HomeMy WebLinkAboutPermit Building 1990-1-19
Job Address ,-/QfJ5 J.hJ., fwrJ/AJ I2L
Legal DescriPtionF111~ :J~ Or) (,()1(Y)
. CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Ranqe
.
INFDRl1ATlON UNE
726-3753
Sq. Ftg. Hain
~q.- Ftg. Access.
Sq. Ftg. Other
flew Add Alter Rep.
--Fence Demo Change/Use
Other -- -
J
I INSPECTION UNE
726-3769
OwnerNDI!--II1VJLsJ Ai'c.LS.S II'n/JAf{tvnd. /n./{, "file..-
Add ress :3'1<6 'It" J\I\ at0.wS R-iL
Wprv-, C)iU- 5P--
Phone
ValUE of Hark: 0"
7-b) GlQO -
BUlldinQ Permit Info: Describe Work{i.e.,
Familv nesidence With Attached Garaae'
Build Single
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Ui
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Address
UI:.:illjN TEAr1
Phone(,fl- 7fsI
(address)
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IJJO-ILL/JO LlS-L. ;'Y!l)((J. ~t. y ltRL+
(lies. no.' (exoi'resl
Construction Lender /J5.~
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(name)
7'f7 -I fiN
7'f7-{ygSI
Primary
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J1W--rn b/;..;-. l
(Dho~e no.
71b -old7
Structural
Electrical
Meehan; ca 1
CONTRACTORS
tnarnel
(addrpss 1
l1 ice;.. no. \
Cexoiresl
(ohane no. \
Gp.nera 1
PlumbinQ
Electrical
~lechanical
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FFF CH'tRGF Nn
:~~ r~4ijr.~ NO,
~n ru!RG.E..
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
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snac@ hp~tpr ~nt vpnt
Storm Sewer
Of
amps.
Appliance vent
~~o~r~~~
Stationary evap.
cooler
Vent fan with
sina1e duct
Vent system apart from
h@atinq or A.C.
Mechanical exhaust
hnnrl i1nd r!1Jf't
Sewer
Temporary Construction
Change in existing
r@s i q~.nc@
multifamily, comm. or
Inrlustri~l
Water service
COMfI./IND. FEEDERS
Install/alter/relocate
distrih. feeders
Wood stove/heater
Of
amps.
~...... ;;>~~...--
6 't?';.T. ~/Y77-?Ak- n::s-ri'
~ 6'-= ~"'-_/A/ Al-
, . _,: ' I
/"5;:-~f'.:'-'-""'~,~;; ~~_:7: ISSUANCE OF PFRt1lT
TOTAL CHARGES , TOTAL CHARGES , TOTAL CHARGES M/H. /~ ~
WHERE STATE L'W REQUIRES that the Electrical work bo 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein. and that NO OCCUPAIlCY will be made
of any structure without the permission of the Guilding Division. I further "certify that my registration with the Builder's
Goard 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 701.055 will be used on 'this project.
~
NN~E(please print)
alAll.d.6-~e. Gtu0.n~(
Zone_H I
Fire Zone
Flood Plain
Units
Occy Load
Occ'y Group
SIGIIATURE
FOr. OFFICE USE DIlLY
Sq. Ftg. 'iain~--,~~";>P{
Sq. Ftg. Access. x
Sq. Ftg. Other ,
iPC-. :tJ;:. 15ft 0 r TOTAL VALUATION
/ / _q 23 Systems Development '
(J , :/ Char~e (1. 5~) .
DATE
/-''l.cto
Tyoe/Const.
Bedrooms
Stories
Value
Value
Value
'7ES~--'
.
BUILDING PERHIT
Charges ant:
Surcharges
. Plan Ck. COIlll1/lnd
__~_~..5:<:?__ ~/B)do P.l'r F..
Plan Ck. Res
n. ~?? 30%lBldo Per Fee
h25:~
PLU'~BING PERMIT
Charges and
Surcharges
Fence
D~o'
ELECTRICAL PERIUT 'Sidewalk
C~~esand ------------
Surcharges AlC Paving
MECHANICAL PERMIT
Charges and
Surcharges
___L~~_ Curb Cut
-7~
'.
TOTAL
--Zf?9.::;::,8
'1~(l::<>8 I
Total Comb. Permit
.
.
.J.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnIsh
A. Job Address
B, Legal Oescription
I. examele- Tax Lot 100. Lane County Map Reference
II U3 43
2. exam~le- Lot I. Block J. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
I." exame 1 e- hea tIe 1 ectri ca 1 ceil i ng/or forced a I r Das
2. example. waterheater/eJectrlcal/or solar
E.. Square footage or valuation, etc. -----
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project, check-nfw - 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. examJPle - 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 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 OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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 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 penmit is issued.
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V. FOR OFFICE USE ONLY
Penni t Cl erk ~ \HJl D
1
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Pennit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name / A-:;-,~~A~~ Signatured2'..j~'-7-,date /-/~-5!:::>
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