HomeMy WebLinkAboutPermit Building 1988-3-25
I INSPECTION LINE
726-l769
.
Job Address ..J
Legal Description
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CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
p, ,P r /- // r. ValuE of WorkA I
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Address 1... 6 7 I C /I- '.In., Phone Builtiino Pennit Info: Describe Work{Le., Build Single
I-~f./I./; Familv nesidence I~ith Attached G,a;aael t. .
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'constr~cti6n Le~"J, -j- uft-LI b~ If -Ul/j..w-..
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Owner
Address
Ut~ll:iN TE.Ar~
{name)
Phone
(addressl
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Plumbina
//21
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GJ-
(address)
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General
Electrical
~'echanical
PLUlIBI NG
ELECTRICAL
NO.
FEF rHAPf,f Nn
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
I ~Iater service
] Sewer
IStorm Sewer
SERVICES
Temporary Construction
Change in existing
fPs-jcty.nl"'P
multifamily, camm. or
Innllc;tri<ll
Of
COffi1,/INO, fEEDERS
Install/alter/relocate
cli<:.trilL fppr!prc;
amps.
(@
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be v~li1 until the
J Ji4-- TOTAL CHARGES
that the' Electrical work be done by an'
label has been si~ned by an Electrical
~y~
Electrical Contractor, the electrical portion of this permit
Supervisor and ~etur~ed 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 IlO OCCUPAllCY 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.
((0 CA L.L 1. -J;' SIr.IIATURE-.t,. l~',
FOR OfFICE USE OIIL Y I
So. Ftg. l1ain
Sq. ft9. Access
Sq. Ftg, Other
llAr-IE(please print)
Zone
Fire Zone
Tyoe/Const.
Bedrooms
Units
Occy Load
Occy Group
Flood Plain
Stories
BUILDING PERfIlT
Charges and '"\
Surcharges .J-
Plan Ck. Comm/Ind
6St/Blr!n Pj'r Fpp
Plan Ck, Res
lO%lBldo Per Fee
Fence
.. __ _ _ J_ 5_()7t1
17~
PLOl1BING PERMIT
Charges and
Surcharges
Demo
I'Side,;al k
I A/C Paving
I Curb Cut
I
ELECTR ICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
flir.c;. nn_ l
(1ic.~. nO.l
<- 'l 'I/,7
j:n" rl:iARG.E. NO
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AJ/A
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INfOR/IATlON liNt
726-l75l
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
--Other -- --
0<;)
CS
~
(exoires)
(ohone no. \
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..
~); ;'S~OC)
"l:".ll-
(pxoirpc;)
(nhnnp nn
2.-/... J"L_J t//-l/;'dt'
MECHANICAL
~ ~~~ r~1lRG.E...
furnace/burner to
BTU's
Floor fu rnace
and vent
Recessed wall
~o~rp hp~tpr ~nr! vpnt
Appliance vent
c;eoaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart
heatinq or A.C.
Mechanical exhaust
hnnr! and dUl"'t
from
Wood stove/heater
ISSUANCF OF PFRI1IT
TOTAL CHARGES
DATE,~ -lS-j>Y
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charae (J.5~)
~/4
Total Comb. Permit
TOTAL
)';i J~'
.
.
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. example- Lot I. Block l, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ/or forced air Qas
2. examyle- water'heaterjelectricalfor solar
E. Square footage or valuation, etc.
I, examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
enee Ki add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examyle - 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 l03 (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. 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
electricalj! 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'ltype written copy and return it to the
applicant at the time the actual permit is issued for his
signa ture. II
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.
II
V. fOR OFfICE USE ONLY
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Permit Clerk
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PROJECT CONDIlIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
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signature
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date ,~~