HomeMy WebLinkAboutPermit Building 1990-11-19
I INSPECTION LINE
726-3769
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CITY Uf SPRINGfiELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range~_".
ValuE of Hork~~
"7$._e>~ ~ .-
Buildino Permit Info: Oeser be Work( Le.,
Family ~esidence With ^ttached ~araQe\
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INFOR/IATlON LINE
726-3753
Sq. Ftq. I.lain
~q. Ftg. Access.
Sq. Ftg. Other
IIew Add A Iter P.ep.
-Fence Demo Change/Use
Other - -
J
Job Address '2 7&,0 ~7i":=v.v~Y 57:
Legal Oe<cription 170;il-'Z2~.21G>~.'2'2~1"~
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Owner' L.AN/C." m~1'l"";L r 'p.cs:r~/-&::. 'T
Addre<< /9~~ IA/LC-.-:>'T ~~ 57' Phone
~/.,~~, ~.
Construction lende'r . .
Build Single
97V<P2
-~til- ~(')'^'-. I
(name}
Phone
{address 1
I
Address
DES I GN lEAr'
{lies. no.\
(exn; res)
(ohone no. '
Primary a~K z?"?Yr~.I.r,,;t../r-"o.:V-J'" V :::25"'9 E~#~~...,,---ei<v~
" . / )' /
--3s<"2.- <. ./././
Structural
Electrical
f1echani ca 1
CONTRACTORS
{namel
(address \
{l ics. no.'
(pxniresl
(nhone no. \
General -:zc:;;,~~7;' kt'7.;13ot:'.x //~O. ~~~.C>.?r.q7V<:ri.. 4/e.r->.,/' SI'''''''~_ ~~Y:;;''E-
/ v,., - , ~
Plumbina
Electrical '7?...-M ~./Et::::.e..~/
Hechanical
PLUllB I NG
ELECTRICAL
MECHANICAL
....ill'
FFF r."~RhF 'ill.
~rr I_~ Nn
err: rl.1AB.G..E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath\
Duplex (I bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~cp hp~tp~ ~nri vp~t
amps.
Appliance vent
senarate
Stationary evap.
cooler
Vent fan wi th
s.in~le duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ~nd duct
Sewer
, .
Temporary Construction
Change in existing
re~5 d_c.nce.
multifamily, comm. or
Inrlustrial
Water service
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
dic:trib. fppders
Vood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali1 until the
6 ~ec.~/CA'-C.. /' ~;'?<".
:::W~ ~~0( A2-
~::;~<,-"'A-~ A~RI::?/.r.:
TOTAL CHARGES
ISSUANCE OF PFR!lIT
TOTAL CHARGES
that the Electrical work be done by an.'Electrical Contractor. the electrical rortion of this remit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAtllNED the completed app 1 i cat i on for permi t, and do hereby cert ify tha t a 11 in forma t i on hereon is true
and correct, and I further certify that any and all work nerformed 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 OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify th<<t 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 OP.S 7nl.055 will be used on this project.
b<~ Co"., u/'Ue liD"; , b.t ,;l~ p~Cb.Dr'-
HAI-IE(please print) Y;,,'Ktt T"frOff),. 5tzcretar-l SIGII^TURE ~~A4""1 ~Itu.u DATE "j9Au
FOr. OFFICE USE DIlLYV'
S~. Ftg. 11ain.4.~~~
Sq. Ft~. Access
Sq. Ftg. Other
Flood Plain
/
Units
Occy Load
Occy Group
x
Value//-S:~_-'<;'
i
Value
Value
Zone~
Fi re Zone
Type/Const.~~
Bedrooms
Stories
,
x
TOT^L V^LUATlOtI
BUILDING PERflIT __.!L~.75 Plan Ck. Conm/lnd
Charges and 65~/Blda Ppr Fpp
Surcharges Plan Ck. Res
27 ~4' 30~tBldo Per Fee
PLUI'BING PERMIT Fence
Charges and ------------
Surcharges Dll1l1o
ELECTRICAL PERIHT Sidewalk
Cha rges and ------------
Surcha rges A/C Paving
11ECHANICAL PERMIT ,
Curb Cut
Charges and ------------
Surcharges
7b'?>-A'~
. if'<l"?~'systems Development I /<'?'-?'- 60
'277.:<>5/7;; <b Charco (I.5~) '" -'<'"'>_
4z,o/7'/,,:;;.yA't:. ; ~A7
'~~.r~ 7~.B'7
Total Comb. Permit 6/5".93
TOTAL ,:JJ:J~/),qg
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COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
11 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources .
1. example~ heat/electrical ceilinQ/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- Tfilew project. checkfiew - if additi.on, .~
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
a ttached garage
2. example - remodel existing garage into family foam
3. example - convel't 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 TE~I 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 itelll(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 b~ 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 char-ges are due and
payable when the permit is issued.
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vY
II.
III.
IV.
V.
FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT, VALIDATION
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P
y;1
1- ,C',qo
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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:
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name ?-t7/-J'HG 72:~<9) signature ~~~-:-' date /'2-~<-.(?7.
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