HomeMy WebLinkAboutPermit Building 1990-7-20
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater ~ ~
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INFORJ1ATION UNt.
726-3753
SQ. Ftg. I,'.;n
~C]. Ftg. Accc!;s.
SQ. Ftg. Other
r~ew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
I INSPECTION LINE
726-3769
Job Address :l.5~:J- 6eJe....i
Legal Oe<cription r7 ()?, 72_()(')
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Owner J:~-}j, er'A'P /'11 #,;,....cR -ri-...&7-
Address '?'I # tJ / fr ('.. .';1,.. 4<11 Phone
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Construction Lender . )lO/'l-.e..
Valu, of Hork:,,~ II ry
'f-, f. Nt) - i\ \I' '
Builril-tfQ Pennit Info: Describe l~ork(Le..
Familv l1es;dence Hith Attached Garaoe)
Build Single
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Range
'; (I'ii\7.II"\/lly
'500..
I
Address
Ut,IGN rEAr~
Primary
(name)
J."J"s-Je,,,
Phone
(address)
fl ics. no.)
(exnires)
(ohone no.
Structura 1
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fl' /'"J,,,,rQ !fd. 1f6_.:l0i('
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Electrical
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Plumbino
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(name I (address) (1 ; ~<. nfl. \ .1-." (P'tl); fPC:; \
/1ar-rJ...1:t ('rv<"tI'OA~;c".. (If:) / 33b~I'''cKI'VjlJ/J rr S7lo'1rFw:/!"'t
1'- 1 /'
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10'.14. I/~cf"','f J I. 7 No '3;-f>- " y,n(hQ.
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ELECTRICAL MECHANICAL
It
<<
Mechanical
CONTRACTORS
(I1tmnP nn
General
9~'1-11, fD
Electrical
7'1-r - j'l&. ,
'37'5", ~J7~-
~'echan; Cd 1
PLUJ1B I NG
FEE I~ CHARr:F Nn..o...- Residence of
SQ. FT.
I
I
I
I I Temporary Construction
I IChange in existing
rpc;.jrlj'J'lC"P
I ImultifamilYI camm. or
lnrluc;.tr;al
I IOf
5?~ r...j..Jl..ll:__ 18 - ICOMI.I.IINO. FEEDERS
/ I I' I Install/alter/relocate
rl;~trih_ fpprlpr~
I I IOf
I Br::;c,,77-?/.c:;,.p-c ~.>~~,
I ~~L c--,t'v~.,_;./A _~~~
I ;;.7~A-/7". ,I
TOTAL CHARGES ~~ /<: &1ft> TOTAL CHARGES
WHERE STATE L'W REQUIRES'that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
NO.
liE-..cJJAB.liE. NO
liE-..cJJAB.liE.
Each single fixture
/
furnace/burner to
J 55" rHO:> BTU' s
Relocated building
(new fix. additional)
each
.,
!New circu~ts alts.
or extenSl0ns
I SERVICES
I
Floor furnace
and vent
S.F. Residence
(j bath)
Duplex (1 bath)
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
"
Additional bath
"
Storm Sewer
./
amps.
Appl iance" vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart
heatino or A.C.
Mechanical exhaust
hood rind dud
from
~Jater service
\
Sewer
Wood stove/heater
amps.
ISSUANCE OF PFR!1IT
TOTAL CHARGES
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. 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein. and that rw OCCUPAtKY 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 701.055 will be used on this project.
aflt"..... ~ DATE 7-;ZO. 9~
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IWIE(please print)
BUILDING PERHIT
Charges an~
~~B
PLU'~BING PERMIT
Charges and
Surcharges
, "Plan Ck.
------f----.-- 65%1Bldo
A, "7"> Plan Ck.
/ y~ Z?-r-. 30%!BldQ
~~__/S: t?~
#/5"
SIGNATURE
FOr. OFFICE USE OIILY
,
Units Sq. Ftg. t1ain x Value
Occy load Sq. Ft9. Access x Value
Occ,Y Grou~ ~Q. Ftg. Other~~.c1"'~~.Value ~,--~.coe
D1 N:s--- l'),j1 .\I'i~.ol~ VALUATlOtI
COll1\\IInd u-r 4-~ Systems Development /~_ 6e>
Per 'ee ,,') CharQe (1.5~) ?J.
Res
Per Fee
Zone h?.~
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stor"ies
ELECTRICAL PERI~IT
Charges and
Surcharges
-
Fence
I Demo
I Sidewalk
------------
.... .'. I A'/C Paving'
. Iff: -- I Curb Cut
_n _=~_I
'.
, -,"
.~/ ~SC>
Total Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
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-.1. _.. 1....,,_
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
'II 03 43
2. examole- Lot I. Block 3, 2nd Addition to
sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
"1. exam~le- heat/electrical ceilinqlor forced air qdS
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. example- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
cneck 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 of work as defined in Section 303 (aJ 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
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 SCHEDOLES
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. ---
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
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 is issued.
V.' FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANGY:
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PERMIT VALIDATION
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Permi t
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
C-:)G ,'\l>"
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,
name
~#E ft~~
signature
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date g.~a
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