HomeMy WebLinkAboutPermit Building 1990-11-7
I INSPECTION LINE 4IIIJ CITY OF SPRINGFIELD
726-3769 COMBItlATION APPLICATION/PERMIT
Job Address \ ~ 50 ffi.t f\b)h ') \ lX \ oe.. ~~;~GY SOURCES:
Legal De5Cription l f I ()~~ r)"::l'\4 nf::J1 n()Q / \iater Meater
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Owner Q_('\~'f\ 'f\()\f) \ ~\\Cl O~9-Id(JI~ valu'r\f)ktfJ0,uJ
Address, \ Clr-!-{'~~ 1 ^ ' . "\ i'\ ,""",ooJ Bui1liino P~niit Info: Descrlbe \iork(i-.e" Build Single ---
0(1) f'( \ , f .... J.-) )I \- n.. Faml1v l1esldence 1~1th Attached Garaop)
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constr~~t~~ Lender - 1 ll.l"\\ 'rt (\\
Address Phone l
DESIGN It::Ar~ (name) (address) flies. no.) (exoiresl (ohone no.'
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INFORltATION LINt
726-3753
Sq, Ftg, 1,1ain
~q. Ftg. Access.
Sq, Ftg, Other
Ilew Add Alter Pep,
--Fence Demo Change/Use
-Other - -
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Primary
Structural
Electrical
Mechanical
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Plumbina
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(P"{l"P !''In. )
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Electrical
~'echanical
PLUJ,IBING
ELECTRICAL
rrLIJ:I!AllG.E.I Nn
MECHANICAL
NO.
FEF rHAPGF Nn~
rrr
<:HAR!iL
Each single fixture
Residence of
SQ, FT,
furnace/burner to
BTU.s
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath \
Duplex (1 bath) each
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Water service
Temporary Construction
Change in existing
rp~ j nj',nrp
Imultifamily, comm. or
Innuc;.trial
IOf amps,
I COI~'1. /lND, FEEDERS
I Install/alter/relocate
,dic;.trib. fppdprc;.
[Of amps.
I
I
I
Appliance vent
$~oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
Additional bath
Sewer
Storm Sewer
Wood stove/heater
ISSUANC, OF PFR!11T
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1INED the completed aprlication 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 rm -OCCUPAIlCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
:::,:(:~::::t:::~aop~~e: ~:o ar~:~o:ance with :~:'u::~~:55 CJ used/~th~:'r DATE l\-~- ~o
'!. FOP. OFFICE USE OiIL Y
Sq, Ftg, rlain
Sq, ft9, Access
Sq, Ftg, Other
Zone
Type/Const,
Bedrooms
Units
Occy Load
Occy Group
,
Value
Value
Value
Fire Zone
,
Flood Plain
Stories
x
TOTAL VALUATION
BUILDING PERflIT
Charges an~
Surcharges
_QJ_L~._~_ ~~~~~~~; ~~~~~~d
'\" -10 Plan Ck, Pes
I J, IT") 30%/Bl do Per Fee
Fence
Systems Development
Charoe (1.5~)
PLur1BING PERMIT
Charges and
Surcha rges
Demo
ELECTRICAL PERmT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Paving
Total Comb, Permit
TOTAL
c9JIo,~'6
Curb Cut
.
.
,
a
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj 43
2, examEle- Lot I, Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam21e- heat/electrical ce;lin~/or forced air Qas
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -----
I. examp1e- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examEle - 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. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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
0, 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, ---
Ill, 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
Permit Clerk
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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:
name
signature
~~