HomeMy WebLinkAboutPermit Building 1991-3-20
Job Address ;;3 ISO (. M 1\ \'"
Legal Description \ () ()'rl. ~ \(1)
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CITY UF SPRINGFIELD
COIIBIilATION APPLICATION/PERMIT
C!IERGY SOURCES:
Heat
\~atcr Heater
Range _
.
INFORllATION liNt
726-3753
Sq. Ftg. l,lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other -- -
1 INSPECTION LIIIE
726- 37 69
.
Owner'
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'4"'"
S. r-, Phone -U 3Sl1S1
Valu€ of HO~
/0. ;2~O '
Builriina Permit fnfo: Describe Work(i.e.,
Familv nesidence With Attached Garaael
Build Single
~
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Address
3130 EO
(name)
Phone
(address)
, fuli- '>AO(Q r\(J cl (\f1'f\l'.. jj A.
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Construction lender
Address
DtSIGN ItAll
(lies. no.)
(exoires)
l-f1hone no.
Primary
~
Structural
Electrical
f1echanical
CONTRACTORS
Genera 1
i' [J.\cl/,...:.,
,
(address)
gob
(lics.no.) (exDirp<d
(nhonp no. )
(name)
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l=';,L
b.......~
721..- 5S/~
Plumbina
Electrical
ME'rhrlOiral
I .... .,
PLUIIBING
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE NO,
FFF rHARC,F NO,
I ~~~ r~ARr,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
Cl bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snace heatpr and vpnt
Storm Sewer
Of
amps.
App 1 i ance, vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Water service
Temporary Construction
Change in existing
re.s j rle-.nce
multifamily. comm. or
Industrial
Sewer
COMM,/IND, FEEDERS
Install/alter/relocate
rlistrib. feerlers
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,"~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
ISSUANCE OF PFRflIT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this perQit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM11NED 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 fm OCCUPAtKY 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
,.~bc~~sretors and employees who are in. CO~ith ORS 701.055 "ill be uS';.d on this project. ,
IW1E(p1ease p~~~ ~~y ~ )R512/Ycfj DATE
FO~ OFFICE USE DilLY- I
Sn. Ftg. Ilain x Value
Sq. Ft~. Aeeess~ flit ~7 Value ~o/.!!!!:it::?_
Sq. Ftg. Other,py7. ;&?~~'.~--c. Yalue '?;)7,e:~
, TOTAL VALUATlorl~~<,0
zoneU'4\ '-
Fire Zone
Type/Const.
Bedrooms
Units
Occy load
Occy Group
Flood Plain
Stories
PLUt1BING PERMIT
Charges and
Surcharges
0/, 5"0 Plan Ck.
==. 65%/Bldo
------;:.733--- Plan Ck,
T, 30%/Bl do
Fence
Conm!l nd
PE'r I='...e
R-es
Per Fee
5'(", z J
Systems Development
Charoe (1.5~)
/
/,s~ {IF'''~50
'7'7,,"0
BUILDIIIG PERI.lIT
Charges an~
Surcharges
D~mo
ELECTRICAL PERlHI
Cha rges and
Surcha rges,
rlECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Paving
To~al Comb. Permit
,
TOTAL
I ;2-4'120'
1
Curb Cut
.
.
~ .
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 03 43
2. exa~le- lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D.. Energy Sources
1. exam~le- heat/electrical ceil;nqlor forced air qas
2. examDle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examDle- if new project. check new - if addition,
check add, etc.
F. Building pennit information: _
1. exam~le - construct single family house with an
attached garage
2. exam~le - 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 (aJ 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, & Elect~ical Schedules
A. Except where blank spaces occur in the description
por.tion 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. ---
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.
.,
III.
V. FOR OFFICE USE ONLY
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicaot exempt from registration with 'the Builder's Board because:
A~~itional Project Information:
'.
PLANS REVIEWED BY:
name, L~AN~ n~~
signatured~__ _
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