HomeMy WebLinkAboutPermit Building 1990-11-1
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INFOR/1ATION LINt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Uew Add Alter Rep.
-Fence Demo Change/Use
Other- -
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...........
W
I~
(namel
Phone
f address I
Val~ of Hark: t
Y( 1.10/ {)(J.f? /J.!!-
BuildinQ Permit Info: Descr,be Work(i.e.. Build Single
Family /1esidence Hith Attachpd Garaae)
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Owner 0pr:ifltifreJ ce Uhf i fl-J t5NVU:,f /'Jtfir
Address 7(0 JA) 1114-11 ,\fr~ Phone 846'1
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construc~o\-Lend~r -\\" - J \qr4-77
Address
UI:.SlliN TEAl1
f1 ics. no.)
(exo; res)
(ohone no.'
Primary
Structural
Electrical
Hechanical
CONTRACTORS
(name)
(addrpss)
(lies. no.)
(exnirpc;)
(ohane no.)
Genera 1
Plumbina
Electrical
~lechanical
PLUI.IB I NG
ELECTRICAL
MECHANICAL
NO.
FEF CHARGF NO
FFF rHARhF NO.
FFF rHAIU:;F
SQ. FT.
furnace/burner to
BTU's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath \
Duplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp ~p~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rps i dJ'nr:p
multifamily, comm. or
Tnrlu<;.triill
Water service
COMI'I./IND. FEEDERS
Install/alter/relocate
di<;.trih. fppdpr<;.
Of
amps.
ISSUANcr OF PFR!\IT
TOTAL CHARGES ~ TOTAL CHARGES -' TOTAL CHARGES __ ________
WHERE STATE L.\H REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 Derformed 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 exe~the basis for exempt11n 's noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7111.055 \ i be used on this ~ojec
NAIIE(please pelnt) f)-r./J lvlS A. M.c ,;>-;..., ~ I SIGIIATUREL "Au.. rl t./lt'l DATEj! -I -~
FO~ OfFICE USE mILY~ 'I
Sq. Ftg. f1ain ,x
Sq. Ftn. Access x
)5"-2.... Sq. Ft~. Other ;;;lr7"'~L!Ec.'
PrJ:.. tlj,q /) .p IqU[fTOTAL VALUATION
I v /l.L&
, // D-:2 ",.- ,)syste_~s Development'
/__ ~. ~ ~ y CharQe (1.5~)
Zone
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Type/Const.
Bedrooms
Stories
'2
Units:
Occy Load
Occy Group
Value
Value
Value Ca.........- c.-
Fire Zone
Flood Plain
BUILDING PERMIT
Charges and
Surcharges
, ~ r7 a;p , Plan Ck.
~-'~: 65%/Bldo
- ~ -:;;'r - Plan Ck.
/i~ .~~ 30%lBldo
COfllTl/Ind
Ppr Fpp
Res
Per Fee
PLUI1BING PERMIT
Charges and
Surcharges
Fence
Demo
ELECTRICP.L PERr:1T
Charges and
Surcha~ges
I1ECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
A/C Pa~ing.
Curb Cut
Total ~omb. Permit
TOTAL
3'~8.6S I
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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
11 U3 43
2. example- Lot I. Block 3, 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example. heat/electrical ceilinQ/or forced air Qas
2. exam~le- waterheater/electr1cal/or solar
E. Square footage or valuation, etc. -
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. examp.le- if new project, check-new - if addition,
check add. etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. examJPle - 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 penmit 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
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 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
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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Permi t Cl erk fiJ\A./V'...L-
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PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additiqnal Project Information:
PLANS REVIEWED BY:
name~LP~;~ H~C.:t?signatur. ~ ~ /~_- ,late
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