HomeMy WebLinkAboutPermit Miscellaneous 1989-11-3
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I INSPECTION LIIIE .a CITY Uf SPRINGfIELD
726-3769 . . COMBIIIATlON APPLICATION/PERMIT
Job Address / ( )( O!-) I r}() if7 ) ~~;~GY SOURo/
.l~ater ter
Owner ( III J J /) ~ fI / CY 'i~ 0 Jh JLQfL}
Address ~ U ) i;'/--im $)1{ ) . Phone
cons~u~t-t-li.) } C!14 If
INfOm\ATION lINt
726-3753 ,
Sq. Ftg. Main "
~q. Ftg. Acce .
Sq. Ftg. 0 er
New A Alter Rep.
nge -Fen, Demo Change/Use
valu'{I\HotO--J rOt r- -
BUilril~Q 'Permit Info: Describe.~ork{i~e," Build Single
Famil~ nesidence With Attached Garaae'
,
I~
Legal Description
Address
DES I GN T EAI~
(name)
Phone
(address'
,/)tlf?m h n t f .; lUron~ C17(]
'A )01(}\J / - ~ r_1ITV(lI~
. I) irics. no. I (ZY~l (ohone no. \
.,~
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
{namel
(address \
nicS_ no.)
(exoires'
(ohone no. ,
Genera 1
Plumbino
(0 .l.JVLuf /
Electrical ::.\
~'echanic'al ~
PLUI1BIrIG
ELECTRICAL
MECHANICAL
NO. '
FFF . rll^Rr,f NO
~~r r4ARf,F NO.
FFF
rH~or,F I
SQ. fT.
furnace/burner to
BTU1s
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(l bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~~~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoaratp
Stationary evap.
rnoler
Vent fan with
sin9le duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rpc;. i q~n('~
multifamily, COfJ111. or
Innuo:;trial
Water service
COMM./IND. FEEDERS
Install/alter/relocate
rlidrih. fpprlprc;
Of
amps.
I SSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WIlERE STATE L\H 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 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of OreC)on pertaining to the work described herein, and that NO OCCUPAr~CY will be made
of any structure without the permission of the ~uild;ng Division. I further certify that my registration with the Builder's
Board is in full force and effect as re~u;red 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 OP.S 701.055 will be used on this project.
IWIE(please print)'>:,f/# /Y ~~~# SIr,tlAT4-~ d~ OATE//-;>-~
FOr. OFFIC~ QilLY ,
Sq. Ftg. riain x
Sq. Ftn. Access x
Sq. Ft9. Other x
Zone
Fire Zone
Type/Canst.
Bedrooms
tJni ts
Occy Load
Occy Group
Value
Value.'
Value
TOTAL VALUATION
Flood Plain
Stories
BUILDING PERNIT Plan Ck. ConmlI nd
Charges an~ ------------ 65%/Bl de Ppr Fpp
Surcharges Plan Ck. Res
30%/Bldq Per Fee
PLur~BING PERMIT --'~~'~) Fence
Charges and
Surcha rges D6mo
ELECTRICAL PERIHT Sidewalk
Cha rges and ------------
Surcharges A/C Pavi ng
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charoe ('1.5%)' . . ,
Tota' Comb. Permit
TOTAL
5E\:~I)
,
-,
"----- .-.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
.1. example- Tax lot 100, lane County Map Reference
11 U3 43
2. example- Lot 1. Block 3, 2nd Addition to
Spr,ngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. . examele- heat/electrical ceilinq/or forced air Q3S
2. :',example- waterheaterlelectnca Ilor ~
E. Square footage or valuation, etc.
1. ,example- 1250 sq. foot house, 500 sq. foot garage
"2. examDle- if new project. check new - if addition,
.. check add, etc.
F. Sui lding pennit information:
1. example - 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. OESIGN TEAM 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
signa ture.
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
PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY:
e
'~
..
PERMIT VALIDATION
/5f)f3
.
Permit Clerk ~A...-
I
rt/3/J9
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
'-
I . \ )f"
")" -J<'
'-___...J /'" (
,~p.!
date