HomeMy WebLinkAboutPermit Building 1990-11-26
J INSPECTION LINE
726-3769
Job Address L.17.)p /; ,J iA- <;pW (2d
Legal Omription I >t () 7..nC, z.U - O~ t.-/rn
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
t~ater Heater
Range
lNFORlIATlON L1No
726-3753
Sq. Ftq, /.Ia i n
~q. Ftg. Access.
Sq, Ftq, Other
Ilew Add Alter Pep,
--Fence Demo Change/Use
ValuE of Hork: J\ Other--
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BuilriinQ Permit Info: Describe Work(i.e.. Build Single
Family ~esidence With Attached Garaae)
.
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Owner\)/i'//II\ MlI>+-.'5Iov~
Addre.'> (oW) h r.e-c.VlIAl7m) . g-- Phone 11'1-
....t lA Ii\r~LJV1 ~1<'-hA 2-3~~
Construction lender ~
.m'5~U ,7J~.D~.z.V"",,;(/ ~.q"
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Address
Uo~j~N TEAH
(name)
Phone
(address)
(l ics. no.)
(exo;res)
(ohom~ no.',
Primary
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
(lin. no.)
(~xoires )
(ohone no. )
Genera 1
Plumbina {I/; (rlAllIAi:J
Electrical
P I.LLu\A L- iW.
U
~~7<)? IlmuayJ tJ"J,C
::u:>.....o. -;::;:~~-9/
~1echanical
PLUrIBING
NO. FFF rHARGE Nn
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (I bath) each
Additional bath
Water servi ce
Sewer
Storm Sewer
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ELECTRICAL
MECHANICAL
1'E..E.-..cJiAJ!G.E. NO.
I <<LI..cJiAJ!G.E.
Residence of
SQ, FT,
furnace/burner to
BTU's
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Of
amps.
Appliance vent
c;poar"t.p
Stationary evap.
cooler
Vent fan with
sinole duc:t.
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dud
Temporary Construction
Change in existing
rp~ i ~~.n("p
multifamily. comm. or
tnduc;.tri"l
COMfI,/INO. FEEDERS
Install/alter/relocate
rlic;.trih fpprlprc;.
Wood stove/heater
..)" :~
Of
amps.
--.::. -.,', ' .~ ....
ISSUANcr OF PFR!1IT
TOTAL CHARGES /s: - TOTAL CHARGES TOTAL CHARGES
WHERE STATE Lm; 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 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 IlO.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 7Ql.055 will be used on this project.
IlAI'lE(please print) lfn b P. tc YI../ (Z.t c",t2!L/ SIGIIATURE <I?~J'f;"77iJ.1D:>,.
FO~ OFFICE USE DIllY
Sa, FIg.
Sq, Ftg,
Sq, FIg,
omlJ_ '7(:' .9n
Zone
Tvpe/Const.
Bedrooms
Units
Occy Load
Dccy Graup
Hain
Access
Other
x
Value
Value
Value
Fire Zone
x
Flood Plain
Stari es
x
TOTAL VALUATION
BUILOING PER~1lT
Charges and
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Per Fpp
------------ Plan Ck. R-es
30t/Bldq Per Fee
/e:::::' --~ Fence
____~L:....____
_ 7.51 Demo
'Sidewa,lk
Systems Development
Charqe (1.5%) ,
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI1lT
Charges and
Surcharges
A/C Paving
. -
___________J Curb Cut
I
TQt~l Comb, Permit
11ECHANICAL PERMIT
Charges and
Surcharges
TOTAL
15: 75
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B. Legal Description , .'
I, example- Tax Lot 10D. Lane County Map Reference
II D3 43
2. example- Lot I. Block 3, 2nd Addition to
'". ~prlngti~ld Estates , . _
C:o' ,'Name', etc :~~of~ OWner and:'cons trl1cti on 1 etnder t
D. Energy Sources .' .... .
"I. example- heat/electr.ical' c"ei.lin-,Qior"forced:air cas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. example- I2SD sq. foot house, SOD 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. example - remodel existing garage into family room
3. exa~le - 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 TEM1 AND CONTRACTDRS
To. avo; d,_ de_s i gn... or. c9ns truct i on de lays. Sui 1 d i n9
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
0, 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
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.
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.....~.. . .,....... ,......... ....... - ..
V, FOR OFFICE USE ONLY
I(-<~-~
Permit Clerk ~~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.-.
Permit applicant,exempt from registration with the Builder's Board because:
Additional Project Information:
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"
PLANS REVIEWED BY:
. ......
name LP.b'..s.e-A ~~6'~
Signature~? ~.;--")
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date / /--:2C-9_
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