HomeMy WebLinkAboutPermit Building 1989-10-19
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jINSPECTION LINE
726-3769
,.
Job Address I.!.? I') Lf...A,)f)/h.J" 1).e,
Legal Dmription \ fJ n3;l 71 'd 0(")3IJ.-J
CtTY U~ SPKINGflELD
COMBINATION APPLICATION/PERMIT,
EIIERGY SOURCES:
Heat
l4ater Heater
.
INFOR/lATlON LINt
726-3753
Sq, Ftg. Main -A
~q. Ftg. Access.~~"'"
Sq. Ftg. Other
..Jlew,t:Add_Al ter 'yep.
Fence Demo Change/Use
-Other- -
lS
-
Owner 5 F. 0 tJ () J It ;:; PI'S _
.^ddress J.j/'I'l -L/NtJAI.J: ??.e,
Phone 7 <{ 7-
.t"'? ,,"?
Range
Valu' of Hork:
", C. 550,tJQ
Bull(iinQ Pennit Info: Descrjbe Work(i~e..
Familv nesidpnce With Atta~h~d Garaae\
Build Single
~
..p.-
I
Construction lender'
S7DR./fb E .#01)/ /lbN - /.:;) '.",.,:v; I
J:O/? An. JIYl h;e .
Address
Dt~ HiN n.m"
lname)
Phone
(addressl
nies.rio.'
-tJ39('1/
(exn; res)
(ohane no. J
Primary ORE. /....$13K', p/,t< 6, rAY. ~/ vtJ w, )/ 'Jtf!.
3i75-f?177
Structural
"
Electrical
Mechanical
CONTRACTORS
General c>f< E .
(name)
(address)
Cl ics. no.'
{exniresl
(l)hone no.)
'/118/2. ~K6, 7/JC) 91Yb u),II'#o-
*396/1
3sc"r-Sj"} 7
~
Plumbina
Flprt,rirl'Jl
- --. ..
~lechanical
PLUIIB I NG
ELECTRICAL
MECHANICAL
....lli',
FFF r~^Rr,F Nn ~
< < < .CliAllG.l...llil
rt'r: r~~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hPntpr nod vpnt
Storm Sewer
Of
amps.
Appl iallce vent
sp.oarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
Sewer
Temporary Construction
Change- in existing
rp$i4e:nr.p
multifamily, COIlJI1. or
Tnriuc;.triil.l
Water serv; ce
CO~1./INO. FEEDERS
Install/alter/relocate
distrib. fpeders
Of
amps.
ISSIIANCF OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an.'Electrical Contractor. the electrical portion of this permit
shall not be vali1 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 Springfield and the Laws of the State of OreCJon pertaining to the work described herein. and that un OCCUPAllCY 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 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7n1.055 will be used on this project.
SIGII^TUR//~7 ~
Fan orFICE USE ~"'"7 ,
,
Sq. Ftg. r1ain x Value
Sq. Ft~. Access-2.../,fpoft' x Value~:L::>D'-::"-
7- L Sq. Ftg. Other x Value
\A (\rC~ N, \1,.4 ~~To,~f)~11
/'? .c,." Plan Ck. Conm/I,n,d A) \ ::l - Systems Development ~.b -?__
___~_""i=-~"::"_~/Bldo p.pr Fpp .~. n:-, Charqe (L5~). -/)5.....-:::>
";;> r::? Plan Ck. Res
.)- t --' 30%/Blda Per Fee
HAI,IE(please print) ':J:eR1'lYf c.. CtJn<-e.
DATE/a> -r?-~~
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
~-N.units
Occy Load'
Occy Group_
Stories
/
BUILDING PER~IIT
Charges and
Surcharges
PLU!~BING PERMIT Fence
Charges and ------------ I
Surcharges Demo
ELECTRICAL PERil IT 'Sidewalk I
Charges and ------------
Surcharges .A/C Pavi ng I Total Comb. Permit hS:~"5
MECHANICAL PERMIT Curb Cut I,. I'" .
Charges and ------------ I TOTAL :/b"3.~
Surcharges
-
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examole- Tax Lot 100, lane County Map Reference
1/ 03 43
2. example- Lot I. Block 3. 2nd Addition to
sprlllgtield Estates ....
C. Name. etc. of owner and construction lender
D. Energy Sources -
1. exa~le- heat/electrical ceilin~/or forced air Q3S
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc.
1. __ example- 1250 sq. foot house._500 sq. foot garage
2: example- if new project, check-new - if addition,
enee I< add. ete.
F. Building permit information:
1. exam~le - construct single family house with an
attached garllge
2. exam~le - remodel existing garage into family room
3. examele - 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 TEM4 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. BOILOING 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 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 permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
)
PERMIT VALIDATION
\S\~1
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Permit Clerk
~~
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. "'Permit appl i cant- e'xe,mpt from' .regi ~tr:ati on wi th the Buil de'r'\ s'Board 'becatiie:.
Additional Project Information:
PLANS REVI EWED BY: , '
'name ~~'?~
Signature~_-
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date /t!P 71ti'
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