HomeMy WebLinkAboutPermit Building 1989-4-6
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I INSPECTION LINE /'"'-"'-'-'
726-3169 /~
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Construction ~der
Job Address
.. CITY Uf SPRINGfIELD
r .A7a.:?p'JfT"e ~m1BIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Beater
.
INFOR/1ATlON LINt
126-3153
Sq. Ftg, '.Iain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add A Iter P.ep.
--Fence Demo Change/Use
Other- -
Phone t(fe:;
5??WJ
~-
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Builtiina Pennit Info: Describe Work.(f..e" Build Single
Family nesidence With Attached Garaael
/?e-~..q.""/"";:--c_ _-:--:""?;::_~< /3t~ ~
itV' Mj,y~ ./"'"...;- __, '.;. ~/-.:v< ~
.~ <,:~_-:""o;Y;;;~;"'- -
v . (1'ie5. no.) (expires) (phone no.
Valur of W;:S'l()O
Range__.
- ..
Adllress
DESIGfl TEAll
(name)
Phone
(address)
Primary
*
Structura 1
Electrical
I~echani ca 1
CONTRACTORS (name)
Genera 1 # ~-/'. ';z?
I~,;r / '
p~-;,.;.......-~
t/tt:. .....
(address) flics., no.) (exnires.)
r::::--~ V: _ "'5'~/ /V- ~~, r.tJ~C-"""";
- / I
(ohone no.)
6R"T-~~.
Plumbino
Electrical
~lechanical
PLUIIBltlG
ELECTRICAL
\
MECHANICAL
\
NO.
FEE [HARGF NO
~FF r~4Qr,F NO
t:H rUAQ(i~
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. P..esidence
(J bath)
Duplex (1 bath) each
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
C;PDarat.~
S~tationary evap.
cooler
Vent fan with
sinol~ duct
Vent system apart from
h~atinq or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
r€!: i d.;nrP.
multifamily, conJll. or
Inc1uc;trial
Additional bath
~Jater service
COIf.I./IND. FEEDERS
Install/alter/relocate
dic;trih. fef'ders
Wood stove/heater
Of
amps.
ISSUANCF OF PFRlm
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHEnE STATE L.\l.j REQUIRES that tile Electrical work be done by an [lectrical Contractor, the electrical portion of this pemit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division
I HAVE CAREFUllY EXM1INED the completed aprlication for permit. and do hereby certify that all infonmation hereon is true
and correct, and 1 further certify that any and"all work nerformed shall be done in accordance with the Ordinances of the Cit~
of Springfield and the laws of the State of Orel)on pertaining to the work described herein, and that IlO OCCUPAUCY will be made
of any structure without the permission of the Building Division. J further certify that my registration with the Builder's
Board is in full force and effect as required by or.s 701.055, that if exempt the basis for exemption is noted he~eon. and that
::r::(:~::::t:~~::~~n~;:~h~are :::ce with :~:fl::~R:7LZ 7~D;~ES/io-~
FD~ orF I CE USE miL Y
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Uni ts
Occy load
Occy Group
Sf!. Ftg. t1ain
Sq. HI]. Access
Sq. Ftg. Other
x
x
Value,
Value
Value
x
TOTAL V ALUA TI ON
PLUf1BING PERMIT
Charges and
Surcha rges
c/, CO Plan Ck.
'____Q!R...<_CL_ 65X/Bldo
"\ V"7 Plan Ck.
()l < Q;) 30X/Bldo
Fence
Conm/lnd
Ppr Fpf>
Res
Per Fee
Systems Development
Charqe (1. 5~)
BUILDING PER~IIT
Charges an~
Surcharges
Demo
,\
ELECTRICAL PERr~IT
Charges and
Surcha rges
Sidewalk
Ale Paving
Total Comb. Permit
TOTAL
I Gq.33
J
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
.
'"
COMBINATION APPLICATION/PERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
I. exam~le- Tax Lot 100, Lane County Map Reference
.r II U3 43
2. example- Lot I. Block 3, 2nd Addition to
_ spr.,ng!ield Estates .
C. Name, etc. of owner. and construction lender
0., Energy.Sources . .
.'.. I. exam~le- heat/electrical ceilin,a/or forced. air aas
2. examDle~'waterheater/electrlcal/or solar .
E. Sq~are footage or valuation, etc. -"
I. examole- 1250 sq. foot house, 500 sq. foot garage
..2. example- Tfilew project, checknew - if addition,
check add, etc.
F. Building pennit infonnation:
1. example - construct single family house with an
a ttached garage
2. examgle - remodel existing garage into family foom
3. examJPle - 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 penmit fonm the schedules
have been abbreviated
2. I f the item! s) to be ins ta 11 ed a re 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 penmit is issued. I
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
.
. "
Permit Clerk
.
.'
PERMIT VALIDATION
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
date