HomeMy WebLinkAboutPermit Building 1989-9-19
I INSPECTION LINE
726.3769
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~ COMBlllm~NOKp~rmm~~~ERMIT .
Job Address 2~7 <) L.4?-/1~?7' ~~~~GYir~fu0:wnL
Legal Dmription /1IJ 3 ;;J.;:)'cL-'-I- 07706 lIater lleater..EIf'I'..
\" Range ~/~I!,
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INFORllATlON LINE
726-3753
Sq, Ftq. 1,Iain /loom
~q, Ftg, Access,
So' Ftg, Other.!1o
Ilew Add A 1ter Pep,
-Fence Demo Change/Use
70ther ..J1LaJO.r'
Owner Cnl'l.swuj CteiJf'j/t ~
A.JJrcss 1.:311 I'(j" r;{}f;~
Valu,S~~
'j .'tc/."",Buil(i;no Permit Info: Describe Work{Le"
rhoncZ2ro'/~Fi\milv flesidence Hith'Attached Garaoe'
Build Single
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Construction Lender QSe/~
v
Phone -e-
(address \
(1 ics. no.1
(exoires)
(ohane no.
I
Address r:{)(}JrJe,
DESIGN rEAM (name)
Primary
ClJV{;;,ti ne. /..aV-SOVV (I!4Aa)
,
13rt "6"
-0-
-c,-
~7S0
Structural
Electrical ~ro0Q.m f';kctn'(j
11cchanical
CONTRACTORS [name)
(address'
(1 ics. no.'
(exo; reo" 1
(ahOM no.)
Genera 1
~1f
Plumbino
Electrical
&'a.bhaWl
f=leC!.,
~lechanical
PLUIIB ItIG
ELECTRICAL
MECHANICAL
*/1. f!;.di.-
SQ. FT,
furnace/burner to
BT(1' s
ml~
..BQ..,.I
I Each single fixture
Relocated building
(new fix, additional)
FEE CHARr,E.NO
ELL .GliAOr" Nn
Residence of
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
II bath I
Duplex (I bath) each
Add it i ona1 ba th
SERVICES
Recessed wall
SJ~~P he~tpr ~n~ vent
Storm Sewer
Of
amps.
Appl iance vent
seoarilte
Stationary evap.
cooler
Vent fan wi th
sin91e duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond ilnd rlur:t
Sewer
Temporary Construction
Change in existing
resJ Qcnce
multifamily. COnIn. or
Indudrial
~Ia tar serv; ce
COMl'I.I1 NO, FEEDERS
Install/alter/relocate
distrih. fperlerc;
Wood stove/heater
Of
amps.
TOTAL CHARGES
WIlEnE STATE L.\\~ REQUI RES
shall not be vali1 until the
ISSUANCF nF PFR!llT
/ <<);t:n? TOTAL CHARGES , TOTAL CIlARGES
that tfte Electrical work be done by an Electrical Contractor. the electrical portion of this pe~it
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM11NED the completed application for permit, and do hereby certify that all information hereon is true
and correct. and 1 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 OreC]on pertaining to the work described herein, and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. 1 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 exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Units
Occy load
Occy Group
SIr,II^T~~ eJJI-Sc:>I'V
FQr. OrF'~F l,isrnlll.Y
Sf!. Ft~. f1ain x
Sq. Ft~. Access x
S~, Ftg, Other x
DATE 9/f91'l9'
I
1lN-IE(please print)
(ht'i sf, nc C;. lai"9J1IV
Type/Cons t.
Bedrooms
Stories
Value
Value
Value
TOTAL VALUATlDII
PLUI1BING PERMIT
Charges and
Surcharges
:;;- t?C> Plan Ck,
.___1___"____ 65X/Bldo
c::- Plan Ck,
. :/ ~ 30t/Blde
_n-/5~:~- Fence
-7S D~mo
Conm/l nd
Ppr Fpp'
lies
Per Fee
Systems Development
Charoe (J.5~)
BUILDING PERflIT
Charges and
Surcharges
[L[CTR 1 CAL PERIHT
Cha rges and
Surcharges
I1ECtlANICAL PERMIT
Charges and
Surcharges
Sidewalk
AIC Paving
Total Comb. Permit
'.,
Curb Cut
TOTAL
:;?/. SO
.'
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PERMIT VALIDATION
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Nap Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air QdS
2. examyle~ watcrheater/electrical/or solar
E. Square footage or valuation, etc. -
1. example- 12S0 sq. foot house, SOO 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 gar.ge
2. example - remodel existing garage into family room
3. examjle - 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 TEA/1 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, Mechanic.l, 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. -
III. 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.
.
/qt1/1
V. FOR OFFICE USE ONLY
P,mit c~ \ \/,\ t <tj
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
LoRge:
>>~~signature ~~~~_ ?late
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