HomeMy WebLinkAboutPermit Building 1990-2-5
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1'1 INSPE""'iO~ L1NE......~.. . CITY OF SPRINGFIELD ._ IHF0R11ATlON LINe
726-3769 COMBINATION APPLICATION/PERMIT. 726-3753
Job Address -'\Q ~ (....2......r-^" ,r-v-\ . J-. EHlelEaRtGY SOURCES: Sq. Ftg. 11ain J::..\}o\\'2....
CY ()\ ..x. ---1 --11 i AJi)LA. I J.. J.. /v Sq. Ftg. Access. J
Legal De"ription l7-C)g-'2.-;? '::'.0. 7l9./IIr'67~ I~ater Heater SAre~tgAd~th~~ter Rep.
/ -=:.. Range~ .~_ -Fence Demo Change/Use
va~r):~ Other- -
BuilolnQ Permi't Info: Describe Work(i.e., BuildlSingle
Familv nesidence With Attached Garaoe'
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(address\ dies. no.' Jexoiresl (ohane no. i
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Owner, r X\\~'\\ \")\'\\. \JI\(l_
Address"' \ Phone
SJ
2
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Construction Lender
Address
DESIGN TEAM {namel __
Primary t\~'\\coro \ \Jluo.f1o.
~
.Phone
Structural
Electrical -
Mechanical
CONTRACTORS lname'
General b~o'fC\Q G,D..~
(address' {lie<;.. "9. \ (p~D;rE"s\ (ohoop nn..:'
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Plumbino
Electrical
~1echanical
PLUllB I NG
ELECTRICAL
MECHANICAL
NO. .
FFF
CHARGE
Nr
..EEL .cJJARCF NO.
I furnace/burner to
BTU's
I j:j:!=,
I
rH~
Each single fixture
Residence of
SQ. FT.
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 wall
~n~ce ~~~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
5;eparate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood ~nd duct
Sewer
Temporary Construction
Change in existing
res.i de.nce .
multifamily, comm. or
Industrial
Water service
COffi1,/IND. FEEDERS
Install/alter/relocate
distrih. feeders
Wood stove/heater
Of
amps.
ISSUANCE OE PFR!lIT
TOTAL CHARGES l TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L,\\; REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pemit
shall not be vali~ 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 infonmation 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 Spri ngfi e 1 d and the Laws of the Sta te of Ore9on perta i n i ng to the work descri bed herei n. and tha t UO OCCUPAllCY wi 11 be made
of any structure without the penmission of the Building Division. I further certify that registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis or empt~n is noted hereon, and that
only subcontractors and employees who are in compliance with OP. .055 wil be used n is pr~ J I
IlN.1E(please prin Ot\t-\ ENJr'\.e... DATE2!.5/cro
I - FOr. OfFICE USE/OIlLY ~ 1
Type/Const..~-)(I. 6~.Units '----sq, Ftg, 11.in4'7.7ll$~A"./"--Value
Bedrooms Occy load Sq. Fta. ~~. /7 ...;,. ~....,~..........: Value
Stories. 2. Occ,V GroupJ?-'2. Sq, Ftg. Othe6~..'~~~alue
TOTAL VALUATION ~~~
9m.cP '~1t:~;~~s (~~5~loPm.ent g /~. e7 0
~5'a'7J ~""~Y/~""'.A5~ 9~-5"~~
6~,....../ .&a..'liA 'T -~'&9 . _e>
&...wGe L:!?^ ~ ??EV~
~ p~ 7~~. 'f~
ITota' Comb. Permit 1'162. 6.~
"1/4~./O
Zone CC
Fire Zone
Flood Plain
BUILDING PERHIT
Charges and
Surcharges
_J'3_12,-~__
'b~.6r')
Plan Ck. Comm/lnd
65%/Bldo p.r F..
Plan Ck. Res
30%/BldQ Per Fee
Fence
PLU'~BING PERMIT
Charges and
Surch~rges
D~~o
ELECTRICAL PERIHT
Cha rges and
Surcharges
'Sidewalk
A/e ..Pavi ng
11ECHANICAL PERMIT
Charges and
Surcharges
'.
Curb Cut
TOTAL
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COMBINATION APPLICATION/~ERMIT (CAP)
I.
PERMIJ_ VALIDATION
II.
Applicant to furnish
A. Job Address
B, Legal Description
1. example- Tax Lot 100. Lane
17 03 43
2. examp]e- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
"I. example- heat/electrical ceiling/or forced air Qas
2. examole- waterheater/electrical/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.
check add, etc. .
F. Building permit information:
1. example. construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exa~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 information or job site
corrections. etc.
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 SCHEDULES
D. As noted on the CAP, the label must
electrical contractor:for signature
supervisor. The general contractor
to sign the electrical label.
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
signature.
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;
""HlfY) _ )
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County Map
Reference
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p\:)y CoL-
be delivered to the
by his electrical
is .not authorized
IV.
-
V.
FOR OFFICE USE ONLY
Permi t
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS, REVIEWED BY:
name.k;9#c ;z:::t~E/f
Signature~_..~ date "7 -7-"76>
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