HomeMy WebLinkAboutPermit Building 1988-11-18
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INFORllATlON LINE
726-3753
Sq. Ftq. 1,lain
~q. Fta. Access.
Sq, Ftq. Other
lIe" Add Alter Rep.
-Fence Demo Change/Use
-Other - -
'1 INSPECTION LINE
726-3769
//S/t./ C;;#r~//V~o/' ~;~
. CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Ran~e
ValuE of Hark:
/3'. 700, ere
Builci1nQ Pernlit Info: Describe Work(;~e.. Build Single
Family nesidence With Attached Garaqe'
1,<'::;<;h?H/5?/'IA/E~k' G;,""'/V7. . m.::- .
". .
/E#A..,qr" ftPV.?~/"""h':S"
6.n'r~vvA"r ~/9'=- H42.&,
(address) flies. no.) (exn;res) (ohone no.)
3;)'.-Y..::!:": //T,b,4.Ii~
.4//.1. ~rLAA./Z:>. &><? 97:Z~::z. ?-=?9-7.-)''2t:;;
- Job Address
Legal Description 17.,0-:;; 2Z-t:)O O'Z~OO
- /
Owner O;;t? FC;;OA/ 1f' .a.A:,V
AddreSs ~"'3i~ --s: W /7JAc4z:14/7'? Phone
~rrTZHJ4n /pK. '9?-:Z<PB
Const;uction lender )
Address
DESIGN TEAM {namel
Primary l5J?vcc4. -::S?/:>7~r-L ~N
;
Phone
. ,
Structural
Electrical
r~echan; ca 1
CONTRACTORS (name)
General, ~--'1.J:7/c, #.=L r~
Plumb;nq
{address'
Electrical
~1echanica'
PLUIIBING
NO.
FEE CHARGF ~n
Each single fixture
Residence of
IRelocated building
(new fix. additional)
Is.F. Residence
.f1 bath)
Duplex (1 bath) each
Additional bath
I ~Ja ter servi ce
I Sewer
I Storm Sewer
New circuits alts.
or extensions
I SERVICES
I
~
IS
~
~
E!IERGY SOURCES:
Heat
Hater Heater
,
(l ies. no.'
(exnires)
(ohone no.)
6:E?-:;: ~ I?..?
ELECTRICAL
MECHANICAL
I-EEL J:IlARG.E. Nn
~H rH~
SQ. FT,
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl vp~t
amps.
Appliance vent
seoarate
Stationarv evao.
cooler" .
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ilnd duct.
Temporary Construction
Change in existing
residf'ncp'
[multifamily. comm. or
Inrlll<;trirll
Of
C0I11-1. (I NO. FEEDERS
IInstall/alter/relocate
,di<;trih. fppdprs
Wood stove/heater
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\H REQUIRES that tl,e Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrica1
ISSIIANCF nF PFRl1iT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAR~FUlLY EXAMINED 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 Ore~lOn pertaining to the work described herein, and that tlO OCCUPAHCY will be made
of any structure without the permission of the ~uilding Division. I further certify that my registration with the ~uilder'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 OP.S 7nl.055 will be used on this project.
SIGilATURE
FOP. OFFICE USE OIIL Y
S~. Ftg. riain x Value
Sq. Ft9. Access x Value
Sq, Ftg. Other 7-?~DCC x Value.
TOTAL VALUATION
IIAI,IE(please print)
Zone ~/:
Fire Zone
Flood Plain
"P/AtR.
Tyoe/Const,
Bed rooms
Stories
Units
Occy load
Occy Group
"2.
;??-.::z
CD
Conrn(l nd
Ppr Fpp
Res
Per Fee
BUILDING PWIIT
Charges an':::
Surcharges :1-
.~ <-; Plan Ck.
__.l~L-.v.:.q__ 65%1Blda
~"23 Plan Ck.
...., . 30%/Bl do
I Fence
I Demo
I Sidewalk
I A!.C Paving
PlUl1BING PERMIT
Charges and
Surcha rges
ELCCTRICAl PERI:JT
Charges and
Surcharges
I1ECHANICAl PERMIT
Cha rges and
Surcharges
Curb Cut
DATE
/'::?:~.=
~'7- #/ '2 7'V2
Q-9-8'8
A'~7.9"'3
I
[
I
I
Syste~s Development
Charoe (1.5%)
Total Comb. rermit
I TOTAL
1C)9. 73 ~
.
.
I' .- ...
,"
.'
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 03 43
2, example- lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examj>le- heat/electrical ceilin9/or fo"rced air qas
2. example- waterheater/electrlcal/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. exam~le - 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 AIIO 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 be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
Ill. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible. Building ~ivision Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. 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 ;s issued.
/2J9 g
Permit Clerk
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
rl.a.J~
//-)/ f) - <<;-1("
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name / /'JRHt;o 71: ~ ~
.<?~~
~... "
signature
,.
,
date
//-/&? -88