HomeMy WebLinkAboutPermit Building 1990-8-7
I IiISPECTlOtI LIIIE
726-3769
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CITY UF SPRINGFIELD -."
CGrmIiIATION APPLICATION/PERMIT ""'-
ErIERGY SOURCES:
Heat
Ua ter Hea ter
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INFORllATION llNt
726~37S3
Sq, Ftg, 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Owner, 'C:) _-:.-;/ /~,
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Address
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_ ~aluE of Hark: '
r- 2. ",eo DO
Bui~inQ Perolit Info: Describe Work{i~e.. Build Single
~ Phone7.2t 6r4'i Fam; 1 v l1esidence 1.lith /l.ttached GaraQe \
F.ounpA!1-r-/oq ~t?lZ
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Job Address / J/ 1-/ 'l
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A-
Legal Oe!icription
Range
Construction Lender
Address
DES I GN TEArl
(name)
Phone
{address}
/::'..a "'" I ... 'f b' CJ ?"f ~
E\/J:;" j I,{.... D ,//"1/.':::'/ I ,! J.'" ,~_ _
(lies. no.) {exniresl (ohane no.
Primary
Structura 1
Electrical
f1echani ca 1
CONTRACTORS
(name)
(address)
(1 ire:.. no.)
{exoiresl
(phone no.)
Genera 1
tO~...,
t-r-1 cC.L Un'e
Plumb;na
Electrical
"lechani cal
PLUllBltIG
ELECTRICAL
MECHANICAL
NO.
FEF rHARf,F Nn
r:j:"f: rHARf,F NO.'
FFF rHAF(;F
sq, F1,
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Scace hp~tpr ann vent
Sewer
Temporary Construction
Change in existing
rPsin~nrF>
multifamily, comm. or
rnrlu<;tr;~l
Appliance vent
senaratp
Stationarv evao.
cooler" .
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
honn and dur:t
Additional bath
Hater service
Storm Sewer
Of amps.
I Cor~I'1. /lND, FEEDERS
I~~~~~~~~a~;:~~~~locate
IOf amps.
I
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LW REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
ISSUANCe OF PFRP11T
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXNlINED 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 Oregon pertaining to the work described herein, and that rw OCCUPArKY 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 subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this project.
Uni ts
Occy load
Occy Group
,
SIGI:'~TURE' I r9n. 07-v1 0(7./2, '.
FO~ OFFICE USE DIlLY
S~, Ftg, Ilain h \ ( ~I X
Sq." FtQ. Access x
Sq, Ft9, Other x
OAT~ ~ctV
I~AI'IE(please print)
I@W!
./'1 Cc L U/2......
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Value
Value
Value
TOTAL VALUATION .2.,rvY'l~
BU I LD lNG PERI.IIT
Charges anc
Surcharges
I Pl an Ck. Comm/lnd
2L7. tJ() 65~~/Rl rla Ppr Fp!"
------------ PT'an Ck. Res
, :~ 0 30%/BI do Per Fee
loW
ISystems Development I
Charoe (1.5%)
PLUi1B1NG PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICP.L PERI~IT
Charges and
Surcharges
Sidewalk
A/C Pavi n9
Irotal Comb. rermit
I
I TOTAL
~
, Ol CJ, 8'8 ,__,I
IIECHANlCAL PERMIT
Charges and
Surcharges
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I.
II.
Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
017 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air
2. examole- waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot gar. {
2. examole- if new project. check new - if additi
check add. ete.
F. Building permit information:
1. example - construct single family house with e (.
attached garage
2.' examole - remodel existing garage into family
3. examole - convert single family residence iote
restaurant (change of use) (
G. Value of work as defined in Section 303 (a) of th
Structural Specialty Code
H, DES I GN TEAI'I AND CONTRACTORS
To avoid design or construction delays, Building (
Division Staff must be able to contact appropriat
persons regarding design information or job site
corrections. etc.
Abbreviated Plumbing. Mechanical. & Electrical Schedl s
A. Excep.t \.,here blank spaces occur in the descripti'
portion of the Mechanical and Electrical Schedul
the applicant need fill-in only the No. Boxes ad
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical, and Electrical Sched~
are available at the Building Division
1. To conserve space on the permit form the set
have been abbreviated (
2. If the item(s) to be installed are not cove: '..
the abbreviated schedules you should consul
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application will be
a \",orksheet only, Where possible, Building Divisi \St,
will prepare a type written copy and return it to
applicant at the time the actual permit is issued ~ .
signature.
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.
be del iverE
by his elee
is not au tl
I II.
IV.
V, FOR OFFICE USE ONLY
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CITY ncnMTT VALIDATION
OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
Dote
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Rec'd
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Address
Received For:
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Permit Clerk
PROJECT CONDITIONS TO BE SATlSFI ED BEFORE OCCUPAtICY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name
signature
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