HomeMy WebLinkAboutPermit Building 1990-8-24
..
140,4~
I INSPECTION LINE
726-3769
Job Address t!R ~2 72....7 cJ?tIE-/f{;{j,'f J
Legal Description (jJ.NIPrWOOI/ . lr Al'r!i;'
(I
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EifERGY SOURCES:
Heat
Hater Heater
Range
ValUE of I-Iork:
#. 22'74 ~
~uildlnQ Permit Info: Describe Work(i~e..
Family nesidence With Attached Garaae)
.
INFORlIATION LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
-Other- -
~
0-
-
Owner IIIAlI1NeA/r CJ5A/"f13'~'7I3.tfj//(//E
Address 1.0, h / () /7.. 'TII f3..- dA>ft 13-5
0/11;, Of7tJ5R'"
Build Single
o
~
r
Address
Ut~II.:iN TI:.Ar~
(name)
Phone
(address)
YEA-.l I)rr:- frJ/)J A'EAtJOr
It/!'CJleAT/tJAJ ~~~~, 11/1 ,It rjI()PJ/9-
CO,rA/I!l/F- "7/-,vC- ,9J?PC.
(lies. no.1 (exoiresl
(&,t.fi% A)
(ohone"..no.
Construction lender
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(namel
(address)
(1ic~ nn.)
(PXO;I"pc,\
(nllnl'll'> "n ,
Plumbina
;<fJ07A C/fNU /RJ1 :ttl9'o"?
/f()tfWE r-;/lJ::;. 9''/4-0:7.
1;f;4P-/l
":#/~40.z6'1
General 11".F:- .HODF/N'/':- /,110.
Electrical
~1echanical
PLUI.IBING
ELECTRICAL
MECHANICAL
NO.
Each single fixture
FFF rHARGF Nn I FFF rHARliE.--KO....
Residence of furnace/burner to
SQ. FT. BTU's
J:'J:'I=' r~l1RG..E.
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath \
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~~p np~tp~ ~nrl vpnt
Storm Sewer
Of
amps,
Appliance vent
s~oaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dUl"t
Sewer
Temporary Construction
Change in existing
l"psiljp,:nre
multifamily, camm. or
Industrial
~Jater service
COffi~./IND. FEEDERS
Install/alter/relocate
r!idrih fpprlpl"c:.
Wood stove/heater
Of
amps.
ISSUANCE OF PFRIHT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'I/ REQUIRES that the Electrical work be done by an-Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I 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 Derformed 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 NO OCCUPAHCY 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.
Zone
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
Jl/( I ),--F ~..L1'.I/e SIGN^TUR~~J1~_
FO~ OFFICf'USf OllLY
Sq. Ftg. 11ain
Sq. Ft~. Access
Sq. Ftg. Other
DATE ~A,:
./
NAI.IE(please print)
Units
Occy Load
Occy Group
x
Value
Value
Value
,
x
TOTAL V ALUA TI ON
BUILDING PER/lIT __2~_~<?__ Plan Ck. COIllllII nd
Charges and 65%/Bldo ~pr Fpe
Surcharges 1 <7~ Plan Ck. Res
30%/Blda Per Fee
PLUI~B1NG PERMIT Fence
Charges and ------------
Surcha rges Demo
ELECTRICAL PERI~IT 'Sidewalk
Cha rges and ------------
Surcharges A/C Paving,."
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charqe (1.5~)
ITotal Comb. Permit
I
I TOTAL
ift? <13
~
.
"
.'
I
,
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
II uj 43
. 2. examEle- Lot I. Block 3, 2nd Addition to
sprlngtield Estates ,
'c. Name.. etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/electrical ceilin~/or forced air Qas
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, SOD sq. foot garage
2. examp'le- if new project, check-n€w - if addition,
cneck add, etc.
f. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examOle - 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
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
fu 11 schedul es
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 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
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
i
PERMIT VALIDATION
~,~;,~ jl!/'J?-
Pennit Clerk IU.Jl / U;r1"?J.-
I
Pennit appl i cant exempt from regi strati on with the Buil der I s Board because:
Additional Project InfDnnation:
PLANS REVIEWED BY:
!
name
signature
\
, .
. ,
o___~~
'0:. .
~
~ .
date
J