HomeMy WebLinkAboutPermit Signage 1989-12-28
I INSPECTION LINE . CITY UF SPRINGFIELD -- INFORtlATION LINE 'I
726-3769 COMBINATION APPLICATION/PERMIT ,. 726-3753
Job Address \ DU'2>1. Ptr)'(\O~ y, \~y t l' 't'~~;~r,Y SOURCES: ~~: ~~;: ~~~~ss,
Legal Description \r'lf'..':J C\~ao, Df'. I~ater Heater Sq. Ftg. Other_
, II )~'" ~_,l N Ilew Add Alter Rep.
- I - Range -Fence Demo Change/Use
Owne~. ~\'X\ '- k~\\)\ \.. ~ valuE-of f\k\~ . Other- -
Address C'/~.1 ~ \ f\\~ C~ ~ Phone Bui1ciinQ p~rinillnfo: Descr,be Workl~..e.. Build Single
~t ) ~ ~ ~\ ~~ r- u-l~ Faml1v nesldence Wlth Attached GaraQe,
. .- 'r\('UJL)
I
/
Address
DI;SI~N TtAr1
lnamel
Phone
(address 1
f ~Q ~,,~;,~~-~ ~,",I
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
(name1
{address'
(lics. no.'
{exnires1
(ohone no.'
:: ~:::::a 1J~ nllif-VhlO\ 'f'L C) t
~1echanical \
PLUI.IBI NG
u 0 (\~
UDi-y 'utI q u
~q \ \( \C,p{'(O. ) 02>32. Y \ o~9, -\ o\ilL
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ELECTRICAL
MECHANICAL
Genera 1
..J!!l..
FFF rH~or,F Nn
~~~ r~~Qr.~ NO
':EL .cliARliE.
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
nt_New circu~ts alts.
-j. or extenslons
I (]j, 'j )
Floor furnace
and vent
I
Recessed wall
~n~rp ~p~tp~ ~"rl vpnt
S.F. Residence
(J bath\
Ouplex (1 bath) each
SERVICES
Storm Sewer
Temporary Construction
Change in existing
~P'ij~~.nr:P
multifamily, COnIn. or
~;""2{()c )
amps
,);:)~ )
Appliance vent
c;.~D~ ril. tp
Stationary evap.
cooler
V"ent fan wi th
sin9le duct
Vent system apart from
heatinCl or A.C.
MeChanical exhaust
hood and duct
\.Jood stove/heater
Additional bath
~Iater service
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
dic;.t~;h" fppdprc;.
Of
amps.
ISSUANCF OF PFR'IlT
TOTAL CHARGES \ TOTAL CHARGES TOTAL CHARGES
WHERE STATEl:'U~ REQUIRES that the Electrical work be done by an. "Electrical Contractor, the electrical l1ortion of this permit
shall not be vali~ until the label has been signed by an Electrical SUl1ervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED 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 Ore~lOn pertaining to the work described herein, and that 110 OCCUPAUCY 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 sUbco~acto;~thect~lU~ OP.S~~ ~ project.
se p~ I1/A .'Ii...... /~ '/-:_ f' SIGIIATURE &..-f'
FOP. OFF I CE USE miL Y
Sq. Ftg. riain
Sq. Ft9. Access
Sq. Ftg. Other
OATE
/::l ~ 28-:<r
j I
I
x
Value
Value
Value
Zone
Fi re Zone
Type/Const.
Bedrooms
Stories
Units
x
Flood Plain
Occy Load
Occy Group
x
TOTAL VALUATION
BUILDING PERfIlT
Charges and
Surcharges
Plan Ck. Comm/Ind
____________~/Blda Per Fe~
Plan Ck. lies
30l'BldQ Per Fee
Fence
'Systems Development ~
Charqe (1.51) .
PLUHBING PERMIT
Charges and
Surcha rges
ELECTR I CAL PERlIIT
Cha rges and
Surcharges
Dgmo.
_ '-\ ~ .CX-JSidewalk
~\ \ ~ A/C Paving
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
j ~~.~S
.r":
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Descriptiun
I. example- Tax Lot 100. Lane Cuunty Map Reference
1/ oj 43
2. examele- Lut I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examplew heat/electrical ceilinq/or forced air gas
2. examYle- waterheater/electrlcal/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 w if addition.
cneck add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example w 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 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:
.
J
.
PERMIT VALIDATION
~ t?;i ~
. t1: l~loS(o
Permit Cl erk
Him
)
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
,
I,
name
signature
date