HomeMy WebLinkAboutPermit Building 1990-11-2
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I IrISPECTION LINE
726.3769
CITY OF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Meat
t~ater Heater
RanQe
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INFORllATION UNt
726-3753
Sq. Ftq. H~in '
~q. Ftg. Access.
Sq. Ftq. Other
New Add Alter Pep.
--Fence Demo Change/Use
Other- -
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Job Address
"1'7/ R;f?v;5<F W#fr'
/.:>,::>-9.-c
Owner.~~L'H 5M.c!/~c,. Lrz::>
Address -ZdS"/#/I:.L~P ."p;;:? -<T.~~
A"~/~ .,0Q. ~'2
Const~cti~n l~nder -, ,
legal Description 1?~-2..':2-?
~~~ ~<QC'::>~C-="?1iT.
Ot,JGN TtAll
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS I name I
Genera 1 "J?,r-#IF,r .I~~ ~_7.
/
Plumbina
i Electrical
~1echanical
PlUI1BING
NO. FEE CHARGE
Each single fixtur~ "
\
Relocated building \ -
(new fix:. additional)
S.F. Residence
(1 bath) ,
Duplex (I bath)-~ach
Additional bath
Z2S ~a ter servi ce
2~ Sewer
5'/7 Storm Sewer
( IJAt:RA.P;V ~~ ,~
5:5:-
S'S:"'"
1~4Olol'
/~.a<
ValuE. of Hark:
9' '- '.:" .....
BU11dlnt Permit Info: Describe Work(Leo.
Family nesidence With Attached Garaael
Build Single
?"'/Y~
,. f>h6"ne ~
(address)
~ r-rr "*~/r/;CCS' -4 ffiw~
~ ~A-n h?~~..p~~
(lies. no.l
(exo;res)
*
~ ...
(I}hone no. l
f addrflss)
':/~.~ #~Lr<Sr-.o'?
/'f~~ .c;a
r
(lil"s. no.)
(exoil"'Pc;\
(onnrlP nn..\
'5' -/?
./
ELECTRICAL
MECHANICAL
Nll..-I
I Residence of
SQ. FT.
INew circuits alts.
or 'extensions
ISERVICES
I
ITempOrary Construction
IChange in existing
res.; Qe.nce
Imultifamily, camm. or
Inrlustrial
IOf amps.
ICOMH./IND. FEEDERS
I Install/alter/relocate
distrih. fppdPrs
fOf amps.
I
I
I
FFF CHI\RG.E. NO. FCF CHI\RG.E.
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa11
~n~r.p hp~tpr ~nrl vent
Appliance vent
seoaratfl
Stationary evap.
cooler
Vent fan wi th
s;nale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
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ISSUANCE OF PFR!1IT
TOTAL CHARGES
WHERE STATE l~H REQUIRES
shall not be vali~ until the
22e:? _a TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr.1it
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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that. UC OCCUPAUCY 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 . is noted hereon,\and that
only subcontractors and employees who are in comoliance with ORS 7n1.055 WX'll ~ useu n t is projec .
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~ l€..(please print) M. MEL GIo-RGES .,.~, SI"IIATUR~ DATE IV2..9O
FO~ OfFICE USE Q;llY . \.
zo,}. <::~ Type/Const.~~~s So. Ftg. 11a1n Value
Fire Zone Bedrooms Occy load Sq. Ftn.~ ~ Value
Flood Plain Stories Occy Group Sq. Ft~. Other~/~ ..LJ-:~;;~""t:'1 ~'.:;
. , - p - p
TOTAL VALUATION
Plan Ck. Comm/lnd
______...:_____ ~/Blda Pj'r F~~
Plan Ck. Res
30%/Bldo Per Fee
___~_~.q:...~_ Fence
II . ~ Demo
'Sidewalk L,5C$ /
BUIlDIIlG PERIIIT
Charges an':
Surcharges
PLU'IBING PERMIT
Charges and
Surcharges
ELECTRICAL PERr:n
Charges and
Surcharges ,
~ ..... -...
11ECHAN I CAl 'PERMIT
Charges and
Surcharges
~-' --
Bc::>~-
q 7"...;:D!'" '
,
e:;.rt;: ..-
Systems Development
CharQe (J.5~)
If3"9$".. dl!'>
"AlC Pavi ng .
3<,.~
~ ""5",...tIS't:' - ~ ToJa 1 ~omb; .rermi t
/ t-/~ S'C>
'2../d/. e>C>
~s/.-o.
Curb Cut
3~~
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
.,
I. Applicant to furnish
A. Job Address
B. Legal Description , _.'
1. example- Tax Lot 100, lane'Co~ntY\Map Reference
1/ 03 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 ceilinq/or" forced air Qas
2. examyle- waterheaterjelectrlcal/or ~ '..
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. examEle - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family fODm
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 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 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 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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I II.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PE~t1H,..VAUDA:rION
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({~2 ~q{)
lit I g~01
Permit Clerk
Hrav
:.:.p.er.!1lit appl icant exempt from regis,tration with the ,Builder,',s.'.Board. :becaus'e:
( . ._~
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.- "Aad-i:~i ona,1_P.rQJe~t ).n~rmation:
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PLANS REVIEWED BY:
'nam~~A>""c h<:5i!;~
'-~i~~~tur4~L ~
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_.?~~date /~-~90
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