HomeMy WebLinkAboutPermit Building 1990-4-3
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jltlSPECTlOIJ L111hr-../ C' (I" ; n--;yr' ,A ;_.J J. CITY UF SPRINGfIELD
1726-3769 K J... ;to (" lJI j I ,lJLf lJ'1I( }:illI6J,IATlON APPLICATION/PERMIT
Job Address ......, , '( ,. ~ ~ ~ E'IERGY SOURCES
~ . -' . J '!, '///'7cET Heat
legal De.cr'ptlOn /7-o3-25-~~ . CJ/'o/C:>C> \Iater Heater
Owner 13~:rAflEL ~5.Fk?BL. Y' ~..c 00Z:>
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Address ///,I,e> //-<7 '2/ ~ $~&=r Phone
_<;?~L.b/ ~?q. "??Y77
CElAstru:+-'''''' liHH;le~ ~A/V7 -se~Rt::)t.P
ValUE of Ilork
'9?" CJO,:p
Bu,iClnq Pernnt Info Descnbe \lark(l e
FaMl1y ~es,dence W,th ~ttached Garaae)
. BUlld Slngle
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,
Ranqe
INFDRlIATlON LINt
726-3753
So Ftq rlaln
~q r::'tg Access
Sq Ftq Other
He\~ Add Alter (}ep
--Fence Demo Change/Use
Other- -
Address
Ut> I GN TEAr1
(name)
Phone
(address)
r If? ~e>:X /.6~~
Z>_~77 A'",L:> ~ 97:2'/';:<;
,;.
/';~PI'GrdF $_______.4</0'0~ n~".
h;:7~##/~( -t/ C2~/f'/,c,#~
56"C'.j.E#37~Y/3 ~i #. 79Z-:?3'9
(11C5 no) (exnlres}
(ohone no
7Yb'" 'I-:?2
Pr1marYGO~R/A C,l0.:&7n,<;' E...a:;,:e;>,
Structural
7~/-C>'7~
E1 ectn ca 1
Mechamcal
CONTRMLIUK;
\ Ildrlle I
(address)
(11CS no)
(eXOlrps)
(ohnnf> no )
General ~L<J'~.-c~
Plumblna
Electrlcal
~1echan1 ca 1
PLUI1BING
ELECTRICAL
MECHANICAL
NO I I FEF
lEaCh slngle flxture
IRelocated bUlldlng
(new flX addltlonal)
S F Pesldenc.e
(] bath)
Duplex (1 bath) each
rHARGF Nfl
'"
('I-lARr.1=" NO
'"
(I-lll.Rr.:1="
ReSldence of
SQ FT
furnace/burner to
BTU's
New clrcults alts
or extenslOns
Floor furnace
and vent
SERVICES
Recessed wall
Snnce hf>ntPf nnrl vpnt
Storm Sewer
Of
amps
I Apol lance vent
seoaratf>
I StatlOnary evap
cooler
Vent fan Wl th
slnale duct
Vent syste~ apart from
heatlna or A C
Mechanlcal exhaust
hood and duct.
Add1t1onal bath
Sewer
Temporary Construct1on
IChange 1n eX1st1ng
rpc; 1 r!pncp
mult1famlly, COmM or
Industrlal
~Iater servlce
COMll fiND FEEDERS
Install/alter/relocate
r!lstrlh fe~rlers
Wood stove/heater
~~:_ ~:;~~,.;~:;1;I~~
c:f'~/..~~..b,... ~~ __,,~,,_&. p~~t
~y~ ISSUANCF OF ~FRt1lT -
,OlAl CHARGES I TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\\~ REQUIRES that tile Electrlcal work be done by an Electrlcal Contractor, the electrlcal portlon of thlS perr.llt
shall not be vallJ untll the label has been slgned by an Electrlcal Suoervlsor and returned to the BU1ld1ng D1vls1on
1 HAVE CAREFULLY EXMlINED t1e completed apnllcat10n for oerm1t, and do herebv certlfy that all 1nformatlOn hereon lS true
and correct, and I further cert1fy that any and all work Derformed shall be done 1n accordance wTth the Ordlnances of the C1ty
of Sprlngf1eld and the laws of the State of Orenon oerta1n1ng to the work descrlbed here1n, and that IW OCCUPAIKY w1ll be made
of any structure w1thout the perm1SS1on of the BU11dlng OlvlS10n I further certlfy that my req1stratlon w1th the BU1lder's
Board lS ln full force and effect as requlred by ORS 701 055, that 1f exempt the bas1s for exemptlon 1S noted hereon, and that
only subcontractors and employees who are 1n cOffiol1ance w1th OPS 7n1 055 \1111 be used on th1S project
IWIE(please pnn~/ 5'AM S<llbold
1\ .
