, etc.
F. Building permit information:
1. examole-construct single famil~ house with an attached
garage
2. example~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 & Electrical Schedules
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill-in anly 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 abbrevi.
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FilL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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111. 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 typewritten 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
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
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'iignaturfD
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