HomeMy WebLinkAboutPermit Building 1990-10-8
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I IrISp'ECTION LIIIE
726-3769
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CITY Uf SPRINGfIELD
COMBINATION APPLICATION/PERMIT
EnERGY SOURCES:
Heat
Hater Heater
.
INfORlIATION UNt I
726-3753 .)
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ft9. Other
flew Add Alter R.ep.
-Fence Demo Change/Use
Other - -
Job Address LJ4:2 1 L}Lj LJ ;1). A s+.
Legal Description 1102.;::>,9-../ - O;)ogDl?^"",..<..l.,u'
(', C'
Owner \)0. Q L _" I ""'<-
Address YY-:l N.. A
Srv',v-v.. 9.<:>1,.,{
Construction lender ~
sJ.
Phone
Ranqe
Valu€ of Hork:
5~1 ,Oc)
Builtiinq Pernlit Info: Describe Workli~e..
Family nesidence With Attached Garaoe)
, -\.!h-oo-P
Build Single
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C)
9..)
9.J
.f'I
R\ol~
Address
DES I GN TEAI~
[name)
Phone
(address)
{l ics. no.l
(exni res)
(ohone no. J
Primary
Structural
Electrical
Hechanical
CONTRACTORS (name)
General W~ \ \Olv-ae:H€. '.vf'ln~/.\N:
6
{addr~ssl
(lie<;. no.'
(~xDirp" )
(Dhonp no.)
~C1ql
C K.:F..S.
QIA(j . -It G;~Sn
'1:1)
l-, 'ij(i1-lCY()
Plumbino
Electrical
!clechani ca 1
PLUllBING
ELECTRICAL
MECHANICAL
NO.
HE rHARGF Nn
~~F rHAR~F NO,
FFF rI-lAR~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
Additional bath
New circuits alts.
or 'extensions
Floor furnace
and vent
SERVICES
Recessed wall
Snnep hPntpr nnrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hnorl and duct
Sewer
Temporary Construction
Change in existing
fE'sirlencp
multi-family. corrm. or
Tndustrial
~Iater service
COffi~./IND. FEEDERS
Install/alter/relocate
rlic;trih. fpprlprc;
Wood stove/heater
Of
amps.
TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L,'~~ REQUIRES that tile Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
ISSUANCf OF PFR!IIT
I TOTAL CHARGES
Electrical Contractor, the electrical portion of this pe~it
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 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 OCCUPAr~CY 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 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 will be used on this project.
HAIIE(please print)~/-< ~ c.A",.cJ( 1/11 ~I;'ilATURE~~.A
./ Fm OFFICE USEg'JrY ,
, Tvpe/Const. . Units . Sq/'"Ftg. t1ain
Bedrooms Occy load Sq. Ft9. Access
Stories Occy Group Sq. Ftg. Other
A~ 'td(AT~
IO/Q}SLL
Zone
Fire Zone
x
Value
x
Value
Flood Plain
x
Value
TOTAL VALUATION
BUILDING PERMIT
Charges anc
Surcharges
, LlIIS" ' Plan Ck.
_ _:::L"J.. eLL _ _ _ ~/BI do
""' ,,-::> Plan Ck.
~.~~ 30%/Bldo
Fence
ConmjInd
Ppr Fee
Res
Per Fee
'Systems Development '
Charge (1.51-) .
PLU'~BING PERMIT
Charges and
Surcha rges
D~mo
ELECTRICAL PERI:IT
Charges and
Surcharges
.Sidewalk
A/C Paving
Total Comb. Permit
11ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
Li~.7~
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT V~LID~TIDN
1. Applicant to furnish
A. Job Address
B. legal Description
1. example. Tax lot 100, lane County Map Reference
17 03 43
2. examEle- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. exa~le- waterheater/electrlcal/or ~
E. Square footage or' valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examp'le- if new project. check:ruew - if addition,
check add, etc.
F. Building permit information:
1. examyle - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examyre - 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 TE~1 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 ANO
CHARGES ON THE SCHEOULES
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
00
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PROJECT CONDITIONS TO BE S~TISFIEO BEFORE OCCUPANCY:
. ,
,
Permit ap'pl ican.t.exempt from xegistration with the .~uiJder',s Board' because:
~dditional Project Information:
.
PLANS REVIEWED BY:
name
signature
date
.