HomeMy WebLinkAboutPermit Building 1989-4-19
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I INSPECTION LINE
726-3769
Job Address JCJqJ LAuA'A '5':7' 51""FL-'o
Legal Dmription MA P lI'Jn 3;;;;./'
~.X' '--01 :2hO(')
Owner J.lVi-AA//? I3RdS,
Address ~)9.t-J/ L-A#.RA
CITY UF SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\.Ja ter Hea ter
Range
INfDRlIATlDN LINt
726-3753
Sq. Ftg. /.Iain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
--Fence Demo Change/Use
Other- -
Phone
ValUE of Hark: ;!)~
'3; t:JeJO ---
BUlldi~ Penmit Info: Descr,be Work{i.e.,
Familv Residence With Attached Garaael
Build Single
I~
~
~
//0;';'5:;
......
7#f1::!.~<J;( PAVE" PAl'fk IN'6- /.;4r'
Construction Lender
NONE
Address
DESIGN TEN1 (name)
Primary rJ W N E ~
Structural /'t/oAlE
Electrical .fLIo~t::
Mechan;cal /VnNF
CONTRACTORS (name)
Phon~
(address)
~
;
~
(exoires1
I
(ohane no.')
7"-1/;<;<,'1;<
(address)
nil'S. nn.l
(pxoi feo;, 1
(ohnnp nn,
Plumbina
A.C:-. PAlI/AlG
/7A"?AJAl
ONt,-r'
L-/Nc
tl!?Y ow/l/F/'?
General
1/
J I
~-
Electrical
~'echan;ca'
~
J.
NO.
PLUr1BIrlG
ELECTRICAL
r~' Nn
MECHANICAL
FEf CHARGF NO
...
...
r~
Each single fixture
Residence of
SQ, FT.
furnace/burner to
BTU's
..
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath I
Duplex (1 bath) each
Additional bath
ISERVICES
I
Recessed wall
~n~rp ~eater and vpnt
\ t'\\\'l\\\\\",- "{:fE
'll \().(S)
Of
!COMfl./IND. FEEDERS
l'Install/alter/relocate
dic;trih. fppdprc;
10f
I
I
I
amps.
Appl iance vent
c;!"o~ratp
Stationary evap.
cooler
V-ent fan with
sinole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnnd ilnd dud
Sewer
Temporary Construction
Chan9~ in existing
rp<;,jdr.ncp
multifamily. comm. or
Tnrluc:.t.riill
~~ater service
Storm Sewer
Wood stove/heater
amps.
ISSUANCE OF PERlnT
TOTAL CHARGES \().CD 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 valid 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 Sta te of Oregon perta i ni ng to the work descri bed here; n. and that NO UPAI~CY wi]' be made
of any structure without the permission of the Building Division. I f~rther certify that my registrati n ~ith the Builder's
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is no d hereon, and that
only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project.
J-IYt-A,vO ..s-'l"~5. Ct?NST /J ~ ~
IlAl,lE(please print) SIf,IlATURiY'" ~
FOR OFFICE USE gnLY ~
'/ Ftg. rlain v , Value
Sq. Ft!J. Ac._,,-(", .J: ....)(. Value
Sq. Ftg. Other\--m,'\'-'la( ~ value=.6flfl.T
c:... <DO , TOTAL VALUATION
1= ~c ,.-"./~..../ s/:stems Development \" tI.
7?r"'/H~~"'{; aroe (J.5~) " l\J. ~
DATE ~)'J9--qv,
Zoner\ Pi
Tyoe/Const.
Bedrooms
Units
Occy Load
Dec'y Group
Fire Zone
Flood Plain
Stories
BUILDING PERHIT
Charges and
Surcharges
() LI CC> Plan Ck. COlll11/lnd
____~:l.L____ 65%/Rldn p".,. ~pp
f"\( _ Plan Ck. Res
. ~~ 30%/Bldo Per Fee
\ ~ c::(:) Fence
_____\L./~____
.1..'0
Dljtno
p."c...~ ~~p
\~.~
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
I'Sidewalk
------------1
AIC Paving
I Curb Cut
I
Total Comb. Permit
t1ECHANICAL PERMIT
Charges and
Surcharges
TOTAL
50. a,cp
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. example- 1250 sq. foot house, 500 sq. fqot garage
2. example- if new project. check new - if addition,
chee I< add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garllge
2. examele - 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
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 OOT 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 electric!1 label. ---
Applicant to sign and date
Whenever possible. the initial application will be used as
a wor~sheet 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.
,
i
III.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
\.PERMIT VALIDATION
Pennit Clerk
GJ q 3 ~
, .5=-J7.
I
C~diL
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
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vt:=c\\\\Q~Y\~~"'<;" \.\.J\\~ ('\\~ \-\~\""\F\..,~~F ~V\ "'~(...-3~fl~
PLANS REVIEWED BY:
)~}.\ J~)"E; SignatuC)\.~A~~ V-;~~e L\-7(,..,_<){~
name.\