HomeMy WebLinkAboutPermit Building 1989-7-3
11
1 INSPECTION LINE I .
726-3769 '~!,
Job Address \fl L\.C) 1/7,,1]\1 ,~'.h A ,,4~oQ tl ~~;~GY SOURCES:
Legal Oescription VJ (') 33 t n~l ['/)(;fY\ 11.later lIeater
; - j Range
Jr',otr;k: .CD
\, ..()
l3uildl1Hl Permit Info: Deser be Work(;-.e.,
Famil y nes idencc Hi th Attached Garaae'
CITY UF SPRINGfiELD
Cm1BII-IATION APPLICATION/PERMIT
.
I NfDRIIATION II Nl
726-3753
Sq. ftq. '.lain
~q. Fta. Access.
Sq. ftq. Other
..Jle"-~ Add _A lter::)(.p.ep. -
Fence Demo Change/Use
-Other- -
owner\~~\\2ruQvt~ \::~C\.\L fJ\'\O-\Q ~
AJdrcss\I'\On 'tY ;./f'ilMf\ A. Phone
\. fiil\ t f'(k ~ ~ 0 oj) 1Cl~ ol)fll\ CJ'l4.rn
Construct~n LendefY, ') J - 6 - Ml o-l['O~l\
Build Single
~
~
.~
(name)
Phone
(address)
J\ ~ - J\.~),1> t ~ \Jr\ 1 '\
Address
DESIGN IlAI<
(1 ics. no.)
{exoires1
- (ohone no.
Primary
,.
"!
,',
Structural
Electrical
/1echani ca 1
CONTRACTORS (namel
General A-\SQ 'i.~C\ \~
PlumbinQ a
'I,
(addrp,-ss) (lies. no.") {exnirf>s).
Vf)\~'NJ[1\O~itb\~tf\~\~\\r{) ~1M0
(Qhonl" no. \
f\4J) -lnS'6
Electrical
~lechanical
PLUllBING
ELECTlIl CAL
MECHANICAL
.....llih
FEE
CHARr.E _ Jill._
j:TI="
<;lJARli( ..lID......
FH
1.cJ1ARG(
I
I
I
I
SQ. ,T.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
I'S. F. Res i dence
(j bath)
IDuplex (1 bath) each
IAdditional bath
I ~Ia ter serv i ce
I Sewer
I Storm Sewer
I
I
I
I
I
I
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wa 11
So~ce he~tpr ~nrl vP~t
Of
amrs.1
I
I
Appliance vent
seOflri'lte
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent syste~ apart from
heatina or A.C.
Mechanical exhaust
hooel and duct
Hood stove/heater
Temporary Construction
Change in existing
res i dpncp,
multifamily, con'n. or
lndlJ"trial
cm<I1./lND. FEEDERS
I Install/alter/relocate
di"trih_ fppelpr"
IOf amps.1
I
I
I
ISSUANCF nf PFRlIlT
TOTAL CHARGES
WIIERE STATE L'II REQUIRES
shall not be valiJ until the
TOTAL CHARGES
TOTAL CHARGES
that the Electricill work b~ done by an Electrical Contractor. the electrical portion of this per17lit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAtlWED 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 performed 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 OCCUPAIlCY will be made
of any structure without the permission of the Building Oivision. I further certify that my re9istration with the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with Or.S 701.055 71f)used on this !1roject.
IlAI.IE(please print) ,/ 6-a (..j H. EI2 If L~ SIGrr^Tl!R[~ ;t/~?a.r L DATE 7 - ~-ft
fn~ OFfIcE lISE nmv I !
S~. \1~.
Sq. rt~.
S~. Etg.
Fi re Zone
Type/Canst.
Bedrooms
lJni ts
Occy load
Occy Group
11ain
Access
Other
x
Value
Zone
x
Value
Value
Flood Plain
Stories
x
TOTAL VALUATION
BUILDING PERmT
Charges and
Surcharges
. 1(100 .
__ ~i...______
,(,\5
Plan Ck.
65%/Bldo
Plan Ck.
30%/Bldo
rence
Comm/l nd
Per Fee
Res
Per Fee
'Systems Development
Charqe (1. 5~)
PLUI1BING PERMIT
Charges and
Surcha rges
'.
D.~mo
ELECTRICAL PERIIIT
Cha rges and
Surcharges
Sidewalk
11ECHANICAL PERI<IT
Cha rges and
Surcharges
.,
.1. A/CPaving
____________1 Curb Cut
I
Total Comb. rermit
TOTAL
\~.C\~
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100. Lane County Map Reference
II 03 43
2. examD 1 e- Lot 1. Black 3. 2nd Add it; on to
Springfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinq/or forced air QdS
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- Tflnew project, check-new - if addition,
check add. etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examt?le - 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. DES IGN 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. 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.
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
signa ture.
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMCY:
...
.
.!
PERMIT VALIDATION
.
~,~
\ L\ ZC(Cl
i
:
"
,
Permi t
Cl erk N~iXG
. ..
"
Permit applicant exempt from registration with the Builder's Board because:
.
.,
Additional Project Information:
PLANS REVIEWED BY:
name
signature
.
;1'
.I
date
,-