HomeMy WebLinkAboutPermit Building 1989-10-25
I INSPECTION LINE
726-3769
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CITY Uf SPKINGflECO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Water Heater
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INfORllATION LINt
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other - -
Owner EL"IUIllelf/
Address~c 2. 7'J- rUllII' IUOt:E PR.
ge.T.('~ IJI?, ol7rt-rtY
~ction L~nder 1, r.... I(/v (d H T
Phone/fY.'9lfJ '
Ran!le
Valu. of Hork: m)~
BU11dinQ Pennit info: Oeser be Work(l~e,"
Familv Residence With Attached Garaoel
(11.J1!1p,! tiitii( /"
Bulld Single
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Job Address ;Lt::1 ?O'/.-Avfi/l 5Tf(Eci
Legal Description \ (j n?:> QI\ If) /)4?CY)
Primar.v
,
{exoiresl
~
fA\.
(ohO.. no. (
Address
DESIGN TEAI~
(name)
Phone
(address)
(lies. no. \
Structural
Electrical
Mechanical
CONTRACTORS (name)
General /'/',U.;.........~~
{address\
(1 ics. no.)
(exoires)
(ohone no.)
Plumbina
Electrical
~fp.chanfcal
PLUr,lBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGF .n
ffL'J:IlAB.liE. NO
ffLJ:IlAB.liE.
SQ. FT.
furnace/burner to
BTU's
Each Single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
~n~~p hPAtpr Anrl vpnt
Stann Sewer
Of
amps.
Appliance vent
::eoaratp
Stationary evap.
cooler
V.ent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
i.
Sewer
Temporary Construction
Change in existing
residence
multifamily, comm. or
Incluc:.trial
Water service
CO~~./IND: FEEDERS
Install/alter/relocate
clic:.trih. fpp~prc:.
Of
amps.
I SSUANCF OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\l/ REQUIRES that tile 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,EXAMINEO 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 Springfield and the Laws of the State of Ore90n pertaining to the work described herein, and that 110 OCCUPANCY 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 701.0S5. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
Units
OccY, Load
Occy Group
SIGrl^TURE f? ';it
fOr. OFFICE USE miL Y r
Sq. Ftg. r1ain x Value
Sq. Ftg. AccessC~"" ~~?"i'""Value
Sq. Ftg. Other x Value
(Q'?-S, $.s{;\ tos '2.--\C\ s.~AL VALUATION
c::l f'1c.. . syste~s "tlevelopment
~I ~ ) Charge (I. 5~ '
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~A7-
DATE 1<>-:J.5"-f'9
rlAHE(please print)
E L,
1(/lI {f; If T
~=a
BUILDING PERHlT
Charges and
Surcharges
/~~ Plan Ck. Conm/lnd
__-L~':_____..92!/BJdo p.pr fpp
-S- Plan Ck. Res
, ? 30%/Bl do Per Fee
PLUI~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERlHT
Cha rges and
Surcharges
I Demo
______ ___ __-"Sidewalk
I AIC Paving
___________-' Curb Cut
I
I
ITotal Comb. Permit
I
I TOTAL
/5?S-1
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
Jt oj 4J
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Est~tes
C. Name, etc. of owner and construction lender
O. Energy Sources .
1. exa~le- heat/electrical ceili~Q/or forced air Qas
2. examole- waterheater{electr;cal/or solar
E. Square footage or valuation, etc. -
I. example- 12S0 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. example - construct Single family house with an
attached garage
2. example - 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 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 infonmation or jab 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 fonm 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO
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. ---
Ill. Applicant to sign and date
Whenever possible. the initial application will b~ 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
signa ture.
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 penmit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
\\-3-'61
\5l<6'0
Pennit Clerk
IDU
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
(!/
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PLANS REVIEWED BY:
name ~?Y#c ?~~Signature4',:: ~'
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date //-"2~
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