HomeMy WebLinkAboutPermit Miscellaneous 1985-6-26
I INSPECTION LINE
726-3769
Job Address ~ -r-
Legal Description
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Clry Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat
!4a ter Hea ter
Ranqe
Phone')U....37(B
Val~_r~\<\q
Builciina p'ermit Info: Descr;be-Work(Le.~
Family nesidence With Attached Garaae)
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INFORlIATION lINc
726-3753
Sq, Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
-Fence Demo Change/Use
-Other -- --
Owner ~ ~ ' J)
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Address ~S )vlAIN
5'p,:..,{)reld
v
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Build Single
Address
DcS 1 GN TEAI'I
(name)
Phone
(address)
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(lics. no.l (exoires)" (ohoneUno.
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Construction Lender
on,
Primary
.~
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addresc;)
(lics. no.) (pxnire~d
(ohone on, )
General IJlt.ertl/flVt:= ,/'R/lYl'r<'~ I'......~.. 5,/1/l'Id,,?rC"-/\ 1"/2"&'""ov~ ,)7;),7';>0"
2'1'1-,z)?7
Plumbina
Electrical
~1echanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.
FEF
CHARGE
NO _ I I FFF
I'Residence of
SQ. FT.
INew circu~ts alts.
or extenSlons
ISERVICES
I
I rHAR(;F I NO. j I FFF I rHAR(;F
furnace/burner to
BTU's
Each single fixture
Relocated building
(new fix, additional)
Floor furnace
and vent
S.F. Residence
(J bath)
Duplex (1 bath) each
Additional bath
Recessed wall
So~~p hp~t~r ~nd vpnt
Sewer
!Temporary Construction
IChange in existing
rP5,i rle.nrr:
Imultifamily. conm. or
Tndus.trinl
IOf amps.
ICOMM./IND. FEEDERS
I Install/alter/relocate
d;s.tr;h. fppnpr<;
IOf amp~
Appliance vent
<;pnil. ra te
Stationary evap.
cooler
Vent fan with
s;nolp duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and rtuct
~Iater servi ce
Storm Sewer
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l/ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
ISSUANCE OF PFRrlIT
TOTAL CHARGES
"Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the camp 1 eted apfll i cati on for permit, and do hereby cert ify that all in formati on hereon is true
and correct, and I further certify that any and all work Derformed 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 rm 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 701.055 will be used on this project.
aL-L;fi~ DATE
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Dcc.v Group
0' - ~ G-,ys-
(
A.
L Ue-.el ,.-1./~1r
IWIE(p1ease print) .JOhn
Sq.
riain
x
Value
Value
Value
Sq. Access
Sq. Ftg. Other
x
x
TOTAL VALUATlON
BUILDING PERflIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%1Rlda Ppr Fpp
-----~----- Plan Ck. R"es
" - 30%/B1 do Per Fee
-c=;;- ,
Systems Development
Charae (1.5~)
PLU'lB ING PERMIT
Charges and
Surcharges
D~R10
I
I
I
]Total Comb. rermit
I'
I TOTAL
"
Fence
ELECTRICA,L PERIHT
Cha rges and
Surcha rges
11ECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Paving
____________1 Curb Cut
I
No'~
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example~ Tax Lot 100. Lane County Map Reference
II uj 43
2. example- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examyle- heat/electrical ceilinq/or forced air qas
2. exa~le- waterheaterjelectrlcal/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,
check add, etc.
F. Building permit information:
1. example - construct single family 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 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 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.
t~ I (11(;~
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V. FOR OFFICE USE ONLY
Permit Cl erk
.
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: mC.or tlJ(; PtftE ~'l ~A'(.("
PLANS REVIEWED BY:
name 1;)ClUM'~ L. MtJ2xE. signature
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date ~/..u~5
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