HomeMy WebLinkAboutPermit Building 1990-6-7
J INSPEC.TION LINE CITY Of SPRINGr!ELD
I 72b-3769 COMBINATION APPLrCATIONiPERMIT
Job Address 7) Q_G{\i)G \l~~ \\.. \q... \l.l
Legal Description l~\LX"'.L
11 O~ d.jLf ~ - QS2CO' Ra.lge'
owner~ITll\ ~ill l\()Jffiir\ &.D\\
Address f) .C'). ~ -I.. -1 '":6::J.~ . (h3r1e
E \Av-e. kC\ \ r A otc;<s;O/
Construction Lender.
Address
DESIGN TEAt1
" Primary
Structural
Electrical
(name)
Phone
(address!
I NFORl1ATION LlNt
726-3753
Sq. Ftg. r.1a i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter P,ep.
--Fence Demo Change/Use
,Vaiuf ,)f ~ro Other----
\~I. . . ,
8uil~'~ Permit Info: Describe Work(i,e., Build Single
F~;~~idenc~ l~it~:che; ~(Q~
s 00 --,-\\~J.~ )
i:t \:J .. -
(lics. no.) (exnires)
, 1'\ :.
~).
B'
Ib
-B
Et!ERGY.-SPURCE. L.... ",
Heat T \Pr" \) \. C-.
- . - -
H~~er Heater
(ohone no.'\
. Mechanical
. :::::::T\~ ~'\W~x":h~ sffiw ~f\QE1~f?C(t.-~ffi[) o~'f~~l~2.~~
Plumbinat)t~ ~ {) f> \J\ ro~ () \) t) \~ f)Nn~~ G ?A~ 3-'lo. /
Electrica\l ~~~6\M . J)~IQ~ 'lIe( I
M"h,"i~,,-\t)~ \'?t1I\ ~/ ~"cf.\ wpn
PLU!r1B G ~ ELECTRICAL MECHANICAL
NO. '
,~
Each single fixture
, FEE 'CHARGE NO_
I FFF I rHARGFI NO.
FFF I rf,ARGF
'1~ 2.2.~
Residence of
furnace/burner to
BTlI's
SQ. FT.'
Relocated building -
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Iater servi ce
Sewer
"
.
Storm Sewer
-,
SERVICES
Recessed wall
Saace heater and vent
~~~?I
OJ ~>
Temporary Construction
Change in existing
res i deilCe
multifamily, comm. or
Industrial
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
I
Of
amps.
COMM./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
.....--.
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ISSUANCE OF PFR11IT
TOTAL CHARGES 22fi) _ TOTAL CHARGES ~1, ~U 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 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 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 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 subcontractors and. employees who are in compliance with ORS 701.05~_Wi~~d n t '~roject. Js-u~
fcJlt~ C- v/1-c:c.4-- ,. ~ / ~~,;- p2tJrJS'sC-
rmiE{please print) ),i1.e-[ f?~.-er f1l/r/ C, _ : SIGN^TU~~ ~ D/l.TE
50. u fU//JSdl~..rnCI a.",FOr.. OFFICE IISVOi~L Y
Type/Canst. J Units ~. Ftg. t1ain
Bedrooms Occy Loa~ Sq. Ftg. Access
Stories \ Occy Group \:-c)-\:~- Sq. Ftg. Other
m 5-30-Q n
In \ .0 "":l..... - Systems Development
. I ".......J Charge (1.5%)
-~ \1 \C\'::>
Zone~
Fire Zone
Flood P.l a in
BUILDING PER~1IT
Charges and
Surcharges
PLur~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERMIT
Charges and
. Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
\~~~
"'j7/ft>
/ tJ ,.--!" 0
x
Value
Value.
x
x
Value
TOTAL VALUATION
1~D_~5f>____
~. 6~
~~) 56
----t~\~----
__35_._~_'__
\. - .-
___'.65?':>_'___
.75
Plan Ck. Comm/Ind
65%/Blda Per Fee
~FA....
\~\ ~.
Fence
Demo
Sidewalk
AlC Pavi ng ,'.
'Curb Cut
Tota], ,CofTIb. Permi t
, ~\C\ l\. D5L I
. I, . .
TOTAL
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. ~xample- Tax Lot 100, Lane 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 qas .
2. example- waterheater/electrical(or solar '
E. Square (ootage or valuation,etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-m2w - 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 qf work as Q~fined in Section 303 (a) of the
~tructural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid desig~ or construction delays, Building
~ivision Staff must be able to contact appropriate
persons regarding design information or job site
correct ions,. etc.: I .;' .
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
h 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'j:o' the
electrical contractor for signature by his eiectrical .
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 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.
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
PERMIT VALIDATION
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PROJECT CONDITIONS TO BE SATISFIED. BEFORE OCCUPANCY:
.~.\ \
Permit applicant exempt from registration with the Builder's Board because:
r-
Additional Project Information:
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PLANS RE~[D ~Y:
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signat~\ ~A.," ~
- .......
date
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