HomeMy WebLinkAboutPermit Building 1990-1-8
J .~..~
INFORI1ATION LItH:.
726-3753
Sq. Ftg. r.lain
~q. Ftg. Access.
Sq. Ftg. Otl1er/
New Add c..,n ter Rep.
--Fence Demo Change/Use
--Other-- --
t
~
Construction Lender,
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat Hulf-L
Hater Heater
Range__
ValuE. of Hork:
~. '1. 'f')OO
Phoner<1l7/tR:., Buildinq Permit 'Info: Describe Work(i..e., Build Single
~ -.~ Family Residence Hith Attached Gara0e) ,
\~c1\tM-rrhM );"-~RNdO
~~~~~~.. "
I INSPECTION LINE
726-37.69
Job Address 54:7 (6a~"1 ~ed. _ , '"
Legal Desc~i~tion \1f'\(J-b'd lo64 0\ S(JU
Owner. % 7ip~h.e.r 115':>)\lt:/
Address 'BID c:S> a....~
Address
DESIGN TEAf~
(name)
Phone
(address)
(lics. no.)
(expires)
(phone no. I
Primary (..6L{IoI--1 ALI~
Structural
Electrical
, ,
r1echani ca 1
CONTRACTORS
Genera 1 1)oM:.e1 ~ ,~~
Pl umbi no A(.,~V'+ ,f It>-o-J1,'1.-,
, ", /
El ectri ca 1 f MI1LV' ) f4l1eb
, . '
~'echanical !3...(!"l1'iW<'CY\ rJ/Jk
/
(name)
(address'
{lics. no.' (exoires) (ohone no.'
-:;;; 5" b'D 7/?f 1'70 '67-23til
.'
/3 7/8/ji'/ ~'{S-~~~
/.{ ~ ~/7 /2/?o/9-D Y6'C.f -2.sb ~
"iIS' tt~ &:s=..
PLUI.1B I NG
, -LEYe/->.- ./-~l
ELECTRICAL
MECHANICAL
/
NO, .
FEE I CHARGE ~O,
~FF r.HARGF NO.
~FE r.HARGE
SQ. FT.
/
furnace/burner to
b~r"1,~J8 .
Floor fu rnace
and vent
6--'
:2
Each single fixture
?-~ 1S:."eI>
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F, Residence'
(1 bath)
Duplex (1 bath) each
SERVICES
Recessed wall
Soace heater and ve~t
Sewer
Temporary Construction
Change in existing
res i dence '
multifamily, comm. or
Industrial
!
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
'?~
Additional bath
~Ia ter servi ce
Storm Sewer
I
I
I
';1
Of
amps.
TOTAL CHARGES
WHERE STATE L'\l~ REQUIRES
shall not be valiJ until the
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of amps,
1 '
~:~/,':,4497'/3'k~-
5~L ~/~~ I
~~h'A';E m~./}-- ISSUANCE OF PfR11IT
~ , (
/5":. ,., . TOTAL CHARGES TOTAL CHARGES .~ ./5": e>7f!!>
that the Electrical work be done by an,'Electrical Contractor, the electrical rortion of this rermit
label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXA~IINED the comrleted aprlication 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 NO OCCUPANCY 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 subcqptractors and employees who are in compliance with ORS 701,055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Const.6=#-,~.Uni ts
,/
Bedrooms Occy Load
Stories / Occy Group..3..z.
SIGtlATURE~ ~k"~c
~.... ~
FO~ OFFICE USE ONLY
Sq. Ftg. f1ain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Other~~~~;;""'~.....CValue 7~
TOTAL VALUATION
DATE Y'~<,)
I~Af"E(please print){DI II; C\...wc (,.. jMf:...J;v/-y.-...
f
BUILDING PER~1IT ___~~2~_ Plan Ck. CommlInd
Charges and 65%/Bldo Per Fee
Surcharges 5- 1""3 Plan Ck. Res
30%/Bldo Per Fee
PLUr~BING PERMIT />~ Fence
Charges and --- --~-----
Surcharges .75" D6mo'
ELECTR I CAL PERf~IT 'S i dewal k
Charges and ------------
Surcharges A/C Paving
MECHANICAL PERMIT ..,-0'
Charges and ___/5;_____ Curb Cut
Surcharges ,,75""
/... ")~9.o :;?<.H4tf'
Vd;),63. (5' 7~ r
- I
Systems. Development
Charge 0.5';) . . . ,
/"t) _57. ~ ~
.. !J
;~~.#"'~r
.~~?'?,'S
.
Total Comb. Permit
9~/:3
I
TOTAL
'2~2. 13
.,;
..:.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
III.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd ,Addition to
Spri ngt"i e 1 d Esta tes'
C. Name, etc. of owner and construction lender
D. Energy Sources
'1. example- heat/electrical ceiling/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if 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 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 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
D. As noted on the CAP, the label must
electrical contractor:for signature
supervisor. 'The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will b~ 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.
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. ATl other fees and charges are due and
payable when the permit is issued. I
)r-( S ~qO
l~~({)-/
be delivered to the
by his electrical,
is ,not authorized
IV.
V.
FOR OFFICE USE ONLY
_._ I
-'';:':'" .~..:.
Permit Clerk
rfmj
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
-nameL(!?8~H.:-;~ Signature~~~~ date /7/-/P
. ~ ~ . ./ ,L/ /'