HomeMy WebLinkAboutPermit Building 1991-2-20
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CITY U~ SPRINGFIElD
COMBIIIATlON APPliCATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
Ranqe
ValuE. of Hark:
lrfr!"'CJ
Buildina Pennit Info: Describe \~ork(i-.e.. Build Single
Familv Residence With Attached Garaoel
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NvV OM (.{fr1(l. (4 )
~ &,-/r:vrom ~('i../Juv';", /:J
flies. no.) texoiresl
.
I NFORlIATlON U Nt
726-3753
Sq. Ftq. I"ain
~q. Ftg. Access.
Sq. Ftg, Other
!~e\'i Add Alter Rep.
--Fence Demo Change/Use
Other -- --
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I INSPECTION liNE
726-3769
.
Job Address Ic.,n c.. YY'\1':UrAJ
legal De,cription Ijo:<'2., L2, '::) _ (){,., 4 ()t')
ClAAr-
Construction le er
qj 'if) J
Address
DESIGN TEAI~
(name)
Phone
(address)
FCvv--.c;;,
(ohane no.
Primary
Mp.chan;cal
CONTRACTORS
(name)
(address)
(lies. no.)
'~ A
~~
~
(pxoi rp~' '( ohonp nn.
Structural
Electrical
General n~V-
Plumbina
Electrical
~1echan;cal
PlUllBING
ElECTRICAl
MECHANICAl
..JlQ.."
~
Each single fixture
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NO
~FF
r"ARIiE. .llfr...
SQ, FT.
furnace/burner to
BTU's
CEL J:liARliE.
Residence of
,
Relocated building
(new fix. additional)
New circuits alts.
or extension~'.
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~"rl vpnt
~Iater service
Temporary Construction
Change in existing
rp~.i(tpnrp
multifamily, comm. or
tnrlus.tr;al
::L
Appliance. vent
seoarate
Stationary evap.
r(l(llpr
Vent 'fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd ",nd durt
- ~~
Sewer
Storm Sewer
Of
amps.
COffi~,/IND, FEEDERS
Install/alter/relocate
dis.trih. fppders.
Wood stove/heater
Of
amps.
TOTAl CHARGES
WHERE STATE l~W REQUIRES
shall not be valiJ until the
~(),~ TOTAl CHARGES
ISSUANCE OF PFRJIIT
TOTAl CHARGES
-a ~ .ad
that the Electrical work be done by an Electrical Contractor. the electrical portion of this perlilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED 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 Oregon pertaining to the work described herein. and that HO OCCUPAHCY 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 d effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors d mp Ye~;Jr ~~iance with OPS 701,055 will be used on this project.
NAHE(please pri -n.!>4' SIGIIATU /J7\J - .J
, FOP-OFFICE US~:;;;;'VV-
i.Je/Const. Units Sq. Ftg. riain
Bedrooms Occy load Sq. Ftn. Access
Stories Occy Group Sq. Ftg. Other
DATE ,;)J:Jc)PJ L
Zone
x
Value
Value
Value
Fire Zone
x
Flood Plain
x
TOTAl VALUATION
PlU'~BING PERMIT
Charges and
Surcharges
Jc 0 Plan Ck,
__ _~_Q_____ 65%/Rldo
""S Plan Ck,
, I 30%/B1da
__:;)O.()O I Fence
I. 00 I Demo
CorrvnlI nd
Per ~""e
Res
Per Fee
q.7S""
Systelils Development
Charae (1.5~)
BUIlOING PERfllT
Charges anc
Surcharges
ElECTRICAL PERr~IT
Cha rges and
Surcharges
11ECHANICAl PERMIT
Charges and
Surcharges
Sidewalk
A/C Pavi ng
___~S-,o.o___1 Curb Cut
I.~~ I
Total Comb. rermit
~
iOTAl
~.IS
.
__M I
COMBINATION APPLICATION/PERMIT (CAP)
"
I. Applicant to furnish
A, Job Address
B. legal Description
1. example- Tax lot 100, lane County Map Reference
II oj 43
2, examole- Lot I, Block 3, 2nd Addition to
>pr,ngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
I, example. 1250 sq, foot house, 500 sq. foot garage
2. examp.le- if new project, check new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examole - 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, & Elect~ical 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
8. 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
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
'".
PERMIT VALIDATION
(\?
Pennit Cl erk
,
~
,q;}C1Y
~
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
date
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