HomeMy WebLinkAboutPermit Building 1986-9-15
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INFOR/lATION lINl
726-3753
Sq. Ftg. I.la i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
I INSPECTION LINE
726-3769
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Job Address
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
ST.
legal Description
Owner D1 to 0
Address 9 D '8"L 'il'
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c..o~u.e...G- reo .
Phone1~~-11u)
ValUE of Work: ~
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BuildinQ Permit Info: Describe Work(i.e.,
Family nesidence With Attached Garaqe)
Build Single
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Address
Ul:'IGN IlAr~
(name)
Phone
{addressl
Th~ Of"F \..ill, 1<.001=-\ /0(,... 1<+1?..b""A
\ q 0 0 Ltr ...... e;;1d.."lO~ 1il}Tlocl Oldt"luS -fi,e/.llt'i;
:!, p/..H CAP S~s-r( 3'M:> V->H-:\CtAS'S~ 'A"
(lies. no.) {exoiresl (ohane no.
Construction lender
Primary
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W6~.""
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Structural
Electrical
Mechanical
CONTRACTORS
(name)
(addrpss)
(lies. no-.1
(pxDirps)
(ohnnp no.)
General
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1__.'~0'1'-l {'Jp'~I" Rf).
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Plumbina
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Electrical
~1echanical
PLUl,iBING
ELECTRICAL
r"MGL! flO
MECHANICAL
....llih
FEE I.QjARr.E Nn
F<F
F<F
r"MGL
Each single fixture
Residence of
SQ. F1.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Resi~ence
(] bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~~~~O ho~tpr ~nc1 vpnt
Sewer
Temporary Construction
Change in existing
rpc;.jli..eflcp
ImultifamilY, comm. or
, Tnc1llc:trial
IOf amps.
I COMI.I./lND. FEEDERS
I Install/alter/relocate
dic:trih. fppc1prc:
IOf amps.
I
I
I
Appliance vent
c;,~Dariltp
I Stationary evap.
cooler
I Vent fan with
sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hnnrl and duct
I \'iood stove/heater
I
I
I
Water service
Storm Sewer
ISSUANCE OF PER!iIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\II REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion 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 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 NO OCCUPArKY 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
:~ll:(::::::t:::::~S and~e~p~oy: who a~o:~nce with :::!l:::~:55 w~n :h~~e~ DATE' Il~ 1 ~~
FOP. OFFICE USE DIlLY I~
Zone Type/Canst. Units Sq. Ftg. r1ain
Fire Zone Bedrooms Occy Load Sq. Ft~. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
x
Value
Value
Value
x
x
TOTAL V ALUA TI ON
BUILDING PERHIT
Charges and
Surcharges
')17 <:1'T\ Plan Ck.
bl.7V 65%/Blda
--------l-.::./C Plan Ck.
, . ~ '1 30%/B1 do
COIIIII/l nd
Ppr Fpp
R.es
Per Fee
Systems Development
Charae (1.5~) ,
PLU!~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERmT
Charges and
Surcharges
Demo
_ _____ ___ __-,"Sidewalk
I A/C Paving
Curb Cut
I
'Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
'.
4{),Dq--
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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
II uj 43
2. example- Lot I. Block 3, 2nd Addition to
>prlngtield Estates ,
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceiling/or forced air Qas
2. example- waterheaterlelectrlcalJor 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 permit information:
1. exam~'e - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exa~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 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 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 SCHEOULES
O. 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 eloctrical 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 aue 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
.
PERMIT VALIDATION
.
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date