HomeMy WebLinkAboutPermit Building 1988-3-21
I INSPECTION LINE
726-3769
.
CITY UF SPRINGFIElD
COMBINATION APPlICATION/PERMIT
E!IERGY SOURCES:
Heat
t~ater Heater
Range
ValuE of Hark:
.
INFORltATION LINE
726-3753
Sq. Ftg, !'!ain
~q. Ftg. Access.
Sq, Ftg. Other
New Add A 1ter Pep,
--Fence Demo Change/Use
-Other - -
,
100
100
o
Q9
+-
Job Address
3qq5
m A- l,.u
legal Description
VrA
'GA:1.
constructi~~d~r.I,
Address
fhj/..J l.F~
1? ~t.LlQ n
q'711- '1'1
Phon r1Lil. ~ ,Builoino Permit Info: Describe Hork(i.e., Build Single
e/~ 77~~am;lY nesidence With Attached Garaael
Owner'
1..1 ~ILU::. ~
(l f)1"JL.a-r
Address
UtSJliN TEAr1
(name)
Phone
(addrpss)
flies. no.)
(exo;res) A {ohane no.
--1\
- . 1
~~
.~
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(addres.s)
(l ice:;,. no.)
(pxoires) (ohone nn.)
Plumbino
~
1.,,11 tN)' 1<1400
Genera 1
Electrical
~1echan;cal
1Jfll\f'S i? .p_~"Qe.--a-h'''" 'P()f'> III to 1
r:,,? p",~ Q7ytjO
10/S~;:;; 'IlE(;>,
~-7OD3
PlUllBING
ElECTRICAl
MECHANICAl
NO.
FFF r:HARr;F Nn
~~~ r~ARr.~ NO.
~~~ \ r....AQr.~ ~
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits a1ts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(] bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~~P hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
c;.poarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart
heatinq or A.C
Mechanical exhaust
hood and rlLJrt
from
Sewer
Temporary Construction
Change in existing
rec;.;den~~
multifamily. comm. or
Tnnuc:trial
~Jater service
COMM./IND, FEEDERS
Install/alter/relocate
rlic:.trih, fppnprc:.
Wood stove/heater
I
I
f"w.rcl
I
I
I
I
I IS':!'
Of
amps.
"Ilk 1<' lt0
ISSUANCE OF PFRlllT
TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES
WHERE STATE l,\l~ REQUIRES that the Electrical work be done by .n"Electrical Contractor. the electrical portion of
shall not be va1i~ 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 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 DCCUPAllCY will be made
of any structure without the permission of the Building Oivision. 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 7nl.055 will be used on this project.
foe::=.
thi s pernit
Zone
Fi re Zone
Flood Plain
Type/Canst,
Bedrooms
Stories
r-.@__/?~ ~ SIGNATURE~h_'~~~ ~ ~
FO~ OFFICE USE ONlY
Sq, Ftg, Ilain
Sq. Ftn. Access
Sq. Ftg, Other
.DATE '3-.2/'-~'
I~AI'IE(please print).L2ltL//J L
Units
Occy load
Occy, Group
,x
Value
Value
Value
x
x
TOTAl VAlUATlOII
BUIlDING PER~lIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Pe>r Fee
---------------pran Ck. Res
3D%/Bl do Per Fee
Fence
Systems Development
Charoe (1. 5~) "
PlUl1B ING PERMIT
Charges and
Surcharges
Demo
ElECTRICAl PERIIIT 'Sldewal k
Charges and ------------
Surcharges A/c Paving
Total Comb. Permit
I1ECHANICAl PERMIT
Charges and \ _
Surcharges \f)
r
____J~.:~___ Curb Cut
'1?
TOTAl
"1<0
1'5 ~
.
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Oescription
1. ~xample- Tax Lot 100, lane County Map Reference
II 03 43
2, example- Lot I, Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air qas
2. example- waterheater/electrlcal/or 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,
check add, etc.
F. Building permit information:
1. example - construct single family house with,an
attached garage
2. example - remodel existing garage into familj 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building i
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
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
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. FDR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
~EJp-r 1//5(,0
Permit Clerk ~~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
.
date