HomeMy WebLinkAboutPermit Building 1990-6-20
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726-3753 '
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I INSPECTION LINE
726-3769
Job Address 0037 ref1l-~fl J1 reef Wc~r
Legal Description "' J ()?. ~ (,.:;LJ3.. ~- 1 ~ IfX')
CITY OF SPRINGETELD
COMBINATION APPLiCATION/PERMIT
-I
'\="~~ r~p~~
P. {}.. B r'N.. I ~ ') <;l Phone
"F,I,~L V ~:>jZOl r A OJ S <...6 )
Construction Lender
Address
ValuE of Hork:
I_S,OOO
Bui1ciinq Permit Info: 'Descrioe Work(i:e., Build Sjngle
Family ne~idence With Attached Garaoe)
('~)WvU ~. le~
~ Ci. .. 11\ (UA) .
-
Owner'
Address
DESIGN TEAr4
(name)
Phone
(address)
(lies. no.)
(exoires) ,
(ohone no. I
Primary
Structural
i;ly
<S~oo
Electrical
Mechanical
CONTRACTORS _ (name) (address) (lies. no.) (exoires)
,..",1 ~CWl1 m Co Q,.,.., t 1(' u Bek . I?SSlJ{) ~.lklP~ Rc.p ~ ~
Plumbinq ~ p\- VYv. ' ~=3SCS;V V:;;
Electrical ~d.A , h:lO-IS~6 ")/~D -
~1echanical f)..eyC'f'~O\,r, S11\.LP;/ Vv\;i-Cti 'L-(Cj(~/q '~/q()
PLUr,1B I NG
(Dhone no.)
q 1 LlOC;;- C:J7 -;;))# /
ELECTRICAL
MECHANICAL
NO. '
, FEE 'CHARGE NO,
, FEE 'CHARGF1 NO. '
'FFF 'CHARGF
?
Each single fixture
Residence of
z ~ :?:?-9
SQ. FT.
/
furnace/burner to
</~ ...........-:>BTU's
Floor furnace
and vent
6,'1>
Relocated building -
(new fix. additional)
~'New circuits alts.
or extensions
-? ,--r-? M~G
SERVICES
~'2.~ .
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
Recessed wall
Soace heater and vent
Storm Sewer
Of
amps.
Appliance vent
, seoarate
Stationarv evao.
cooler - ,
I Vent fan with
sinole duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hood and duct
?-~
~Iater service
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
distrih. feeders
Wood stove/heater
I
I
I
I
I
I
amps.
ISSUANCE OF PF.Rr1IT
TOTAL CHARGES ',.( --<_SiP TOTAL CHARGES -3 ~ 5et:> TOTAL CHARGES ~A7. /:5"': ~'
, WHERE STATE L"\~ REQUIRES that the Electrical work be done by an,Electrical Contractor, the electrical rortionof '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 EXA/1INED 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 oertaining to the work described herein, and that NO OCCUPAHCY 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 sUbcontract~~., nd emPlo~~liance with ORS 701.0~~~~~~~~~ect. ~__~~~
NAr'1E(please )/ ljl!ta./~ 7. tUC--;{';:;L-' SIr;~lATURE 2/././ .d!t~c!.<,,~R-#?- y. DATE.0-72//9(')
FOR OFFICE USE ONLY
Sq. Ftg. t1a i n x Va 1 ue
Sq. Ftg. Access x Value
Sq. Ftg. Other ~~ ~sP~ 7/SFF' Va 1 ue /5; c:3~, ~ ,
CD &>/.lt1 0 19a TOTAL VALUATION
., I . <;(3
cc
-
Type!COnst.~ 5~ni ts
Bedrooms Occy Load
Stories O~cy GrouP-1:~-~
Zone
Fire Zone
Flood Plain
BUILDING PER~1IT
Charges and
Surcharges
___I/d._~~__
S--~ ;:5
~c FT n~b9
Plan Ck. Comm/Ind
65%/Bldo Per Fee
Plan Ck. Res
30%/Bldq Per Fee
Systems Development
Charge (1.5%) ,
/
(lJ!A-
PLUt1BING PERMIT
Charges and rh
Surcharges
___~~2"':::__ Fence
j./3 D!;mo
_ _ _ _ '37.../:; t:? Sidewalk
/ -&b A/C Paving
_ _ _ _!~~::_ _ Curb Cut
.75
Total Comb, Permit
ELECTRICAL PERMIT
Cha rges and
Surcha rges 0'1
TOTAL
1J?7'. 7~
I
MECHANICAL PERMIT
Charges and
Surcharges J\.f
)
'"
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lar.e County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air gas
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 ~,~onstruct single family house with an
attached ga'rage
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.
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 bee_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. ---
Applicant to sign and date ,
Whenever possible, the initial application will be used as
a worksheet only. Where poss~ble, 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. '
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.
II.
III.
IV.
V. FOR OFFICE USE ONLY
~
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PERMIT VALIDATION
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[UCejf* P:Y l740D
, (0 --Z,1 - 90
. Permit Cl erk (iAJlAI\..L-
.. : ',~ .~. - -, "'; !'l' . ,
PROJECT CONDITIONS TO BE SATISFIED BE~ORE OCCUPANCY~
Permit applicant e~empt from registration with the Builder's Board because:
'Additional Project Information:
PLANS REVIEWED BY:
name
signature
"
date