HomeMy WebLinkAboutPermit Building 1990-4-17
vi A no..
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I INSPECTION LINE
726-3769 .
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CITY UF SPRINGFIELO
COHBIIIATION APPLlCATION/PERMlT
E!IERGY SOURCES:
Heat
t~ater Heater
Range
Job Address :~ \ ~~, G~ ,,"1\ L\ '
Legal Oescription \1 '\ O~--);J~O ()A.,\ m
Owner ,,~ F . \\r{) '( ~ f\"
Address ,?-A ~ C\ ')'t\ i.s:--.-t \ 0 Y - Phone
constru~r;:;d~ \ iC"\ \ ~ G\lL\-,0
Address
UtSI(jN ItAr1
(name)
Phone
(address)
Primary
Structural
Electrical
INFORl1ATICN liNt
726-3753
Sq, Ftq, I,;.in
~q. Ftg. Access.
Sq, Ftq, Other
flew Add Alter pep.
--Fence Oemo ChangelUse
Other - -
.Q
~
-;2)
f-.
ValUE of I-IOrk:CCO 00
~ - ' .
Buildino Pe~it Info: Describe Work(i.e., Build Single
Famil v R.es i dence Hith Jl.ttached Ga raae)
\ \J Q (\\~lJ iV\{)(\ ~t~
S\{)~ G WJ(\ Q)\ 1. ~
(\r\.l\-) .
(; ics. no,)
(exoires)
Cohoneno,)
Mechanical
CONTRACTORS inamel faddressl (1i(':<:. nQ..) (pxoirpc;l (ohnnp flJl.)
General \~._ . ~ \\ \\\~ "\~-\tt'\-O . R~:/p?[) \\.s\O ,(~ff'U' ?~i 1 U< ()~S':-{) 51q/'J ~\S;L-+\
Plumbina\.A\()rlj),~~t) J(J\)C\.(\ "-~t~O(\ 05rl~::1S \/-lflla I
Electrica~t\ \\\rrn,<;:" vo~~\o\ 0 9. 0 \ cn~ Co It?,lC{O
~lechani~..v\.~ rQ9 ,s,f'\\\ ~.\Y\. 'B!.Af1rVif1YOitt Q, 4C\ l n\ L{ \ 15 7etl
PLUI1B~G ELECTRICAL ~ECHANICAL
-1'0,
FFF rHARhF ~n
,5
Each single fixture
Residence of
?';52:; .~ ('. '~
Relocated building
(new fix, additional)
t't'"t'" fl-l;&GE J:W
t"t"t'" ':.HARG.E..
SQ. FT,
furnace/burner to
BTU's
~ New circuits alts.
or extensions ~
"2 ~R. /'??4'-""=
SERVICES
Floor furnace
and vent
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
Recessed wall
Soace heater and vent
amps.
Appliance. vent
c;eoarAtp
Stationary evap.
coolH
Vent fan wi th
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hnod and duct
Wood stove/heater
~Iater service
Temporary Construction
Change in existing
res i d_eJ1ce
multifamily. camm. or
Industrial
Sewer
Storm Sewer
Of
CO~1,/INO, FEEOERS
Install/alter/relocate
distrib, feeders
/ Of amps. <--' ~{,6-f~~
~"7}'?/~c. ~~~
~~ ~:'5~~?<F
~~/'7'7 ~.J7j"4'" ~ ISSUANCf OF PFRIHT
TOTAL CHARGES ,:?-;?,,5""C:> TOTAL CHARGES TOTAL CHARGES ~~_ .-"().:'<='6'
WHERE STATE L~I-I 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 Soringfield and the Laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPArlCY 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 ons 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 7Ql.055 will be used on this project.
IlAI-lE(please print)~I;~ (2. M e..jAL _
SIr.IIATURE '// 2.$ ~~
om ~;>~/)
Zone
Fi re Zone
Flood Plain
Tyoe/Const,~~~
Bedrooms
Units
Occy load
Occy Group IS?-~
FO~ OFFICE USE Q;lLY
Sq. Ftg. Hai" )( Value
Sq. Ft9. Access x Value
Sq, Ftg, Other;1?.c-----...~-~ Value
'TOTAL VALUATION
Stories
/
,.0v.:>"'7'~~'-"'"~ S-~.:SP
BUILDING PERMIT ~~ ~
Charges an~ ___.-!e..c'--
Surcharges -J ~
, -<-~ ..-
~1rOt1B(NG"P(RM'ff' "" ~ .h?--.s =-
Charges and _____2_.::~_
Surcharges /.$.8
Plan Ck, Camm/Ind
65~/Bldo P~r ~~~
Plan Ck, Res
30%/Bldo Per Fee
Fence
061t10
ELECTRICAL PERI:IT Sldewa 1 k
Charges and ------------
Surcharges Ale Paving
'~W11;r(i'EAl"~fR'Mlti"., /<&---;;;; Curb Cut
Charges and _ _ _ _ ~.:t2'_ _ ___
Surcharges _ ?F
5':<...<---<:---
,
al(,B2lf>
'2.1'\ V -:2.. .3J:1%1) Systems Oevelopment
--Jd ,00 ,'r Charae (1.5~)
A/A.
Total Comb. Permit
TOTAL
':2//-/6
---~ -
. 'U"_'
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COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Description
1, examp.le- Tax Lot 100. lane County Map Reference
11 U3 43
2, example- Lot 1, Block 3, 2nd Addition to
, ~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin~/or forced air oas
2. exa~le- waterheater/electrical/or solar
E. Square footage or valuation, etc,
1. examole- 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. example - 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
Divis'ion Staff must be able to contact appropriate
persons regarding design information or jab site.
corrections, etc.
II, Abbreviated Plumbing, Mechanical, & El.ct.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 Ellict,-ical Schedules
are available at the Building Division
1. To conserve space on the permit fonn 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, BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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 is issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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I .
i) r leD
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Permit Clerk
,M)
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Permit applicant exempt from registration with the Builder's Bpard because:
Additional Project Information: I
~~~QX1 )\ SUIt) fkctJ\'l (' iC\J\~ 3C\\\Cl~ ':,
\ ~t~r\)'lf'~~'
I
PLANS REVIEWED BY:
name
signature
date