HomeMy WebLinkAboutPermit Building 1989-8-3
) INSPECTION LINE . CITY Uf SPRINGfIELO
726-3769 COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Job Address ~q EO#fl/1" ?-. Heat
legal Description Water Heater
Range
ValuE. of Hark:
7&~~"""'"
BuildinQ Permit Info: Describe Workli~e" Build Single
Family nesidence With Attached GaraQe\
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INFORHATION LINE
726-3753
Sq. Ftg. I-'ain
~q:Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other - -
\X)
~
'\l
~
Owner ~T7?k:::'/A! ~.4~#~~,c.~
Address -;;:-? &'0 ~#.o</~ .
-?"~L;';_ _ ~_
Construction Lender I'
~ge
,7?-/h~~
~~/7
Address
DESIGN TEAH
(name)
Phone
(address)
(lies. no.l
(exr>ires)
(ohane no.',
Structural
~
~j
,"',~~
.e\l"
Primary
Electrical
Mechanical
CONTRACTORS (namel
General r~*/? ,f(...<..;~
, "
PlumbiM
Electric;~
,
~lechanical
(addrpss'
(lies. 00.1
(exn; res 1
(ohnne nn.
L/.z?~ fd,/
~A__~~~
I'
6".$7-o~ =---
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE Nn
FFF rH~ NO,
FFF rH~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
~ New circuits alts.
P or extensions
~.6~ /7P#~G
SERVICES
?:2 oS '
Floor furnace
and vent
S.F. Residence
(j bathl
Duplex (1 bath) each
Additional bath
Recessed wall
SQ~rp hp~tpr ~nrl v~nt
"
Appliance vent
s_eparittp.
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ..nd duC':t
Wood-stove/heater
Sewer
Temporary Construction
Change in existing
rps.i ~~Jlce.
multifamily. COI11T1. or
Tnrlustrial
~Ia ter servi ce
Starm Sewer
, "
/ (-
Of
CO~~_/IND. FEEDERS
Install/alter/relocate
rli~trih_ fppdpr~
amps,
Of
amps.
ISSUANCE OF PFR!1lT
TOTAL CHARGES ~ TOTAL CHARGES ::?'2-t:>C/ I TOTAL CHARGES
WHERE STATE l,\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pernit
shall not be vali1 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 OCCUPAllCY will be made
of any structure without the permission of the Building Oivision. 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 OP.S 701.055 Wi~l be use~'on 'this project.
IWIE(please print) :J:w-<.. rUtfV'n~UA SI"IIATURE~ ~/t1~ OATE<l-?J-K9
v FOP. orFICE USE O'ILY I
Units' Sq. il{g: liain x Value
Occy Load Sq. Ft~. Access x Value
Occy Group Sq. Ftg. Other A--.N'/~ Value q, ::., , -
r
TOTAL VALUATION
Zone~L
Fi re Zone
Tyoe/Const.
Bedrooms
Stories
Flood Plain
BUILOING PERftIT
Charges and
Surcharges
_n_S4?:f?c>
t/-C5'3? '
Plan Ck. Comm/Ind
65~/Rldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
<:?_~3
.Systems Development
Charo. tl.5~) "
//'~
PLUliBING PERMIT
Charges and
Surcharges
. Demo
_n~~7~;idewalk
. ~? A/C Paving
/' "Curb Cut
?---------~
Total Comb. Permit I'~~ .r'~
ELECTRICAL PERrilT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
TOTAL /5&JIt
.-
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. examp1e- Lot 1. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exame1e- heat/electrical ceilinq/or forced air oas
2. examele- waterheaterlelectrlcal/or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
cneck add, etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attaChed garage
2. examele - remodel existing garage into family room
J. 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 CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design infonmation 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
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 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.
-;> Hf,(,S
V. FOR OFFICE USE ONLY
Permit Clerk
flUL
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project 'Information:
PLANS REVIEWED BY:
L.ep4g- ~~~ignature
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