HomeMy WebLinkAboutPermit Miscellaneous 1988-4-7
.
I INSPECTION LINE
726-3769
Job Address 112.0 l'V\o...~
Legal Description 11 D'?> '3 (.", -:; I
Owne r .
V I t'-(IL> m A-t? I t0~
17 2-D H(L~
Address
Construction lender
Address
UL~I"N 1LAI1
lnamel
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name)
Genera 1
Plumbina
V ()n
Oj~. rIll lA.L10i liD
J
Electrical
Mechanical
PLUflB I NG
NO.1
Each single fixture
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Ran!le
ValUE of Hork:
.
INFDRlIATlON lINL
726-3753
Sq. Ftq. '.tain
~q. Ftg. Access.
Sq. Ftq. Other
flew Add Alter Rep.
-Fence Demo Change/Use
-Other- -
~
Ie>
I~
.,
01800
Phone
BuilGinQ Permit Info: Describe Work(i.e., Build Single
Familv nes;dence With Attached Garaael
I Dol- €K ~ U l 'QL-
100'
Phone ,~
'address 1 ,..
(exniresl
(ohane no. ')
'Wi-
;~~
(lics.no.)
C1~~
t:::;2.00
,-
II. \
I..(
(addrec;.s)
(1 ;("c;.. nn.l
(pxnirpc:,)
(onnnp nn ,
;:n::J VfLu 'BU.VI'-">
txI/()~r/t1q
I
i./-/80:5:"OO
1/-85 1t>5s1
ELECTRICAL
MECHANICAL
I FEE' I CHAR(;F NO I I H~ I r~AIU~1=' NO I
Res idence of furnace/burner to
SQ. FT. BTU's
I ~~~ I r~Al;lt:~
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
I
I
~~~
I
I
I
I
I
I
I
I
/pD'
Water service
Sewer
Storm Sewer
GJ
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be valiJ until the
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
c:.l'lil.-P hp",h:... ;onrl lIon+
Temporary Construction
Change in existing
rPSo j 1~n.-p
multifamily, comm. or
Industrial
Appliance vent
~_el)aratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hond and durt
Wood stove/heater
Of
amps.
CO~~./INO, FEEDERS
Install/alter/relocate
rl;~trih fpprlpr~
Of
amps.
,-
TOTAL CHARGES
ISSUANCf OF PFRillT
TOTAL CHARGES
that the 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
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 /10 OCCUPAIlCY 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 comoliance with ORS 7Ql.055 will be used on this project.
IlAllE(please print) FRAr<Jk C()Odrr\A~ SIGIlATURE ~~ ~.-..
FOr. OFFICE USE DIlLY
Sq. Ftg.
Sq. Ftg.
Sq. Ftq.
Plan Ck. Comm/lnd
____________....Q2I/Rldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee
_____a)_~__ Fence
I.O;>.""'D 0B1l10
Zone
Fire Zone
Tyoe/Const.
Bedrooms
Stories
Flood Plain
BUILDING PER/lIT
Charges and
Surcharges
PLU!1BING PERMIT
Charges and t!
Surcha rges ::>
ELECTRICAL PERI'lT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
DATf~).,~
~ /
Units
Occy Load
Occy Group
t1ain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
Systems Development
Charqe (I.5~) .
'Sidewalk
lAIC Pavin9
I Curb Cut I ,...()
------------m'\I?oI,~ l?e.. l'
Total Comb. Permit
..Eif)~
TOTAL
4(p/ ~
~
I.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
0, Energy Sources
1. example- heat/electrical ceilinqJor forced air Qas
2. examole- 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-nfw - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examj)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 TEM4 AND CONTRACTORS
To -avol~ 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. ---
Ill. 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. FOR OFFICE USE ONLY
~()O c* II Zb~
Permit C1 erk a .()). ~.{> J.. t>--
I
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
I
name
signature
date
,