HomeMy WebLinkAboutPermit Building 1983-11-18
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I INSPECTION LINE
726-376g
CITY Uf SPRINGfIELD
COMBIIIATlON APPLICATION/PERMIT
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Job Address
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E!lERGY SOURCES:
Heat
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INfOR/1ATlON L1Nl
~ 726-3753
, Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq""Ftg. Other
Vllew Add Alter Rep.
--Fence Demo Change/Use
Other - -
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Owner'
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Phone
ValUE 0\ H17D.cO
BuildinQ fermit Info: Describe Work(i.e., Build Single
Familv Residence With Attached Garaoel
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Address
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{name}
Phone
(address)
Primary
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Structura 1
Electrical
Mechanical
CONTRACTORS
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(addr@ss)
flies. no.)
(pxnirpc;.)
(ohonp no )
Genera 1 \
Plumbina
Electrical
~'echanical
PLUllB I NG
ELECTRICAL
MECHANICAL
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Each single fixture
I FEE I CHARGE NO I I <<L IJ:IlARliE .J:lll....1
Res; dence of furnace/burner to
SQ, FT. BTU's
J n~ Ir~JlR!iE.
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Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~~p hp~tpr ~nrl vpnt
Water service
!Temporary Construction
IChange in existing
rP'S j dJ.nc:p
Imultifamily. comm. or
TndlJc;.tri~l
IOf
ICOMfl,/IND. FEEDERS
I Install/alter/relocate
rlic:trih_ fppnprc:
IOf amps.1
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I
amps.l.
Appliance vent
seoarate
Stationary evap.
cooTer
I Vent fan with
sinoTe duct
I Vent system apart from I
heatinq or A,r.
I Mechanical exhaust
hood and durt
I ~lood stove/heater
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TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L~H REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical 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 Sewer
Istorm Sewer
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I SSUANCf OF PFRllIT
Zone
Fi re Zone
Flood Plain
I HAVE CAREFUllY EXAr1INED 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 NO OCCUPAr~CY will be made
of any structure without the permission of the Building Division. I further certify that my re ~stration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for e~ tion is noted hereon, and that
only sUbcontractors. and employees who are in compliance with OP.S 7nl.0~ed on t (s/project.
IIAlIE(please print) SIGIIAT~~ ~ Dim/I-if-.J:/'
!'cm ii'fFICE USE 0I1LY po
Sq. Ftg. liain
Sq. Ftg. Access
5q. Ftg. Other
Tyoe/Const.
Bedrooms
Stories.
Units
Occy load
Dcc'y Group
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERIIIT
Charges and
Surcharges
JO <:.:X:) Plan Ck,
~ ~ ______ 65VBldo
, /1;-..... Plan Ck.
,-r\ ) 30%/Bldo
Fence
CorrmlI nd
Pj'r Fpp
Res
Per Fee
Systems Development
CharQe (J.5~) ,
PLUI~BING PERMIT
Charges and
Surcharges
I D~mo
I Sidewalk
I AIC Paving
I Curb Cut
I
I
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Comb. Permit I
ELECTRICAL PERI~IT
Charges and
Surcha rges
ITotal
,
I TOTAL
(O,1C)
J
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. examp.le- Tax Lot 100. Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner-and construction lender
D. Energy Sources
1. example- heat/electrical ceili~qjor forced air qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. examjple- if new project. checkiruew - if addition,
cneck 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. exam~le - conve~~ single family res1dence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aj of the
Structural Specialty Code
H. DESIGN TEM1 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. I f the item( s) to be ins ta 11 ed 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. ---
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.
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I II.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VAll DATION '
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Permit
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date