HomeMy WebLinkAboutPermit Building 1989-10-10
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I INSPECTION LINE ' ~ llTY Uf SPKINGflELO
726-3769 I "-:COMBINATION APPLICATION/PERMIT
J b Add /"?//> . ,...; - EIIERGY SOURCES:
o ress /' /G/ ~f".[.~ 'S?- Heat
Legal Description \r J(Y..l)~\ O~\ C)\ y,.a) Ilater Heater
Owner /N7~AWhC'r_..-/'C h>~~ /~
Address '"7:&>X A::/ ~.s-
COc.e/?'c' ~.~V.::::::s-/
Construction lender
Address
DESIGN TEAr1
Primary
Structural
Electrical
..
l"FOR/lATID" lint
726-3753
.Sq. Ftg. 14ain
~q. Ftg. Access.
Sq. Ftg. Other
!lew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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I~
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,
Range
ValuE of Work:
E~~
Buildina Permit Info: Deser be Work(i~e.. Build Single
Familv Il.esidence Hith Attached Garaoe)
?r-""P#/~ ;r~=",/ Av.&.. 4:r-
:k ~-4/;/j.~ ~L/~Y'
Phone
"
Phone
(address 1
(lies. no.)
{exo; res)
(OhOM no..
lname)
~
~
(lies. no. \ (exoires) (ohone no. \
"3~'~ "5?~~C:; ~~~ ~
/
Mechanical
CONTRACTORS lname) {address 1
General~/A'r.#__",.. .a;~~..>;'..2:l~_ -';>-
Plumbina
Fl p.C':trica 1
~1echanical
-ill'
Each single fixture
PLUIIB I NG
MECHANICAL
ELECTRICAL
FFF r.HARr.F NO
':l:.L J:liAIlliE. ..llil.....
FFF rllAll&E.
Residence of
furnace/burner to
BTll's
SQ. FT.
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Water service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rp~ j qr.nr:~
multifamily, comm. or
Tnrlllf;trial
Appliance vent
~.t:oaratp
Stationary evap.
cooler
Vent fan wi th
sin9le duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
Of
amps.
COMfI./lND. FEEDERS
Install/alter/relocate
rlif;trih. fppdpr~
Of
amps.
I SSUANCF OF PFR!HT
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE L'H REQUIRES
shall not be vali1 until the
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 Derformed 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 !ID 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 ~IOYeeS who are in compliance with ORS 7nl.055~used on this project.
IW1E(please Prina, IN"" sJ, ,,; /'I!L~ d SIf,Il^TURL4'/7UUI ~l_.Afl DATE J'O//d./t?
FOP. OFFICE USNmLY ,,/ f '
Sq. Ftg. rtain x Value
Sq. Ftn. Access x Value
Sq. Ftg. Othe~~~ ~~"~~Value
/ TOT^L VALUATION
Zone
Fire Zone
Flood Plain
BUILDING PERflIT
Charges and
Surcharges
PLur~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERmT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor, the electrical rortion of this pemit
l~bel has been signed by an Electrical Supervisor and returned to the Building Division
Tyoe/Const.
Bedrooms
Units.
Occy Load
Occy Group
~~
Stories
/./7<:>_ Plan Ck.
--+'-;2-'------ ~/BldQ
...., <" Plan Ck.
~ ./.v, 30l/BldQ
Fence
Comm/lnd
PPr Fpp
Res
Per Fee
syste.ms Development
Charqe (1.5~ .
D!,mo
______ ___ __JS1dewalk
I A/C, Paving
___________J Curb Cut
I
Total Comb. rermit
TOTAL
/S::75~
..
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
Springfield Estates . ,
C. Name. etc. of owner and construction le~der
D. Energy Sources. .
1. examQle- heat/electrical ceilinqlor forced air Qas
2. example- waterheater/electrlcal/or 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,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family foam
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 TEAN 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
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
W~enever possible. the initial application will b~ used as
a worksheet only. Where possible, Building ~ivision 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
e.(
.
PERMIT VALIDATION
....
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Permit Cl erk
.
, '. '
,'Permlt appl.icant.~xel(lpt fr;om registration with the Builder"s\Board ,because:
Additional Project. Informat.ion:
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