HomeMy WebLinkAboutPermit House Move 1991-1-17 (2)
1 INSPECTION LINE
726-3769
.
CITY Uf SPKINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY S.OUIlC.E~: " _
Heat '-..J L'~
Hater Heater
.
owner'~b' .:~A':ft.Jp"
Address 7~s'O -r)II~rJl".. pt,
W' /--. 9"7'7;>5
Construct~~ ~nder '. ..', - \ ~
~.
Val~trrT
BuildinQ Permit Info: Describe Work(i.e., Build Single
Phone;>~~)/~~lY Residence With Attached Garaael
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IHFOrolATION LINt
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
-Fence Oemo Change/Use
Other- - .
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----
8
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Job Address 3'i1? /J7t:i;." :5i'ry/'e'/...f ~~~7'7?,f
Legal Description \! O? ~\ .~ \ (nf.cfY'J
Range
Address
DES I GN TEAl1
(name)
Phone
(address I
flies. no. \:
(exniresl
(ohane no.
Primary
~
~'~
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Structural
Electrical
Mechanical
CONTRACTORS
(namel
~.#c;..'
(address'
(1 i(".~, no. \
(p\(r:lir'p~ '
(n!,nrlP nn \
Genera'
Plumbina
Electrical
~lechanical
PLUI.lBI NG
ELECTRICAL
MECHANICAL
NO.
FEE -"!lARGE tlO..
':ELI J:I!AIlliE. NO
':EL .QlARlif
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath!
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
SDace heater ~nrl vent
Storm Sewer
Of
COMfl./IND. FEEDERS
Install/alter/relocate
d;~trih. fperler~
amps.
Appliance vent
<;PDarate
Stationary evap.
cooler
Vent fan with
sin9le duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rpo; i dencl;:
multifamily, comm. or
Indu<;trial
Water service
Of
amps.
/
ISSUANC, OF PFR!IIT
TOTAL CHARGES ~ TOTAL CMARGES I TOTAL CHARGES
WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an,'Electrical 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 110 OCCUPAIICY 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 7Ql.055 will be used on this project.
IW.IE(please print) PA/fI Vt'';/Y/''jo. SIGNATURE~ DATE /-/;>- 9/
FOr. OFF I CE US1: "OIlL Y
Zone Type/Canst. Units Sq. Ftg. t1ain x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERllIT
Charges an~
Surcharges
/0
'0.). .J\./
----~~6"'3--
. Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldo
Fence
ConmlInd
Per Fep
Res
Per Fee
. '0',L . ts ::>
. Systems. Devel~Pl!lent
Charoe tl.5~) '.
, UI .f\-
PLUI1BING PERMIT
Charges and
Surcha rges
.~
D~l!1o.'
ELECTRICAL PERIHT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
,
C)0~
-------;z::----
-ct:-'--...
M/C Paving
Total Comb. Permit
TOTAL
I
\ 2.2. G)
Curb Cut
...........:..::...:.:....--.:.,.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample~ Tax Lot 100. Lane County Map Reference.
17 03 43
2. ex.m~le- LotI. Block 3. 2nd Addition to
Sprlngtield Estates .
C. Name. etc. of owner and construction lender
D. Energy Sources '"
1. example- heat/electrical ceiling/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. exam~le- 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. example - 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. 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
fu 11 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 b~ 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
I
.
, . .
PERMIT VAll DATION
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,
Pennit Clerk
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Pennit applicant exempt from registration with the Builder's Board oecause:
Additional Project Infonnation:
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PLANS REVIEWED~
na:e:h-e ~)t /\.
u-:2 ~ignature
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