HomeMy WebLinkAboutPermit Miscellaneous 1989-10-6
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. INSPECTION LINE .
1.726-3769
Job Address c-0r)n~ \\'fl. ~ fl. ~. '-
Legal Omription \, n -~ '?1l 04 'L04 ::xJG I
CITY Uf SPRINGfiELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Heater
INFORltATION LINt
726-3753
Sq. Ftg. 14ain
~q. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
Range _. -Fence Demo Change/Use
ValuE off\r1: D) Other--
BuihiinQ Pentit 1Iil"0: Deser be Work(i.e., Bulld Single
Familv nesidence Hith Attached Garacel
l 1 UJ1-\t\ a Q \'{\OTo v hn D:L
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Address ~ ()nCl ~ ~ (\ c;;,{ . Phone
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construct~n\~~ 1 - - -
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Address
DESIGN TEAr4
(name)
Phone
(addressl
flies. no.}
{axoirasl
(ohone no.
Primary
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wi
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Structural
Electrical
Mechanical
CONTRACTORS
(name)
{addrps~1
(lies.no.l
{exniresl
(ohane no.l
General
Plumbino
Electrical \. \11)JLO lit) fOo t-t
~lechanical
PLUltBING
ELECTRICAL
MECHANICAL
NO.
FEE . CHARGE .lln
FFF r,,'IRliE. Nn
FFF r,,'IRliE.
SQ. FT.
furnace/burner to
Blll's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
11 bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
SD~CP hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarilte
Stationary evap.
cooler
Vent fan with
sin91e duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hood itnd durt
Sewer
Temporary Construction
Change in existing
rP'l-jqf,:ncp.
multifamily, comm. or
Tnrluc;,triitl
Water service
COMft./INO. FEEDERS
Install/alter/relocate
di~trib. fppdpr~
Wood stove/heater
Of
"lmps.
ISSUANCF OF PFRltlT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Surervisor and returned to the Building ~ivision
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 Orel]on pertaining to the work described herein. and that UO OCCUPAI~CY 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 employees who are in compliance with ORS 7nl.055 will be used on this project.
IWIE(please print) IAl'A\/r.J?i" A",,;;;: 0 SIr,rlATUREJ~<LA..P ./a.z DATE
FOr. OFFICE USE DilLY /
Sf!. Ftg.)*iin
Sq. Fta. Access
Sq. Ftg. Other
Zone
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occ.y Group
x
Value
Value
Value
Fire Zone
x
Flood Plain
x
TOTAL VALUATlOII
BUILDING PER/lIT Plan Ck. Comm/Ind
Charges and ------------ 65%/Bldo ~er Fee
Surcharges Plan Ck. Res
30%/Bldo Per Fee
PLU'4BING PERMIT Fence
Charges and ------------
Surcha rges Dpmo
ELECTRICAL PERIHT \5 CX) Sidewalk
Charges and --- ~-~-
Surcharges A/C Paving
~ MECHANICAL PERMIT I Curb Cut
Charges and ------------
Surcharges I
Systems Development
CharQe (J.5~)
,j~o~
50~,
. blO
Tota' Comb. Permit
TOTAL
\CO.q cs
.
~
.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference
17 03 4j
2. exa~le- Lot I. Block 3, 2nd Addition to
Sp~lngtield Estates
C. Name~ etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical cei1;nq/or .forced air Qas
2. examyle- waterheater/electrical/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 pennit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family 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. OESIGN TE~1 ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
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 penmft is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
,
I
.
PERMIT VALIDATION
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\O_wfOC\
Permit Clerk
d~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
..
name
signature
,}
date
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