HomeMy WebLinkAboutPermit Miscellaneous 1983-8-16
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I INSPECTION LIIIE
726-3769
Address
Ut.~lbN H.AH
Primary
Structural
Electrical
.
CITY OF SPRINGFIELD . INFDRtIATION liNt
COMBINATION APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: _______ Sq. Ftq. 1.1. i n
He.t _______ ~q. Ftg. Access. ___
~I.te.e r H r Sq. Ftg. Oth~""---
New Add/'Alter Rep.
_ . -Fence/Demo Ch.nge/Use
V.lUE of Hork: D/tl ~r--
Builciinq Permit Info: Describe Work(i.e'1 Build Single
Familv nesidence With Attached Garaael
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lnameJ
Phone
(address)
(ahOM no.l
flies. no.)
(exoires)
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Mechanical
CONTRACTORS In.mel
Gener.l . ~O ~hf'\.
Plumbina
Electrical
~lechani ca 1
NO.
(address)
I'm rt'i\'l:\ f4-\(")f'\.
nics. no.'
(PXO; rpc;) lohpnp nn _ )
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PLUIIBIIIG
ELECTRICAL
MECHANICAL
FEE r:HARr.F Nn
~~~ rHAR~~ NO.
1=1='1=' r~ARr.1=
Residence of
furnace/burner to
BTU's
Each single fixture
SQ. FT.
./
Reloc.ted building
(new fix. .ddition.l)
S.F. Residence
{] b.th I
Duplex (1 b.th) e.ch
Addition.l b.th
( Iwater service
Sewer
Storm Sewer
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New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
/tJ.oeJ
Temporary Construction
Change in existing
rpsiqe:nr.p
multifamily, comm. or
Tnrluc;tritll
Appliance vent
5.enartlte
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood and dUl"'.t
I Hood stove/heater
I
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I
from
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I (J. XJ TOTAL CHARGES TOTAL CHARGES
that tile Electrical work be done by an.-Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
Of
amps.1
COMM./IND. FEEDERS
I Inst.ll/.lter/reloc.te
rlic;trih_ fpprlprc;
IOf .mps.1
I
I
I
ISSUANCE OF PFRIIIT
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be valiJ until the
I HAVE CAREFULLY EXAMINED the completed .pplic.tion for permit. .nd do hereby certify th.t .11 inform.tion hereon is true
and correct, and I further certify that any and all work performed 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 OCCUPAIKY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
IlAI.IE(ple.se print)])~ttl.d~r::::ffi J(J J"n~SIGIIATU-~~~.iZ'y
FOR OFF I CE ~Il~..v. ,
Sq. Ftg. r1ain .x
Sq. Ft9. Access x
Sq. Ftg. Other x
Zone
Fire Zone
Flood Plain
BUILDING PERIHT
Cha rges and
Surcharges
PLUt~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
MECHANICAL PERMl1
Charges and
Surcharges
DATE tP-/6 ~
Tvpe/Canst.
Bedrooms
Units
Occy Lo.d
Occy Group
Value
Value
Value
Stories
TOTAL VALUATION
Pl.n Ck. Comm/Ind
65%/Rldo Per Fee
------------ PI.n Ck. Res
30t/BldQ Per Fee
__ID_._c:9.___ Fence
.40 Demo
.Side....lk
Systems Development
Ch.rae (1.5~) .
AIC Paving
I Curb Cut
____________1
Total Comb. Permit
J
TOTAL
I (). 10
.
.
COMBINATION APPLICATION/PE~~IT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, Lane County Map Reference
II oj 43
2. examole- Lot 1. Block 3, 2nd Addition to
;pr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examyle- heat/electrical ceili~Q/or forced air Qas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition.
check: add tete.
F. Building pennit information:
1. example - construct single family house with an
attached garage
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 TEM4 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 avallable 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
O. 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
signa ture. I
IV. Fees and Charges
Plan check fees are due and payable at the time of the
app 1 i ca ti on ,I and no plans wi 11 be processed unti 1 these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
Gr6Sv
8 /10~g3
V. FOR OFFICE USE ONLY
cler;iILJf})
/
Pennit
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
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name
signature
date