HomeMy WebLinkAboutPermit Building 1988-7-22
I INSPECTION LINE
726-3769
.
CtTY OF SPRINoFrE~O
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Heater
~
C)
6'
I\W
~
Job Address
436 () IVlj}-I~
Descrr;;;~1~~f~ ~~fj
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/J j:J () ,0 0/. SS;t::; Phone -12J~
p(~1iA.T AhI
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INFORllATION UNl
726-3753
Sq. Ftg. I.'ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
Range_c. -Fence Demo Change/Use
ValuE Ofl'/ r :j 00 Other--
5~, ,
Builoina Permit Info: Describe Work(i.e.t Build Single
Familv nes;dence With Attache~Garaae) ~
(~A-D-~ _ / 'ffl./frJ\
({ l ~
.
Legal
Owner.
Address
Construction Lender
Address
UESloN TEAI~
(name)
Phone
(address)
(1 ics. no.)
~
r
(exoiresl (ahoM no. I
Primary
Structural
Electrical
"6)-y. ))~
Mechanical
CONTRACTORS
{name}
[UUI1P.AJ
(address)
fl ;ce;.. no.)
(pxnirpc;.\ (nhoop no. \
Genera 1
Electrical
,
/}'-/
Plumbina
~lechani ca 1
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FEF r.HARGF NO
~~~ rHAR~F NO
I='n" rUAQr,1='
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
(] bath)
Duplex (1 bath)
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
each
Storm Sewer
Of
amps.1
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A,r
Mechanical exhaust
hood and dur:t
II'lOOd stove/heater
I
I
I
Additional bath
Sewer
Temporary Construction
Change in existing
rpc: j ItPJ'll"'P
multifamily, comm. or
TndlJc:.trial
Hater servi ce
'.
I
t\0 )1
\:./1
COMM,/IND. FEEDERS
I Install/alter/relocate
rlic:trih_ fPPrlprc:.
IOf amps.
I
I
I
ISSUANCf OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\~ REQUIRES that the Electrical work be done by an':Electr;cal Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 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 ORS 701.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
,SIGIl~UR~~~..?"'~ DATE
FOP. OFFICE USr-OrrrY
Sq, Ftg. Ilain
Sq. Ft9. Access
Sq. Ftg. Other
7,.;Z;z-1f<Y
IW.IE(please print) 0 t()f-.j
SUlU VAt....t
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERflIT
Charges and
Surcharges ~
PLur~BING PERMIT
Charges and~'--. ."
Surcharges .
'")5'llO Plan Ck, Conmflnd
_ _ __ _.?:. _~ _ _ _ ~/Bldo P.f'!r Fpp
I" Plan Ck. Res
.. 'olC) 30%/Bldo Per Fee
Fence
syste,rns Development
Charoe (1.5%) .
D~mo
I
I
I
ELECTRICAL PERlllT
Cha rges and
Surcharges
'Sidewalk
------------
I A/C Pav; ng
____________1 Curb Cut
I
ITotal Comb, Permit
I
I TOTAL
-zro I ;;B "j
'/j
MECHANICAL PERMIT
Charges and
Surcharges
.
.
..
.
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
17 03 43
2, example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. exanlPle- waterheaterjelectnca (lor 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,
cneck add, etc.
F. Building permit information:
1. exa~le ~ construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exa~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. 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. BUILOING DIVISION STAFF WILL FILL DUT 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 b~ used as
a worksheet only. Where possible, Building ~ivision 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.
((9'7r
1-- J;) -8 r
V. FDR OFFICE USE ONLY
Permit Cl erk
CL
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appl icant exempt from registrati on with the Builder I S Board because:
Additional Project Information:
"
PLANS REVIEWED BY:
name
signature
date