HomeMy WebLinkAboutPermit Building 1990-7-19
Phone
(address)
,.,
INFORf1ATION LINt.
726-3753
Sq. Ftc). r.1ain' q'b-~
:q. Ftg. Access.
Sq. Ftg. Other
f~ew Add Alter 'P.ep.
--Fence Demo Change/Use
Valuf of Work: --Other-- --
~ '10 '2.0 c).~ cA --
BuildiAq Permit Info: Descrlbe Work(i.e., Build Single
Family nesidence With Attached Garaae)
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, (lics. no.)
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'~'i INSPt:crION LINE CITY OF SPRINGFIELD
17~6-J769 COMBINATION APPLICATION/PERMIT
\\ \ l \ , '32.C:.CGI.,)'t.....f">I EflERGY SOUP.CES:
: Job Address \'"\(.\W\ ~-uY\t\: ole! ~""~.:l\~\~ ~ Heat <:1 ~c..~~~, F.. ..,,,J
'I 1 0 . t./ Water Heater~ b.
. .ega. eSCrip ion /J"d~"':ZEt!::>-~Y, ~tt;;?e:so.
, Range;oJ I ~
; ownerS?Q.:~(;.~:J\~ ~ l "^.;)~\ <D .:s. ~
'Address S L. '.)' ,^^', \ l ~ + . Phon e?Z D1'7S
~(~~(,i). ~ lJ. Or't G7 '"11'i
; Constr~ction Lender
(name) (address) (lies. no. t (exDires)
""" "L - -:--... oc..747U.t:1Cc
General E\\...,Ie-Q. ~Ov....I~~~",<t ~~~...uI,...1:~<. !.--/~C;I
,Plumbinq "r>-. h \~8\-' m.€... .(~...)d~~\..JO ...
Electrical\),~~ ~~....:\ \..ti"H~ .~ ~... V~l:~'" dJ~ ~
I ~ . ..557 P'S
, Address
DESIGN TEAM (name)
P:-imary ~\ y').~ C:!'\'\.
q
Structural
Electrical
r1echan i ca 1
CONTRACTORS
~1echani ca 1
NO.
(exoires)
(ohone no. I
l t
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?~ {So~'3~S-
C. LJ c& ta. .ka ~ Dl'L
~ ., ~ 8 \ ... 0 3 '1 ~-
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5;:) 1.~' ~ .J ~:r I
(Dhone no.)
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57(,/- .-rS1 J
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PlUt,1B I NG
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MECHANICAL
ELECTRICAL
'FEE CHARGE NO.
FFF rHARGF NO.
FFF rHARGF
Residence of
furnace/burner to
, BTU's
Each single fixture\
SQ. FT.
Relocated building .
(new fix. additional)
New circuits alts.
or extensions
Floor fu rnace
and vent
S.F. Residence
(1 bath)
IDuPlex (1 bath) each
Additional bath
~Iater servi ce
Sewer
Storm Sewer
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SERVICES
Recessed wall
Soace heater and vpnt
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Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
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Temporary 'Construction
Change in existing
residence
Imultifamily, comm. or
Industrial
Of
amps.1
COMM./IND. FEEDERS
Install/alter/relocate
distrib. fppders
1 10f amps.
12 IMiP~A '4"~~
_-::;~ wC'~
ISSUANCE OF PFRmT
TOTAL CHARGES TOTAL CHARGES ---=5~ -P -/:;: - -I TOTAL CHARGES
, WHERE STATE U\\~ REQUIRES that the Elect'rical work be done by an, Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and'returned to the Building Division' '
I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all informaFon 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 oertaining to the work described herein, and that NO 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are ~n compliance with ORS 701.055 wil,l be used on this oject.
fW1E(please print) W'ArO ~ Q!<J~n...,o.J~ SIGijAT~
FOR OFFICE USE ONLY
Units So. Ftg. i~~r7'_XV~.(~lue_~~a::>
Occy Load ~ ~~ . Sq. Ftg. Access x Va 1 ue
Occy Group1"2 Sq. Ftg.Other ~~b~.7'/~~ Value ~~
rp...." T,OTAL VALUATIOt!jk:.c::'~---
UL #"~'"?~~~g!-
Systems Development 7"':/2~ ~
Charge (1.5%) '...... ;?t::!>.' '~
'Zone ~L..
,
Fire Zone---,,,
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICfl.L PERfHT
Cha rges and
Surcha rges ,
MECHANICAL PERMIT,
Charges and
Surcharges
DflTE7.., J Cf- c:; C
-,
Type/Const.
Bedrooms
Stori es
/
-::<2 ' ...... (;...>
--.:",L-~~----
/.63
Plan Ck.
65%/Blda
Plan Ck.
30%/Bldg
'2.1./ =?>
CommlInd
Per Fee
Res
Per Fee
Fence
~~~W'
'7 ~<:::>.;. --
D@mo
__~~WOlk ~~~5'7
I. ~ AI.C Pav~ng~ ' . _
- -- Curb Cut I"
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Total Comb. Permit
. 29 ~.I::;,
rt:u-c ~"~,,
1;&7 1--
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TOTAL
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COMBINATION APPLICATION/PERMIT (CAP) \
PERMITVALIDAT10N
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Sp~ingfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources, -,
1. example- heat/electrical ceiling/or forced air gas
2. example- waterheater/electricalior solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if,new project, check-m2w, i~addition,
check add, etc. ' ,; .:\.
F. Building permit information:
1. example - construct single family house with an
attached garage _ .
2. example - 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 Special'ty Code', '
H. DESIGN TEAM AND CONTRACTORS ,
To avoid design or construction delays, Building
.Division Staff must be abl~ to contact appropriate'
'p.~rsons:. regar:ding <;l~~igi""informati'pri or job sHe:...,--'---'.-
correctlons, etc. '
II. Abbreviatedp'lumbing, Mechan-l'cal, & Electrical Schedules
A. Eice~t w~ere 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 be~n 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.
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V. FOR OFFICE USE ONLY
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, . ;'Permi t
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Clerk~tYlJ
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PROJECT CONDITIONS TO BE SAnSfI~D BEFO~~ .gCCUPANCY:
",,- .
'- -,
':,. eerm'it applicant exempt'from-regist:ati~n with the 'Builder's.Board,/b,ecal!se:
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Additi'ona 1 Project. Informati:dn:
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PLANS REVIEWED BY:
........, ~:'..;'. ..... ~,
s ign:t~r~&z ~ ~-c,--~ate 7-;'" ~ef>.
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'name~~',~~~
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