zone~kf7"lrYDe/const ...<5"-/h".A'_Un1ts
Fl re Zone / Bedrooms Occy load
Flood Pla1n Stones / Occy Group
S Irjj^TURF ~ ~~
Fon OFFIC" USE DilLY /
Sn Fto f1aln x
~?' Sq Ft~ Access x
4-~ Sq Ftg Othev::::;.~t'~ x
om '1- ~ to
Value
Value
Value""6',""'~
TOTAL VALUA,IOtI
BUILDING PERIIIT
Charges anc
Surcharges
__ ..L'2-'5~~ _ ~:~~B~~a ~~~';:d
Plan Ck Res
9.65 3D%/BldQ Per Fee
Fence
05: Y6
Systens Development
CharQe (l 5')
~~
;'?'<IEV/OOS < r
PLUI~BING PERMIT
Charges and
Surcharges
I D@ffiO
Sidewalk
ELECTR I CftL PERI'IT
Charges and
Surcharges
AIC Pavlng
Total romb rerm1t
-202 tGS-
t1ECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
'5:;:'8./1
COMBINATION APPLICATION/PERMIT (CAP)
II
Appllcant to furnlsh
A Job Address
B legal DescrlptIon
1 example- Tax Lot 100. Lane County Map Reference
11 U3 43
2 example- Lot I Block 3, 2nd Add1tlon to
SprIngfleld Estates
C \ Name, etc of owner and constr~ctlon lender
o ,Energy Sources.. ~ . r
1 examqJe- heat/electrlcal celJlnq/or forced aIr qas
2 .. example- waterheaterjelectncal/or solar
E Sq.jJare {Dotage or valuatlon, etc ~ ----=-
... 1 .example- 1250 sq foot house, 500 sq foot garage
2 example-,f new proJect, check new - If addltIon,
check add, etc
F.' BUlldlng perm1t InformatIon ...
1 example - construct slngle famlly house wlth an
attached garage
2 example - remodel eXIstIng garage Into famIly room
3 examyle - convert SIngle famlly reSIdence Into
restaurant (change of use)
G Value of work as def1ned 1n Sectlon 303 (a) of the
Structural Speclalty Code
H DESIGN TEAM AND CONTRACTORS
To avold deslgn or constructlon delays, BUlldlng
DTvIsIon Staff must be ab1e to contact approprIate
persons regardIng desIgn InformatIon or Job sIte
correctIons, etc
Abbrevlated PlumbIng, Mechanlcal. & ElectrIcal Schedules
A Except where blank spaces occur Tn the descrIptIon
portlon of the MechanIcal and Electrlcal Schedules,
the applIcant need f,11-1" only the No Boxes adjacent
to the approprIate Item(s) to be lnstalled
B Full PlumbTng, MechanTcal, and ElectrIcal Schedules
are available at the BUIldIng DlvIslon
1 To conserve space on the permIt form the schedules
have been abbrevlated
2 If the Item(s) to be Installed are not covered on
the abbrevlated schedules you should consult the
full schedules
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
o As noted on the CAP, the label must be dellvered to the
electrlcal contractor for s1gnature by h1S electr1cal
supervlsor The general contractor 1S not author1zed
to s19n the electr1cal label -
Appl1cant to s19n and date
Whenever posslble, the 1n1t1al appl1cat1on w1ll be used as
a worksheet only Where poss1ble, BU1ld1ng 01v1s1on Staff
w1ll prepare a type wrltten copy and return It to the
appllcant at the tlme the actual permlt 1S 1ssued for h1S
s19nature
Fees and Charges
Plan check fees are due and payable at the t1me of the
appllcatlon, and no plans w1ll be processed untll these
fees are pald All other fees and charges are due and
payab V: when the perm1 t 1 S 1 ssued
FOR OFFICE UStONLY
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p..~"'JI!od;IU~aia~'d2I
PERMIT VALIDATION
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Perml t
Cl"k~)
111
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PROJECT CONDITIONS TO BE SATlS~IED BEFORE OCCUPANCY
".
Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because
.
Addltlonal Project Informatlon
...
PLANS REVIEWED BY
name &~#~ nt!!Z;~
Slgnature~? ,--r-~_.IIfU? date
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