HomeMy WebLinkAboutPermit Building 1989-8-30
I INSPECTION LINE
726,3769
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CITY Uf SPHINGflELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
.
INFOR/1ATlON LINE
726-3753
Sq. Ftg. 14ain
~q: Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep.
-Fence Oemo Change/Use
Other - -
J
i
"\
Job'Address qa::;> W. ~/7;'I//CW 7:?::?
Legal Description
Owner #'dC::::-:5A
Address '?~t:5 W .l5?~V/~t::;',..r~
;5P/?D, 07<'. q:;;>:r??
Construction lende~
Phone
Range
ValuE of Hark:
1'7/ 't"V--P- =
BulloinQ Pennit Info: Oeser be Work{ Le., Build Single
Familv Residence With Attached Garaae~
7&'"-;.'...;,-,;:;>62...4 /<='I/6,?-< .-Q'-//c"",-
S?.#'c-G" m /~/f'-~.P/9-a:a--/9'CC:S.
~"Y~':::>
Address
DESIGN TEAf~
(name)
Phone
{address \
(lies. no.)
U~xoi res 1
(ohone no.
Primary
Structural
Electrical
Mechanical
CONTRACTORS lnamel
General p.uAL<'E'?f'
Plumbino
Electrical U; vE5' ~- ,-/-,
~1echanical m~6-/'\
(address \
(1 if'''. no. \
(pxnirpsl
("him! no. )
PLU1,1BING
ELECTRICAL
MECHANICAL
NO
FFF
rHWi[ _NO,
FFF
rHWi[
NO,
FFE
I CH~RGE
Residence of
Each single fixture
SQ. FT.
furnace/burner to
BTU' 5
S.F. Residence
(J bath)
Duplex (1 bath)
New circuits alts.
/ or extensions
"7 &:p, /'ho/-?G
SERVICES
'Z?~
Floor furnace
and vent
Relocated building
(new fix, additional)
each
v
Recessed wall 1
So~rp hp~tpr ~~n vp~t
-f'''(T"-''''.>n:> bJ.___C://#d _, . /Lf<"
App 1 i ance ven(- .-
s~par:atp.
Stationary evap.
cooler
Vent fan with
. sino1e duct
I Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnd ,. nrl rlur t
Sewer
Temporary Construction
Change in existing
rp1' j rje.nce
multifamily. comm. or
Inrlllc;.trial
Additional bath
Wa tel'" servi ce
Storm Sewer
Of
amps,
COMH,fINO. FEEDERS
Install/alter/relocate
dic;.tr~h. fppderc;.
Hood stove/heater
Of
amps.
t!:. ':l!'2-7'. '-::""'#7;Q, ~ n ~
I/H~"-L 7?E' "??/LI'61P I~
E, 627- ~/'#'/;r:
I SSUANCF. OF. PERlm
TOTAL CHARGES ~ TOTAL CHARGES
HHERE STATE L'l~ REQUIRES that the Electrical work be done by an,
shall not be vali~ until the label has been signed by an Electrical
I TOTAL CHARGES ~N. /,-:;:-=
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
1 HAVE CAREFUllY 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~on pertaining to the work described herein. and that NO OCCUPAI~CY will be made
of any structure without the permi~sion of the Building Division. I further certify that my registration with the Builder1s
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 701.055 will be used on 'this project.
IIAI'iE(please print) ~n C~ci-vZ:"<: SIGNATURE.~ ~
FOP. OfF I CE USE ONL V'" ./
Sq. Ftg. l1ain
Sq, F.tg, Access
Sq. F.tg. Other
\)\ 4 .~G ~ ,U,,~L VALUATION
, '1 \ /') "? 's~sternsoevelopment'
.'"rJ ... CHarqe (1. 5~ '
--
OATE
J>- Ju'-rY7
~
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
x
x
BUILDING PW1lT
Charges and
Surcharges
// 'PlanCk.
___L!-!!?.!.5.:'9__ 65%/Bldo
~ Plan Ck.
;;> - ~ 30%/Bldo
Conm/Ind
Pp,- f'pp
ROes
Per Fee
#/1'
PLU!~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PER1\IT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Oemo
'S1dewalk
A/C Paving
_ _ _ _1.f2:. :: !'..'_ Curb Cut
?5"
Tota' Comb. Permit
/3/.78
TOTAL
;2~'? {;/
~
.
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
/L(,I !
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
i 1 oj 43
2. 'exa~le- Lot 1. Block 3, 2nd,Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources .
"1. examele- heat/electrical ceilinq/or forced air Qas
2. exam~le- waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. ~- if new project. check new - if addition,
CfieCk'add I ete.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examJPle - 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.
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
I. 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. BOILDING DIVISION STAFF WILL FILL OOT ALL FEES ANO
CHARGES ON THE SCHEDOLES
O. 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. I I -
III. 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
signa ture.
IV. Fees and Charges I I .
Plan check fees are due and lpayable 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.
V. FOR OFFICE OSE ONLY
Pennit clerkCh.A' ./ -I Y{~
It./ v--- ,
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
Pennit app~ i cant exem'pt from regi'strati on with the Bui i der' S Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
,
name
L ~/.l~:-;7i~-~.::./ .~
,
sig~ature 4~....-?~.----?
// . /'
,
date &'-2 Sf: .&7'
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