HomeMy WebLinkAboutPermit Miscellaneous 1990-4-6
"'I INSPECTION LINE . CITY OF SPRINGFIELD
726-3769 COMBIilATION APPLICATION/PERMIT
Job Address ~ ~ ~\\\ggJ:- ~~~~r,y SOURCES:
Legal Description \il ()r;J" ,?>,,-\ 7\~ ()L\~()\ I/ater Heater
- - Ranqe
Dwner~\f'\,('-Q()t'Q .~\~()~ VaIU(,\\I,\(\) I
Address ~~ ~ -', .fl(\l 1'<"\. _'.. .,~. Phone Builriinq Pe~lit Info: Describe Work(i.e.,
~ ,~ r-\~. \\f7~~ \\ ~ ~ Familv nesidence With Att~~h~d G~r~?~l
fUQQ\I\~ ~ ~ C\"l4()\ _ 1-
Cv",,"vc,,u"cenoer Cl \ ~3-\\43 ~Jn\Q<< )t'NfUL)
.
INFOR/1ATIDN LINt
7?'- 1751
Sq. Ftg.11airi-u
~q. Ftg. Access.
Sq. Ftg. Dther
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
-.-C) ~-
~
------.
--
Build Single
L\~r
Address
Ut,UiN ItAH
(name)
Phone
(addrp<:<:l
f1 ir:<: nn'
(~xl);res)
(ohane no.\
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name 1
(address)
(lire;. no.)
(pxoirpc;)
(ohnnp nn.
Genera 1
Plumbinal1-)L \ \ ml~~< lA.1) f1'1/ C'o'frt1I~ dop
Electrical () (:)
Hechanical
PLUlIBI NG
ELECTRICAL
MECHANICAL
ND.
FEE CHARGF NO
~~~ r~QQr.~ NO
~~~ rl-l1l.ln~J:'
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
(1 bath)
Duplex (1 bath) each
IAdditional bath
I ~Iater servi ce
I Sewer
I Storm Sewer
I
I
I
I
I
I
ISERVICES
I
Recessed wall
So~~P hp~tpr ~nrl vpnt
ITemporary Construction
IChange in existing
rp<;_i d('nr:~
multifamily, comm. or
lnrlu<;.tr;al
Of
CO~1,/IND. FEEDERS
I Install/alter/relocate
,di<;.trib. fppdpr<;
amps.l
Appl iance- vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
" Vent system apart from
heating or A.C.
I Mechanical exhaust
hood ~nd dur:t
I Hood stove/heater
I
I
I
IOf
I
I
I
amps.
ISSUANCF OF PFRr1IT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
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 HO OCCUPAUCY 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 ons 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 7Ql.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
i?re.de......SIGIIATURE ~~_ C ~~_ Dm f-~-~'
FO~ OFFICE USE OIIL Y
So. Ftg, Ilain
Sq. FtlJ. Access
Sq. Ftg. Other
Units
Occy Load
Occy Group
,
Value
Value
Value
IlAJ.lE(please prin~ rk I-'~ e-- e
x
x
TOTAL VALUATION
Systems Development
CharQe (1.5~)
':~~1!2,
V
\ S .Ul)
TOTAL
. ~u.'\~1
.
.
II
.
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
11 03 43
2. exam~le- Lot I. Block 3. 2nd Addition to
>prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. examole- 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 permit information:
1. example - construct single family house with an
attached garage
2. examole - 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. ---
Ill. 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.
~
~;~b4()
(0h(0
V. FOR OFFICE USE ONLY
Permit C1 erk
fiiIYL
.
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