HomeMy WebLinkAboutPermit Building 1988-9-22
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I INSPECTION LINE
726-3769
Job Address ,,~~
Legal Description
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CITY UF SPRINGFIElD
COMBINATION APPlICATIONIPERMIT
-, EilERGY SOURCES:
Heat
Hater Heater
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INFORlIATION liNt
726-3753
5q. Ftg. l'lain
~q. Ftg. Access.
Sq. Ft9. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other -- --
Build Single
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I IX)
I.h.
'.(
a).e.-~ A
~ J.L/ /) I' Range
-L::iLA-~D T~ ~/;?ICAL ( .1"J.n?P'LG..... ""lUE of Hark:
Owner%r. '.1'/1e-t!:.- ~ ~...'C ::)'0. /cb <29
Addr~ss./I'I// ./?~~ / Phone~""" Builcii~Q Pennit Info: Describe Workli~e..
I '-CrTK-4-.:5/ e~9;:l., Family nesidence Hith JI..ttached Garaae)
EZ<qr:-e c:?...e.- 97~.2.--) --t2c ~'F".P9 A:)
,
Construction lender
I.5..u .. ~/ AJ6:
Address
UtSlliN TEAt1
lnameJ
Phone
(address 1
(lies. no.)
{exoires1
(ohone no.
Primary
Structural
(,1,/1 /,r-I-j
.~ .
Electrical
Meehan; ca 1
CONTRACTORS InameJ
General .hf>ou~
PlUJ.lBiNG
(address) flies. no.) (pxoirpc;) (ohonp nn_)
(' ,... ';:5""- c..,. P.o.B.t.. '7"f~1 6'+077 'furY'if<'i 8""~~/c;-
CU? e.. <i " 97y'C ..
q~
ElECTRICAl MECHANICAl
FEF I f.HARr,F Nn I "" J rl-IAR~F NO I "" I rHAJH~~
Residence of furnace/burner to
SQ. FT. BTU's
Plumbina
Electrical
~1echanical
NO.1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath \
Duplex (1 bath) each
Additional bath
I New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
So~~P hp~tpr ~nrl ~pnt
Storm Sewer
Of
amps.
App 1 i ance vent
c;.eo!lr.1t.p.
Stationarv evao.
roolp.r J .
Vent fan with
<;inale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood <lnd rllH':t
Sewer
Temporary Construction
Change in existing
rp<;. i dJ'nrp
multifamily. conm. or
Tnrlu<;.tr;al
~Ja ter servi ce
CDMM./IND. FEEDERS
Install/alter/relocate
d;<;.trih_ fpprlprc;.
Wood stove/heater
Of
amps.
'-/;
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ISSUANCE OF PFRIIIT
TOTAL CHARGES
WHERE STATE l~H REQUIRES
shall not be valiJ until the
TOTAL CHARGES TOTAl CHARGES
that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED 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 Spri ngfi e 1 d and the Laws of the State of Oregon perta i ni ng to the work descri bed herei n. and that rw 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 and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only sUbcontractor~~~l~~S ~~eri~~Oliance with ORS 7n1'0,55 will be used on this project.
NAIIE(please print) ~Yr y .J/;/Jle Y SIGNATURE .P./_: ._' ./4..'/ DATE 7.}-~.f8'
. (- .or. OffICE USE L Y C/' 7
Type/Canst. Units Sq. Ftg. r~ain x
Bedrooms Occy Load Sq. Ftg. Access x
Stories Occy Group Sq. Ftg. Other x
Zone
Fire Zone
Flood Plain
Value
Value
Value
TOTAL VAlUATION
BUILDING PERflIT
Charges and
Surcharges '. .
, , Plan Ck.
__~e.k,-~Q._ 65%/Bldn
.1 ~ Plan Ck.
._"c I '-to 6CJ 30%/BldQ
COll1ll/lnd
Ppr Fpp
Res
Per Fee
'Systems Development '
CharQe tI.5~) ,
PlU'~BING PERMIT
Charges and...--
Surcharges'
Fence
Demo
ElECTRICAL PERIIIT
Cha rges and
Surcharges
'Sidewalk
TOTAl
-506. <SID
'~'~'I
MECHANICAl PERMIT
Charges and
Surcharges
AIC Pav; n9
____________, Curb Cut
I
Total Comb. Permit
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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
II OJ 4J
2. examele- Lot 1. Block 3, 2nd Addition to
Springtleld Estates
C. Name. etc. of owner and construction' lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air Qas
2. exam~le- 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 new - if addition,
check add. etc.
F. Building permlt information:
1. example - construct single family house with an
attached garllge
2. examele - remodel existing garage into family room
3. examyle - 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. BUILOING DIVISION 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 Si9n 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
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PERMIT VALIDATIDN
(~~T#- /Z39cJ
Permit Clerk d q -'~
q~k-..s",
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
.
date