HomeMy WebLinkAboutPermit Building 1991-1-4
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. CITY Uf SPRINGFIELD . INFOR/tATlON UNL
. COMBINATION APPLICATION/PERMIT ' 726-3753
EIIERGY SOURCES: Sq. Ftg. 11a;n
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
Ilew Add A Her pep.
Range -Fence Oemo Change/Use
va1u~~ Other- -
BuilGinQ Permit Info: Oeser be Work(i.e., Build Single
Familv nesidence With Attached GaraQe~
II~)PECTION LINE
7l6-3769 ~
Job Address
1199
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legal Description
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Phone
Construction lender,
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Address
DESIGN ILAr1 (namel
Primary SP,c"C:W....-p- g,:Jf'h",S
Structural ~c:
Electrical NOt-i&-
Hechanical flbNh.
CONTRACTORS {namel
Genera 1 c.t?Gc."";y).,9- S ,,\"'~
PlumbiM Norl'f;.
~l~ctrical f.a7., r6-
~'echan; ca 1 J-f"1-vI4~
PLUI,1BING
Phone
{address'
(lies. no.1
...
5(,07..'2-
(exoiresl
(ohone no.
..W7 .91Gt-l..G" ST: PfO
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(addr~ss 1
{l ics. no. \
(exni re~;.)
(ohnne no. 1
ELECTRICAL
MECHANICAL
NO.
FEF rH~Rr,E Nn
~~~ r~ARr.~ NO
~rr 1..c.J.iARG..E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
il bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~hp~tpr ~nrl vpnt
amps.
Appliance vent
~~oarat.p
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood il.nd duct
Sewer
Temporary Construction
Change in existing
rp~ j 1em"p'
multifamily, comm. or
Tndll~tr;al
Water service
Storm Sewer
Of
COMfI./IND. FEEOERS
Install/alter/relocate
rlic:;trih. fpprlpro;
Wood stove/heater
Of
amps.
ISSUANCF nF PFRlilT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LMi REQUIRES that the Electrical work be done by an,'Electrica1 Contractor. the electrical rortion of this pemit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication for rermit. 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 110 OCCUPAUCY w;ll be made
of any structure without the permission of the Building Division. I further'certify that my registration with the Builder's
Goard 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 ORS 701.055 ., -~ ~~~5 project.
Type/Canst,
Bedrooms
Stories
Units
Occy Load
Occy Group
DATE/-'f~
UAI.IE(please print)-0b \-\f.J ~'l/\ 6N H,IA~l"
~
Zone
Fi re Zone
Flood Plain
x
Value
Value
Value
Sq.
Sq.
Access
Other
x
,
TOT^L VALUATION
BUILDING PERNIT
Charges and
Surcharges
_ _ -"'2Q '-~? __ _ ~~~~B~~~
2 t~] ~~~~B~~~
Fence
COITlll!l nd
Ppr Fpp
Res
Per Fee
Systems, Development I
Charqe O.5~)''''
PLU!1BING PERMIT
Charges and
Surcharges
D~~o'
'Sidewalk
A/C Pay; ng
Total Comb. Permit
ELECTRICAL PERIIIT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
~\
TOTAL
/'5'3,Z;s
Curb Cut
-
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
1/ oj 43
2. example- lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
'1. example- heat/electrical ceiling/or forced air gas
2. exa~le- waterheater/electrlcal/or ~
E. Square footage or valuation. etc.
!. example- 1250 sq. foot house, 500 sq: foot garage
2. example- Tflnew project. check-new'-,if addition,
cneck add, etc.
F. Building permit information: .
1. examele - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examele - 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 CDNTRACTORS
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 schedul es
C. BUILDING DIVISIDN 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. FOR OFFICE USE ONLY
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PERMIT VALIDATION
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permi t appl i cant exempt from regi strati on with the Buil der' S' Board liecause:
Additional Project Information:
PLANS REVIEWED BY:
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name
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