HomeMy WebLinkAboutPermit Building 1989-8-2 (2)
I INSPECTION LINE
726-3769
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Construction Lender /
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CITY OF SPRINGFIElO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Iieater
Range_
ValuE. of Hark:
~ ~~ ~~,6:>
. BuiltiinQ Pernlit Info: Descr,be Work{i.e.. Build Single
Familv nesidence With Attached r.araQel
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(11c5. no. \ (exp;re51 (ohone no.
INFORl1ATION. LINl
726-3753
Sq. Ftg. '.Iain
~q.~ Ftg. Access.
Sq. Ftg. Other
flew Add Alter Pep.
-Fence Demo Change/Use
Other- --
~
~
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Job Address
1/9"0 ~?'7'.4 )1-! 5/
legal Oe5cription
Phone
Address
OE.~ I {iN TEAf..,
(name)
Phone
(address\
Electrical
1
Primary
Structural
Mechanical
CONTRACTORS (namel (addrp.o;.~) (lics.. no. \ (pxnirf's\
General,7/??E ,/f~/C/:>="/P ~.I ,eqc;-h#c".4'a;~//--': ~-=~2f)- :7-9"G?
Plumbino
(ohoop nn_ ,
Y'-""''''-",," '/S""';
Electrical
~'echanical
PlUIIBING
ELECTRICAL
MECHANICAL
SQ.
I rrr
FT.
\r~r.~
NO I
~ ~~r
InJ..ARG.E.
NO. .
FEE
CH~Rr,F
NO
Each single fixture
Residence of
furnace/burner to
BTU' 5
Relocated building
(new fix. additional)
S.F. Residence
11 bat.h\
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~~p ~p~tpr and vpnt
Storm Sewer
Of
amps.
Appl iance vent
Sf"Oarate
Stationary evap.
cooler
Vent fan wi th
sin91e duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hood and dur.t
Sewer
Temporary Construction
Change in existing
reo;. i d~JH'P
multifamily. camm. or
Industrial
Additional bath
Water service
COMfl./IND. FEEDERS
Install/alter/relocate
clio:.trih. fppder..
Wood stove/heater
Of
amps.
TOTAL CHARGES
WIIERE STATE l,\l/ REQUIRES
shall not be vali1 until the
ISSUANCE OF PFRlIIT
l TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMllNEO the completed aprlication for nermit, and do hereby certify that all infonnation hereon is true 1
and correct. and I further certify that any and all work Derfonned 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 fW OCCUPAUCY will be made
of any structure without the permission of the Building Division. J further certify that my registration with the Builder1s
Ooard is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 \'1111 be used on this project.
lIAf.lE(please print) (\(J Y\l.~ '\3(CI nc\<Q.V1\f.\) SIr,rlATUREk~V\lYlc&v- DATE B/dRCf
FOP. OfF I CE USE OIll Y I
Zone Type/Canst. Units Sq. Ftq. t1ain x Value
Fire Zone Bedrooms Occy Load Sq. Ft9. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILDING PERrllT
Charges an~
Surcharges
--;;?.a' C"""'...r> Plan Ck. COlll11lInd
__~....t:2:::~...d~_ ~/~ldo p.PI'" Fpj!>
Plan Ck. Res
/. 9:::3 30%'Bldo Per Fee
Systems Development
Charoe (1.5% .
PlU!~BING PERMIT
Charges and
Surcharges
Fence
D~mo
ELECTRICAL PERIIIT
Charges and
Surcharges
.Sidewalk
AIC Paving
Total Comb. Permit
."
-;
'\
~~Y3'
MECHANICAL PERMIT
Charges and
Surcharges
---------.
Curb Cut
~TOTAl
~
e,
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 43
2. examele- lot I. Block 3. 2nd Addition to
~prln9tield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Q
2. examDle- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. example- 1250 sq. foot house. 500 sq. foot garag
2. examp.le- if new project. check-new - if addition
eneck add. etc.
F. Building permit information:
1. examDle - construct single family house with an
a ttached garage
2. example - remodel existing garage into family rOt
3. exam~Je - 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 adjacen
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 schedule
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 SCHEOULES
D. As noted on the CAP, the label must be delivered to tl
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 a!
a worksheet only. Where possible, Building Division Staf1
will prepare a type written copy and return it to the
applicant at the time the actual penmit is issued for his
signature. .
IV. Fees and Charges .
Plan check fees are due and palable 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
.
..
I
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nl.nUTT \1/11 TI'"\/lTTf'\"
CITY OF SPRINGFIELD
City Hell
Springfield, Oregon
Office 01 Community and Economic Development
OFFICIAL RECEIPT
14547
Date ~/.c;. ::2, 19&"7"
. . ,
Rec'd From .1~"!:'".c"i<'" .~:P'j0<;7Z>F/Y/".FL"5
?t. ~~.n'.Dy/'6"=-> ~
Address D':::"<='5 c/',/'z:-, 67? 97.;/c6
,
Received For ~/T?#:?7o 77' /' /~.~
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Amount Received ~ O. r~
BY - /'/'~-?-Pr:"'~ :/---. I-
I t::: ~UTHORlZEO SIGNATURE ./' r
,. , BUSINESS FORMS. INC. ($03IJ.11'"
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
PLANS REVIEWED BY:
~,7'/Ii!~' h'~~gnatu~_~___:-,
c.....----- V"" C/' .
Additional Project Information:
name
.
date
J?-? ~.-;: