HomeMy WebLinkAboutPermit Building 1990-1-2
CITY OF SPRINGFIELD
C0I1BIilATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Hea t C/)-<
\.later Heatcr"-:;:,oc
Hechanical
CONTRACTORS InameJ Rlat:d~e:'l~ ~. Y~(71::'~ no, ~
General CA/J.e. ~A.:;c;, i P~._ .....c:-:;..:; ;.:.:;., '(bJ' ZT'"
;
P1umbina rA..,. P./..""J'J'''', .1l-II1l....A'~
v
Electrical If'",.( E $--' ~IC-I,
r
I INSPECTION LINE
726-3769
,
.
Job Address
J I ~ J ~.,j.~t:;JltN'~~ RL,,'
. .
170:2, ~L ,&0 - 03/ CT[)
legal Description
Owner (;;.~fJ' t!! L.i~
,
Address / ,C;.I0 k
-;
t:;" <r ~N I! D-L.
~A.A,r
'? 9' ,It./
f;, l:
Phone
t: 98- o~ 3~
Construction Lender A/,,,,,/:-
Address
Ut~lliN TEAf"
(name)
Phone
(address)
Primary
Structural
Electrical
Hechanical
PLUI1BI NG
NO.
FEE I CHARGE
/c?'':'' l7'otlt'"
NO
Residence of
/'1
Each single fixture
Relocated building
(new fix, additional)
New circuits alts.
or extensions
S.F. Residence
II bath)
Duplex (1 bath) each
Additional bath
SERVICES
~
.
INFOR/IATlON liNt
726-37S3
Sq, Ftq, l'lain /~t>fJ
~q. Ftg, Access. ,,Z -;00
Sq, Ftq, Other
!lew Add Alter Rep,
--Fence- Demo Change/Use
-Other- -
~
i~
~
I-lj~.
Ran~e
ValUE of Hark:
IJ"oo~
Bul1riinQ Permit Info: Describe Work(l~e.. Build Single
Familv ~esidence With Attached Garaae)
I1'rYvt WI (X n oJ ~ f) 111/1 f1 rJ. i J
(lies, no.)
(~xoir~s)
-r ohone no.)
(pxlJirps)
fohni'll" I'ln )
S/~f/91
.
I. fj;J- S' -5 D f!
ELECTRICAL
MECHANICAL
'"'
rl:lARliE. NO~
IIL .QJARliL
SQ, FT,
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
Sn~rp hp~tpr ~nrl upnt
amps.
Appliance. vent
seoaratp
Stationary evap.
cooler
"2 Vent fan with ? 6:;:-==
.s; noh~ duct
Vent system apart from I
heatina or A,C.
/ Mechanical exhaust 17'..2
hnnrl and durt
Wood stove/heater
/ /___s ~J7Y ~:?-~ "2. ..-.
~Iater service
Temporary Construction
Change in existing
rpc;jct.e.nrp.
multifamily, comm. or
Industrial
Sewer
Storm Sewer
Of
COMM,/IND, FEEDERS
Install/alter/relocate
distrib, fpederc;
"
Of
"
,-
,.
TOTAL CHARGES /l./o TOTAL CHARGES
WHERE STATE L\IJ REQUIRES that the Electrical work be done by an
shall not be valiJ until the label has been signed by an Electrical
amps.
ISSUANCE OF PFR'm /t:'. aC
TOTAL CHARGES ~~SO
Electrical Contractor, the electrical portion of this permit
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 pertaining to the work described herein, and that IW OCCUPAIKY 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 ORS 701.055 will be used on this project.
SIGrlATURE# ~ ,o:;;~u__'_m
FO~ OFFICE USE miL Y
Sq, Ftg, 11ain,*7 R:>__~--"",--r
Sq. Ft9. Access x
Sq, Ft9. Other x
cl w-<--
fA 1-2341 (2eCl>>/71l-1
CAt"2 . c Sys teQs Deve 1 opmeat
I~ 7 of' Charae (1,5~)
1
I'
I~AI,lE(p1ease pr~~t)..:G4~":
ZoneNR..8_Tyoe/Const.
Fire Zone Bedrooms
~
/":A. ,.,..(:. <'
Units
Occy load
Occy Group
Flood Plain
. Stories
BUILDING PER/lIT ___1?::~___ Plan Ck, Conm/lnd
Charges anc 65%1Bldn Ppr Fpp
Surcharges I.l~3 Plan Ck, Res
30%lBldo Per Fee
PLUI1BING PERMIT Lt~ -- Fence
Charges and --- _.:._----
Surcharges 7.6'C> D~R1o
ELECTRICAL PERlm Sidewalk
Cha rges and ------------
Surcha~ges AIC Paving
/lECHAN I CAL PERHIT :<-=? -,5C:> Curb Cut
Charges and ------------
Surcharges ;./2.
DATE /h' /'llL
/
/':2 ,6""0
Value
Value
Value
TOTAL VALUATION
iV:~
\,
_~ Tota~_ Comb, Permit
TOTAL
-:2 ~ /: 75'"
~~7
----.\'
~
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-. ,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I, Applicant to furnish
A, Job Address
B, Legal Oescription
1. example- Tax lot 100, lane County Map Reference
J7 03 43
2. example. Lot J, Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinqlor forced air Qas
2. examole- waterheater/electrlcalJor solar
E. Square footage or valuation, etc, -----
J, examole- J250 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
attached garz!lge
2. examele - 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 TEM~ 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, & Elect~ical 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 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 permi~ is issued.
l!cpr# 2. 0 2. '//
--7--&> ?, 7 S-
,,' '.."LKII c.(2 7
"'';: ...,
V, FOR OFFICE USE ONLY
C-'i--?/ ,
Permit clerk4 ::0 ~k.!" <::
C// L /' '
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
"
'..;0
,
PLANS REVIEWED BY:
name
L~;?#c
7~g;:;p
signature
~ u f1z:v
,~~~~~e';date
.
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