HomeMy WebLinkAboutPermit Building 1989-8-14
j INSPECTION LINE
726-3769
t CITY UF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
.
181- 3 ~ .,p+- -I-.. EIIERGY SOURCES:
Job Address II to r , zt/ ..-/1/14.1."v _, Meat
Legal Description \ r) 1"'\ 6 ~. f 10 f\.--={..ffY 'I I~ater Heater
\..,..." Range
ValuE of ('/'f!..,,^^. ' _.CP
DwnerLffjPHL u.Jt1J.ff!;t. 7rg.-flSf (UJ
Address '/1'/)(.) JfJ~ .-nJ 'A "'._ Phone Buildino Pennit Info: DescrIbe Work{Le..
fj /, ~ ~ -'~~ Familv nesidence With Attached GaraQe'
construction~d uh, 11'177
I
INFDffilATION LINt
726-3753
Sq. Ftg, Hain
Sq: Ftg, Access,
Sq, Ftg, ,Other
New Add Alter Rep,
-Fence Demo Change/Use
Other- -
.
Address
DES I GN nAr~
lname J
Phone
(address'
(.lics.no.'
(exn; res 1
~
J
ICV
~". """', I-~
C'.!
1t
.LtA1J J
a
Primary
Structura 1
. Electrical
Mechanical
CONTRACTORS enamel
Genera I I/o r ?Yl (I L
Plumbina
(address'
rlC;1 AI3sf17xf.
(lies. l'1O_,
(exnires1
I~{~~
Electrical
~1echan;cal
PLUrIBING
ELECTRICAL
I
MECHANICAL
ND.
, FFF CH~RGE Nn
FFF r~' Nn
C'H rHll8.G.E.
SQ. FT.
furnace/burner to
BTll's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
S. F. Res 1 dence
(J bath)
Duplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~rp np~tp~ An~ vpnt
amps.
Appliance vent
spoarate
Stationary evap.
cooler
Vent fan with
sin9'e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and rtUr't
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res j 4pJ'lCe
multifamily, COIl1T1. or
Inciustrial
Water service
Storm Sewer
Of
CO~1./INO. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
ISSUANCF OF PFR!IIT
TOTAL CHARGES ~ TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\\J REQUIRES that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Surervisor 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 perta i n i ng to the work descri bed herei n. and that NO OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board ;s in full force and effect as required by ons 701.055, that if exempt the basis for exemption ;s noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7t11.055 will be used on 'this project.
rW1E(please print) (' ()(<.y JlA/2telf SIGNATURE ~_~
FOr. orF I CE USE DIlLY /'
Zone Type/Const. Uni ts Sq. Ftg. f1ain
Fire Zone Bedrooms Occy Load Sq. Ft9, Access
Flood Plain Stories Dccy Group Sq, ftg, Other
L~
OATE.4S ~/(17l?';
,
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PERfIlT Plan Ck. ConrnlI nd
Charges and ------------ 65VBl do Per Fpp
Surcharges Plan Ck. Res
30%lB1 do Per Fee
PLUt~BING PERMIT Fence
Charges and ------------
Surcharges Demo
ELECTRICAL PERrHT 'Sidew'l k
Cha rges and ------------
Surcha rges A/C Paving
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
'syste. ms. Development .
Charoe O,5~) ,
5.(J)
Total Comb. Permit
TOTAL
5(](J
I'
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. examole- Tax Lot 100, Lane County Map Reference
17 oj 43
2. exam~le- Lot I. Block 3, 2nd Addition to
5prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
. I. exam~le- heat/electrical ceilinq/or forced air pas
2. exa~le~ waterneater/electrlcal/or solar
E. Square footage or valuation. etc.
I. example- 1250 sq. foot house. 500 sq. foot garage
.2. example- if new project. check new - if addition,
, cneck add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. example - 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
I. 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
O. 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. -. .
III. Applicant to sign and date
Whenever possible, the initial application will be used as'
a worksheet only. Where possible, Building ~ivision 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
payab 1 e when the permit is issued.
,
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS'TO BE SATISFIED BEFORE OC~UPANCY:
I
..-
PERMIT VALIDATION
v\ '(?B5
Permit
Cl"tdllYl )
.
Permit applicant exempt from regi~tration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date