HomeMy WebLinkAboutPermit Building 1990-12-17
Job Address. Cf7 J .'rus::, Wf11
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INSPECTION LIrIE
726-3769
Address
DESIGN TEAM Iname)
Primary ~~Ez:..>
Structural
Electrical
.
t-
INFORltATlON LINE
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
CITY Of SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hark:
",-, ",-
BuiTciinQ Pennit Info: Describe Hork(Le.. Build Single
Familv nesidence With Attached G~raa~)
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M"9 h~7l"'C::
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Phone
(address)
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no.\
(l;es. no.)
(exoiresl
Jl ahone
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A:K4_
r~echanical
CONTRACTORS (name) laddress)
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General n/~t./~ ~~_...._-", ~ ~- ., .
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Plumbina
Electrical
~1echani ca 1
ND.
9'9
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
Dup 1 ex (1 ba th)
Additional.bath
IWater service
I Sewer
IStorm sew~r
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(~xoirp~' (o~nnp nn )______
Alp>lq~
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PLUI.IB I NG
ELECTRI CAL
MECHANICAL
FEF rHARGF Nn~
~~~ r~~ Nn
J:'J:'!:' rllllRGL
Residence of
furnace/burner to
BTU's
~~...
SQ, FT.
New circuits alts.
or "extensions
Floor furnace
and vent
each "I
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ISERVICES
I
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
!remporary Construction
IChange in existing
r~)jdJ".nr:p
Imultifamily, camm. or
Industrial
IOf amps.
ICOMM./IND. FEEDERS
Install/alter/relocate
distrib. fpprlerc;
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hond and dtJr:t.
Wood stove/heater
Of
amps.!
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be vali~ until the
89~."~ TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRllIT
TOTAL CHARGES
"Electrical Contractor, the electrical portion of this pe~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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" HO OCCUPAllCY 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 frJoce nd effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractor an employees who are in comoliance with ORS 7nl.055 will be used on this project.
IlAIlE(please print) . / SIr,IIATURE DATE
I FOP. OFFICE USE OiIL Y
Zone C::::~ I Type/const~-(~.:5~Units Sq. Ftg. 11ain x Value
Fire Zone / Bedrooms . Occy Load Sq. Ft!). Access x Value
Stories "'3 Occ.Y Group R-j Sq. Ftg. Oth:~" ,,,,"'" . .... ~A/":: Y Value-","~_,-
~;~ / TOTAL VALUATION
____2/-'~~ ~~~~Bi~~ ~~:.'"'~~d 'I ~ frS % m~~~'<~~~~lopment ,,?~,-:>
Plan Ck. Res
/5.. ~ 30%/Bldo Per Fee
_____8...7&...... Fence .1
4/'1. :6bI Demo I
I
I
Flood Plain
BUILDING PWIIT
Charges and
Surcharges
PLur~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm
Charges and
Surch~~g~s
MECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
......:- ivc Paving..~
. ...... .. .--~ .
'.." I Curb C~t
---uu-nul
To~\ Comb. rermi ~ _
/263.15"
,
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDA~ION
I I 1.
I. Applicant to furnish
A, Job Address
B. Legal Description '. ...., , ~..... .
1. example- Tax Lot 100, Lane County Map.Reference
II oj 43
2. example- Lot 1. Block 3, 2nd Addition to
:>pnngtield Estates '. _. '. ..
C:';' Name; etc. of ownerJandCOl;structilfn 'lende'r. .
D. Energy Sources ~ ~." . "..
1. examele- heat/electrical ,ceilinq/or"forced ai~.Qas .
2. exa~le~ waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check: add, etc.
F. Building pennit information:
'I. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of"t~~
Structural Specialty Code . '. ,
H. DESIGN TE~l 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 ftem(s) to be Installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu 1 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 sfgn the electrical label. ---
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
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11 /'8Q13
Permit Clerk .a!~'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.... .; ~.
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Permit applicant exempt from registration with the Builder's Board because:
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PLANS REVIEWED BY:
n~~e'.Ld'R;.G ~~~_Signature~. ~,,_~ ~J9
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