HomeMy WebLinkAboutPermit Miscellaneous 1986-9-12
jlNSPECTION LINE
j726-3769
. Cl TY Uf SPRINGf I ELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Work:
Job Address
L(3 (PO
r
m /lJ-.A-
Legal Description
ownerC1/l/J'LI/Ja.P.d If?d p~ ~
Address f5 f) (l> If 11 ::,;J tJ IJ Phone (p 'Ie;
constructi~:~f~ () 53S
~ INfOR/1ATION LINt
726-3753
Sq. Ftg. '.Ialn
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Pep.
--Fence Demo Change/Use
Other- --
oQ
~
o
6'"
-1:.
0',
BUlloinQ Permit Info: Deser be Work(i.e., Build Single
Family Residence With Attached Garaoe)
~L {-a r!nLherrth
Address
Ut>lGN TEAr.,
Phone
(address)
(lies. no.)
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrf'ss)
fl ;cs. no.1
Genera 1
Plumbino
Electrical
! AA./'tA.R~
D 11 d/u--/'_
~1echanical
PLur,lBI NG
ELECTRICAL
rm.
FEE I CHARGF
Residence of
Nn
'=.1='1='
Each single fixture
SQ. FT,
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(] bath I
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
res i {leJlCe
multifamily, camm. or
Industrial
~Iater servi ce
Sewer
Storm Sewer
Of
I
I
I
I
/.51 0'0
amps.
COMI'\.IIND. FEEDERS
Install/alter/relocate
nic;trih. fppnprc;
Of
amps.
!Jfu.. ~
~
C(7o
(expires) (ohone no.l
~
V
(~xoir~c;)
(ohonP no.)
935 - /0:210
MECHANICAL
r"IililiE.NO
furnace/burner to
BTU's
I.E"
I
r"1ililiE.
Floor furnace
and vent
Recessed wall
~n~~p hp~tpr ~nrl vpnt
Appliance vent
C;flDilr~tp.
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood "od duct
from
Wood stove/heater
b?J
TOTAL CHARGES TOTAL CHARGES IS, W TOTAL CHARGES
WHERE STATE Ul~ REQUIRES that the Electrical work be done by an.:E1ectrica1 Contractor, the electrical portion of this permit
shall not be vali~ until the 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 flO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 ORS 701.055 Wil~d on this project.
1lAf.1E(please print)~J:JW<' HAJIJELt.. SIGfIATURE/~ OATE.2..,1~-b!C.
FO~ OFFICE USE DIlLY
Sq. Ftg.
Sq. Ft~.
Sq. Ftg.
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
t1ain
Access
Other
Stories
BUILDING PER/lIT
Charges and
Surcharges
. Plan Ck. ConmlInd
____________~/Bldo p.P!, I='pe
Plan Ck, Res
30%/Bldo Per Fee
Fence
PLU!1BING PERMIT
Charges and
Surcharges
D/IRlO
___nl5.,--~_sldewalk
,CoD A/C Paving
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
;;qCfC;C--
,2{)
'fi!LC. Lhe
ISSUANCE OF PFRllIT
x
Value
Value
Value
x
x
TOTAL VALUATION
'Systems Development .
CharQe (1.5~) ,
Total Comb. Permit
I
I TOTAL
(5.80
J
t
e
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I, example- Tax lot 100, lane County Map Reference
1I 03 43
2. example- lot I. Block 3, 2nd Addition to
>prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -----
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project. check new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garllge
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 schedul es
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.
[3 (p 0o&Z;-
q~(~- fh
V. FOR OFFICE USE ONLY
Permit Cl erk
[c
i
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
'.