HomeMy WebLinkAboutPermit Building 1988-8-1 (2)
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I INSPECTION LINE
726-376g
. 7le;F/ PF&'7'C~. .
CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Job Address
~~'"2.. iA-~.x7;=..A/ Lo-z;P.
;
EIiERGY SOURCES:
Meat
\~ater Heater
Ranqe
INFORllATION L1NL
726-3753
Sq. Ftq, I.tain
~q. Ftg. Access.
Sq, Ftq, Other
-1lew_Add_Alter-Yep,
Fence Demo Change/Use
Other - -
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Address
~/7r:~-
, ,
Phone
-- - -:r-/''-'"
/-<0 ~ / "'"-
ValUE of Hork:
?jOo.--- ,
Builriina Permit Info: Describe Work(i.e..
.Familv nesidence With Attached Garaoe)
Build Single
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1"1)
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Legal De<eription /?-"'::?-::;>')-2~ a<":<=--=
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Owner
;?ce;:~x
#r7.';Z?05 &-
C-...,.,=- '/) .7"
-'P/~- . ,,,r:;?/ ~.
Construction Lender /
~-<:' /L~_",,_~ Pc/<?
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Address
Ut>JGN ItAI1
(name)
Phone
(address)
(lies. no.)
(exo;res1
(ahoM no.l
Primary
~
Structural
Electrical
Mechanical
CONTRACTORS
{name}
(address)
llir:<;. nn.)
(p)(nirp,,)
(ohnllP fln. ,
General
f') I/'#"A~
Plumbina
Electrical
~'echan;cal
PLUI1BING
ELECTRICAL
I -EEL I J:IiARliE.' NO_
MECHANICAL
NO.1
Each single fixture
I FEE I CHARGE
NO. I
Residence of
SQ, FT,
furnace/burner to
BTU's
I ~~~ I fHAIlliE.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
.-
"
,
S.F. Residence
f1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp hp~tpr ~n~ u~nt
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
rli,trin_ fpprlpr,
amps.
Appliance vent
seoaratl?
Stationary evap.
cooler
Vent fan with
sinol@ duet
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood il.nd duct
r
Water service
Temporary Construction
Change in existing
r@sjd..e.nee
multifamily, comm. or
Industrial
).
Sewer
Wood stove/heater
Of
amps.
ISSUANCE OF PFR!llT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\l~ REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit
shall not be vali~ 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 Spri ngfi e 1 d and the laws of the State of Oregon pertai ni ng to the work descri bed herei n, and that IlO OCCUPAr~CY 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 ons 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.
HM1E(please print) k e,Ce e... d.. r>lr.Uf>r- SIGNATURE ~ siL~ OATE 19. /-t1g
FO~ OFFICE USE O!IL Y
Zone---L,7) ~ Type/Const. L;'- ~, Units Sq. Ftg. t1ain x Value
Fire Zone Bed rooms Occy Load Sq, Ftg. Access </87 x Value "/=..~
Flood Plain Stories Occy Group J0-L-sq, Ftg. Other x Value
BUILDING PERfllT LO, "'""" Plan Ck, COIl1l1/l nd
Charges and ___ ._.1::______ 65%/Bldn Ppr Fp@
Surcharges ; ,e;-D Plan Ck. Res
". 30%/Blda Per Fee
PLU'~BING PERMIT Fence
Charges and....... ------------
Surcharges Deo>o
ELECTRICAL PERfllT 'Sidewalk
Charges and ------------
Surcharges A/C, Paving
j MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
.
TOTAL VALUATION
rt::>",.? ,g-/--8ir
/" c-; Systems Development
_n,oO Charae (1.5~)
I
I
"'1
1
TOTAL
/0..50.
/7.-=>-~ i'i; ,
Total Comb. Permit
r
CITY OF SPRINGFIELD
. City Hili
Sprlngeelel, Oregon
OlIIce 01 Community and Economic Development
,'.. . '. .......t'l,o;..
OFFICIAL RECEIPT
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COMBINATION APPLICATION/PERMIT (CAP)
(
Date Au.::. /(_ 1~ $'8
Rec'd From _??~~ ~p;J ~
Addres~ ~~b'~~-;;?-~..~'
"/-
Received For: tk-i7a80 ~ ;-~Z &5'- .
p~ :::rel>f",-~ '
1Jz3.
~6
12007
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.,-
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1. Applicant to furnish
A, Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Refer ~'
17 03 43
2. examole- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examEle- heat/electrical ceili~q/or forced.
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. - .(~
I. examole- 1250 sq, foot house. 500 sq, foot,
2, example- if new project, check-nEw - if add
check add. etc.
F. Building permit information: C
I. example - construct single family house witl
attached garage
2. exam~le - remodel existing garage into fam;"
3. exam~le - convert single family residence il (.'
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of '
Structural SpeCialty Code
H. DESIGN TE~t AND CONTRACTORS (',
To avoid design or construction delays. Buildinl
Division Staff must be able to contact approprii
persons regarding design information or job sitl
corrections. etc. (."
II. Abbreviated Plumbing, Mechanical, &. Electrical Schel
A. Except where blank spaces occur in the descript.
portion of the Mechanical and Electrical Schedui
the applicant need fill-in only the No. Boxes ac" -t,e,.'
to the appropriate item(s) to be installed \
B, Full Plumbing, Mechanical, and Electrical Schedl ,J
are available at the Building Division
1. To conserve space on the permit' fonn the sct 11,,'
have been" abbreviated \.
2, If the item(s) to be installed are not cover' . BY ()'
the abbreviated schedules you should consult ~
full schedules ('
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES! ." , ".,'
,I,. 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, -
".111:' 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
v" 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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POTHORlZEDSlGNATURE /' . ( :
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V, FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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