HomeMy WebLinkAboutPermit Building 1989-2-3
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Legal Description /7-0'3 ::;>'...,:;. - 3-=;> ~/-,/~ ~
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j' INSPECTION LINE
726-3769
Job Address
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
Hater Heater
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INFORlIATlON liNt II
726-3753
Sq. Ftg. i.lain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add A Her P.ep.
-Fence Demo Change/Use
Other - -
Owner "R-/ -=r> ,j..k""R '7-~
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Address /gS- CJz5=5,/ b//f. J;,";1-~:;
Ear4~~.-(.?.A=>
Construction tender r
Range
ValuE of Hork:
/2 c::=.o. .o.e.
BuilGinQ Penmit Info: Describe Work{i.e., Build Single
Family nes;dence With Attached Garaoe)
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M-/?"// /' .......~5:'r 7'? 5h"'A'5.
Address
OESIGrI TEAl!
Primary
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbino
Electrical
~lechan;cal
NO. I
(name)
Phone
(address)
(] ics. no.)
1
(exoires) (ohnne nn.
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1~9
r'Aff)U
("""", ) i./
(address)
flies. no,\
(pxoirpo;,)
(ohonp nn.l
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PUnllliIi
ELECTRICAL
MECHANICAL
l fEf j f.HARhF
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l ~I='~ I rl-l~ _rID,.....'
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NO
Residence of
furnace/burner to
\ BTU's
Each single fixture
~~
SQ. FT.
2
Relocated building
(new fix. additional)
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (I bath) each
Addi tional bath
I ~Ja ter sen'ke
Sewer
I
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I
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TOTAL CHARGES /1)". -- TOTAL CHARGES TOTAL CHARGES
WHERE STA1r L'llIllEQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit
shall not be va]iJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
Storm Sewer
New circuits alts.
or extensions
SERVICES
Recessed wall
~n~re hPntpr ~nrl vpnt
Temporary Construction
Change in existing
rp~ i d_p,nrp
multifamily, COITm. or
Tnrlllo;,triill
10f
ICOMM./IND. FEEDERS
l'Install/alter/relocate
rli~tritL fppdpro;,
IOf . amp~1
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Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
c;inole duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and dud
-I
amps.1
from
Wood stove/heater
ISSUANC, OF PFRrlIT
I HAVE CAREFl:lllY EXMlINED the completed apfl 1 i cati on for permit, and do hereby cert ify tha tall i nformat i on hereon is true
and correct. and J further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPAI~CY will be made
of any str~tUTe -nthout 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
NAME(please print)
Zone
Fire Zone
Flood Plain
BUILOING PERIIIT
Charges and
Surcharges
PLUl1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERIHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
<PT":.k or .1
k 1""1. (
SIGllATURE ~;r P1/ DATE~/3 /J>'j
FO~ OFFICE USE OIIL Y ~ 1/
Sq. Ftg. f1ain ,x Value
Sq. Ft9. Access x Value
Sq. Ftg. Other/.N~/~ f3l7~~lue /2ae>."""
TOTAL VALUATION
v
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occ.y Group
_0--
~ Plan Ck.
-:? &P. '" ~ 65%1Blrlo
-----/~03-- ~6~~B~~~
~ pre> I Fence
---- -~?~ Oemo
\ /-Sldewal k
------\-~--I A/C Paving
V"
ConvnlInd
Per Fpp
fes
Per Fee
Systems Development
Cha rqe (1. 5~) ,
I
I
jTotal Comb. Permit
I
I TOTAL
3' 7. :;;;8
Curb Cut
e
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
. I. - Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, lane County Map Reference
17 03 43
2. examele- Lot I. Block 3. 2nd Addition to
Springfield.Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
'I. . example- heat/electrical ceilinq/or forced air Qas
2. examyle- waterheaterjelectrlcal/or ~
E. Square footage or valuation, etc.
1. examele- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition,
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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
fu 11 schedu 1 es
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 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 ;s issued.
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V.. FOR OFFICE USE ONLY
Permit Clerk
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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
LP~ ~~~ signature
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date=: 7~.,
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