HomeMy WebLinkAboutPermit Building 1990-9-10
'1 INSPECTION LINE
726- 37 69
Job Address (,;,0 <-{
Legal Description
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Owner' t/vI..,tt \.It-A-.;-c. Go. t-\vP""'-","-W
Address &0 r (1q\l~ ,-+L(.l$
SPfJ.IA/6h6tf.) ,tJ (2.
Construction Lender PA-L. C-61\."d;.
Address'
UlSIGN TEAI~
(name)
Primary
g 1C.14....D
"2.t>vtC
Structural
Electrical
Mechanical
CONTRACTORS
(name)
Genera 1
D.4-r2-o!1l1L -S ,,>v4~
Plumbina
Electrical ...1J't1\l\!'\\ L'
/llechan; ca 1
CITY OF SPRINGFIELD
CD/1BIIIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat CO"'l-'S
(-later Heater
.
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INFOR/IAnON UNt
726-3753
Sq. Ftq,I,'ain ;;i:1Y<f
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
-Other - -
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~
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1'1
c..p
73<><> (?<tot
~ Ranqe
Val u€ of Hark:
~ 5'!S"'. 8"
BuilriinQ Penmit Info:
Phone 7o.f-r3t9 (Family l1es;dence \~ith
974'77
I () ,?,.".oil ~ 00 oM
Pi+c..l.. '/-'1
PHASE
t 1 ;C5. no.)
Describe Work(;~e.. Build Single
Attached Garaae)
S eJ!:A/t.OrL-
C>4-~
Phone
(address)
laddrF!ss \
(1 ics. no.)
(
r
.:;n.\
(exoires)
{nhnnf> no.
(Rxoirps)
(ohonf> no.)
C\9-/\~()u~m J\lPf fU;blLo(o::14 Glwla ( lo~~-87z(
I
25""
25'00
;z.5~
1
I
I
I
1
I
n~ I, TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
PLUIIBING
, ,
NO.
FEE
CHARGF
Each Single fixture
~I
tVO~q
Relocated building
(new fix. additional)
I s. F. Res i dence
(1 bath)
IDuplex (1 bath) each
IAdditional bath
Hater servi ce
Sewer
5 to rm Sewe r
TOTAL CHARGES
, WHERE STATE L\I~ REQUIRES
shall not be val;j until the
I
I
I
I ISSUANCf OF
/M~ TOTAL CHARGES
ELECTRICAL
Nn
FFF
rHARr,~ NO.
MECHANICAL
I j::"~~
I
I
I
I
12-
I rl-lllQr:r
16.4-0
I
Residence of
So' FT,
INew c;rcu~ts alts.
or extenslonso~.fO
1 SERV ICES
b5~
I~~
I I
35~
furnace/burner to
(0';> o7U> BTU' s
,
I Floor furnace
and vent
I Recessed wa 11
SOnCP hPntpr ~nrl vpnt
I
I Appliance vent W'/I!
seoafate In.
Stationary evap.'
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
1 Mechanical exhaust
hood and duct
I \~ood stove/heater
3
crOI:;'
I
11-.~o
Temporary Construction
Change in eXlsting
r~,i rlpncp
multifamily, comm. or
Tnrlu<;t\rinl
\
Of
amps.1
I
COMM./IND. FEEDERS
Install/alter/relocate
rli<;trih_ fpprlpr<;
IOf
amps.
6M
zq-o
PFR'HT
/ 00.
0-
7,/.50
"Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed apnlication 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 Soringfleld and the laws of the State of Oregon pertaining to the work described herein, and that NO ,QCCUPAlKY will be made
of any structure without the permission of the- Building Division. I further "certify that my registration \'/ith the Builder',s
Board is in full force and effect as required by QRS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
'I~AI"E(pIease print) rMlc..l~~tL. \~D""'le..\.>\.J SIGilATURE .~ W
FO~ OFFICE USE OIIL y
BUILDIIIG PERMIT
Charges an':
Surcharges
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRI(P,L PERI~IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
3/.0;'1:)
------;.-6i--
D~TE 9 -10-'26
Sq. Ftg, 11ain :Z7~ x '1'2. ?,~__Yalue,j/~~~~>1'c;
Sq. Ft!]. Access x Value .
Sq. Ftg, Otherb?ttl'~""~l"1Jl.I~lUe <:./_6dc;:>r-""
t ~ /:
7/ / _ TOTAL VALUATION
1'k.?.7". /k'2~
I, -..::.. <;>~ 'syste, ms Development
~?_.....-('? ~""6 Charqe (1.5%) .
I' . /02-'5.94
I
Uni ts
Occy load
Dcey Group
CommlInd
Ppr Fee
Res
Per Fee
~l~/,
".-::--#'":.?
'=\t:7;).nYj
, 'i I Plan Ck.
__ 73:--_[;'?.__ 65%/Bldo
Plan Ck.
:z~, ~~ 30%/BldQ
"2 \3 5,0-0 Fence
-----i;;{i.5'h D~mo
'Sidewalk
A/C Paving
Curb Cut {2..f /
/3/1>0
Total Comb. Permit
TOTAL
,b1tG, ~3,
" I '
7'-..
.
COMBINATION APPLICATION/PERMIT (CAP)
'~. \"
, .
J
I. Applicant to furnish
A. Job Address
B. Legal Description .~ (" .\:. -,." \
1. example- Tax Lot 100. Lane-County Map' Reference
II 63 43
2. example- Lot 1. Block 3, 2nd Addition to
'. ':jpringtield Estates .
C. . Name, etc. of owner and cons'trlic\ion lender
D. Energy Sources .
1. ex amp 1 e- h'eat/ e 1 ectri ca l"c'eili'nq/or forced air qa s
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation", etc; '-
1. exam~le- 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. exam~le - remodel existing garage into family room
3. examyle - 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 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 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 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.
I,
:-,.'
II.
III.
IV,
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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.$-/8401
10,2. ,QO
Permit
l J '
Clerk~~
P~r.m,it applicant exempt from registration with the Bu,i.lder.'s'Board'because:
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'" . Additional p(qj~ct:Jn.for~ation;..,
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PLANS REVIEWED BY:
name
signature
.
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I ( . I
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.' " ." .".
date
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