HomeMy WebLinkAboutPermit Building 1984-8-21
I INSPECTioN LINE
1726-3769
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ValuE of Hork:
INFORI1ATION LiNt
. 726-3753
Sq. Ftg. r.1a in
:q. !=tg. Access;
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other -- .--
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Job Address
CITY OF SPRINGFIELD
COMBIrMTI.ON APPLICATION/PERMIT
ENERGY SOURCES:
Heat
Hater Heater
Legal Description
Address
, ..Phone
BuilGinq Permit Info:
Family nesidence With
!..t)vfJl }:LO~
1/
Describe Work(i_e., .Build Single
I'>ttached Garaqe)
~.A~
Construction Lender,
Address
DES I GN TEAI~
(name)
Phone
(address)
(lies. no.)
(exoires)
(ohone no.')
Primary
Structura 1
: Mechanical
: CONTRACTORS
: Electrical Vlfy }//eu.J ;.;tj.e...61- ~~~{J H&h/...Ou.J J2.d
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I
jme)
vi
(address)
(lies. no.)
(exofres)
(o.hone' no. )
, Genera 1
,
, Plumbinq
, Electrical
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! ~1echanical
. PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FFF [HARGF NO.
FFF rHARGF_.
Each single fixture
Residence of
SQ. FT. '
furnace/burner to
BTU's
Relocated building,
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Recessed wall
'Soace hp~tpr ~nd vpnt
I Sewer
I Storm Sewer
I
COMM./IND. FEEDERS
I Install/alter/relocate
distrib. feeders
10f amps.1
I
I Appl i ance vent : I
seoaratp
I Stationary evap. ---~I
cooler
I Vent fan with-I
sinale duct
I Vent. system apart from,,'
heatlng or A.C. ·
I Mechanical exhaust '.1
hood and duct
I Wood stove/heater I
II
I I
II
Additional bath
~later servi ce
liAMElplm, p,io') f};/,p,O...;r t/C5f-f-&.., SI"lATUR~~- DATE ,y -,3-0 -J:1-:
FOR OFFICE USE ONLY , ,
Zone
Fire Zone
Flood Plain
Tyoe/Const.
, Bedrooms.
Stories
Units
Occy Load
Occy Group
So. Ftg. r1ain
Sq. FtlJ. Access
Sq. Ftg. Other
x
Va 1 ue
Value
Value
x
x
TOTAL VALUATION
BUILDING PERmT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldq Per Fee
Plan Ck. Res
30%/Bldq Per Fee
Sys terns. Deve 1 opment
Charge (1.5%) .
PLUr~BING PERMIT
Charges and
Surcha rges
c'.
ELECTRICAL PERMIT
Charges and
Surcharges
Fence
------------
I D!Jmo
~ s--: (IV !Sidewalk
- --- -/~ ;.:v-I AlC Paving
I Curb Cut
I
ITotal Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
~c,caV
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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
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin%r forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
.2. example-.if new project, check-n€w_- if addition,
check add, etc. .
F. Building permit information:
1. -example - construct. single family house with an
a ttached garage
2~ example. - remodel existing garage 'into family room
3. example - 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 schedul es
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. -
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.
I I 1.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
}"- ,:
PERMIT VALIDATION
'Jl*'r;,'5o/lf(.
;c1 f/{JII~CI'
Permit Clerk!\). ~~P ~
Permit appl.icant exempt' from registration with the Builder~s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date