HomeMy WebLinkAboutPermit Building 1987-1-1
1 IrISPECTIOII LIIIE
726-3769
.
CiTY OF SPRl~G~IELO.
COrtBHIATlON APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Ha tel" Hea ter
Ranqe
.
IllFORttATION lHic I
726-3753
Sq. Ftq. (.lain
~q. Ft~. Access.
So. Ftg. Other
Ne\oJ Add A Her ~eD.
-Fence Demo Change/Use
Other- -
Job Address
J./ /DIo
J1117;~
legal De5cription
Bullr:inQ Permit Info: Describe Hork{Le..
Fa~::; ma~d ,r.araoe,
Build Single
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A
I.'it~ ~ rI tw )
Address L(ss4 I~.i tfJ L Phone//U
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!J11& .fZ;;/~ ttd.n, J4122./;:)
Const.toction Lender ..-/
ValuE of l'lark:
Owner
Address
UtS I oil TEAf!
(name)
Phone
(addr~<;5)
(1 ics. no.)
(exn; res)
(ohone no.
Primary
h
\'\Y.a
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ijI
Structura 1
Electrical
f1echanical
CONTRACTORS
(name 1
{addressl (lies. no.)
(exo; ree;.)
(ohnnp nn \
Genera 1
Plumbina
Electrical
~'echanical
PLUllBIrIG
ELECTRICAL
MECHANICAL
tm.1 I FFF
-----lEach single fixture
IRelocated building
(new fix. additional)
Is,F. Residence
(1 bathl
IOuplex (1 bath) each
IAdditional bath
'Ha ter servi ce
Sewer
[HARr,F ..lill.....1
Residence of
ee,
rHIIRG[ ..l!Q...
~f:'~ LHARGL
sq. fT.
furnace/burner to
BTlI's
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SI);lrp hp"tp.. ;Inri Ilent-
!TempOrary Construction
IChange in existing
rp'}id{'nrt;'
multifamily. comm. or
Inclu~triil.l
Storm Sewer
Of
amps.
Apolianc'e vent
",POil.ratp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and durt
CDl11-1. / I NO. FEEDERS
Install/alter/relocate
rli~trih_ fppdpr~
Of amps. I
,c< I
,,\ .DD I.J I
\)~ I I SSUAIICF OF PFR'1I T
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHEnE STATE L~W 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
Wood stove/heater
I HAVE CAREFUllY EXN1INED 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 Soringfield and the laws of the State of Ore~on pertaining to the work described herein, and that 1m OCCUPAIlCY 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 Or-S 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
IW!E(please print)
Zone
Fire ZonE'
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Uni ts -
Occy load
Occy G~oup
S IGIIATURE .. u____
Fo!fOrffiE US( Dill Y
Sq. Ftg. r1ain
Sq. Ft9. Access
Sq. Ftg. Other
O^.TE
x Value
x Value
x Value
TOTAL VALUATION
BUILDING PERI'\IT . Plan Ck. COIl1llII nd
Charges anc ------------ 65%1Bldo Per Fep
Surcharges Plan Ck. Res
30X/Blrla Per Fee
PLUI1BING PERMIT I Fence
Char..ges and ------------ I Djjmo
Surcha rges
ELECTRICP.L PERI:IT Sidewalk
Charges and -----
Surcharges A/C Pavi ng
11ECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
Syste~s Development
Charoe (1.5~)
I
I
I
'j
Total Comb. rermit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax lot 100. Lane County Map Reference
II 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. examole- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. 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 garllge
2. examole - remodel existing garage into family room
3. exam~le - 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. OES I GN TEAI.I ANO CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jab site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechani~al 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
ha-ve been abbreviated
2. If the item{s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 es
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 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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PRDJECT CDNDITIDNS TD BE SATISFIED BEFDRE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
'.'
name
signature
date