HomeMy WebLinkAboutPermit Building 1990-3-30
~-----=-=-- J
I NFORl~ATlON LI NE
726-3753
Sq, Ftq. I~ain ?--:zqq
~q. Ftg. Access.
S9,' Ftg. Other
~Ilew Add Alter Pep.
Range _ Fence Demo Change/Use
#';)~1-~ln~~ $9S: ~ Other- -
~~A=: '8,.. &i'd'/:;.p--D
-B'ulltifnQ penlllt Info: Descr be Work{Le., Build Single
Fa~ilv Residence With Attached Garaae'
jlNSPECTlON LINE
726-3769
.
C TY F SPR NGFIELD
COMBINATION APPllCATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Job Address -::f'2:2C> ~7F~...... 57.
. .
Legal Oescription P~r CJ"'" (.c:>:r-
17~-::::?2--::?C>. CJ27"0/
r
Owner 6P -I ~A"/'?/€ urE~~
1 .. . ~
^ddrcss~~ ~__.-:>-/...v.
;P-~/?7 #/-L.?~.
, -, r
Construction Lender /tf n:Jt;/1?I~99
Address..dM?- lo~r) - ~ Phone
DE~I(jN TtA'f., lnamef (address'
Phone
...-,;7 :;-'/: ~
";7;:>9:::., 'i
l
~
0~/ "RoLr-~..,s.lJQ:::/-
.~.?;-V~,~-r-j(~', 5"/r~
f~~~~4C~//~ . ,I
. flies. no. \ !exnires1 (Qhone no.\
-:< Of -::;:Q' 'S--- amps '3';:'.'5'; ~- h,
I ' '26> e:> ,;;?;?~
eL~. U/<7?;z"A-C'7_=>-R: ;l;...../L
126m/-</" ~~~~ '?-,1/:7":
r
TOTAL CHARGES -:<~'7.~"O TOTAL CHARGES /.57. ScP TOTAL CHARGES '7<'9: 5'0
WHERE STATE l,'li REQUIRES that tile 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 returne~ to the Building Division
I HAVE CARE FULL Y EXNlI NED the completed apr 1 i ca t i on for permit, and do hereby cert ify tha t a 11 i nformat i on hereon is true
and correct, and I further certify that any and all work nerformed 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 UO 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 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.~ 7QI.055 will be used on this project.
SIGIIATURE2d~()/?..r! (;)~
FOr. OFFICE USE OfILY-
Zone C:::c. Type/Const. 6-A'/ Units Sq. Ftg. liain "72?<1 x~~"" value/tl;&9.:5.BO'
Fire Zone Bedrooms Occy Load~.? Sq. Ft~. Access x Value
Flood Plain Stories / Occy Group A-:5 Sq. Ftg. Othcr~~W'~ Value ~r?~.,e>
~ -;?/. r--_ /':. _ -,., A~_... -1Z~ TOTAL VALUATlOII/~::<:95:~
,-,?,,4#/)cv/~~e~<;O ~~~/' r~/' 7S:A5:., .
BUILOING PERNIT 1/':/ CJrZli' (Plan Ck. CorrmlInd . ISystems DevejOPl!)ent 1
Charges anc ____~<?-'____ ~l~o Ppr F.. ?,!2.-9'1"? /-/"'-,.,;charqe (L5t ' -:2''278. ~q
Surcharges csO Plan Ck. Res '
~~_ 30~/Bldo Per Fee
Primary
Structural
Electrical
r1echani ca 1
CONTRACTORS Inamel
General ,J:!-, p>3"~
P1umbino
Electrical
(addre~s '
flies. no.'
Hechanical
-
ELECTRICAL
PLUIIB I NG
~ FFF CHARGE NO . ::-r:r:
Residence of
~~ Each single fixture
~.,.., 7.S2/61:?'" SQ. FT.
Relocated building New circuits alts.
(new fix. additional) or extensions
rH'JUiF NO,
S.F. Residence
(J bath!
Duplex (I bath) each
Additional bath
~~ ~Iater servi ce
~
/'/tJ' Sewer
//.I)' Storm Sewer
I
/ ~""'R"""""~\4~'
SERVICES
;z
(~ I
I Temporary Construction
Change in existing
rps.ir'p""'rt'_
multifamily, corrm. or
Inl'llJ~tr;al
~-
~."'"
"'5'5""" / Of
7.<50
'I
75""'1
';<
~
amps.
COMfI./INO. FEEDERS
Install/alter/relocate
di<;.t.rih. fppders
IIAI,IE(pleasc print) P'D/JJARO WT=I3E 11.
.
PlU'~B ING PERMIT
Charges and
Surcharges
_ _ _..g,6~7. 5,;> >Fence
/ '9. '"7~c D",""
___________-' sldewalk~6,'h,;?#:s:?9/?/Y
AIC Paving -:239. cot!:>
n__~~~~_ Curb Cut::se~h,z:;~9/'3/~
-2.r&
ELECTRICAL PERIHT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
(exoiresl
(ohonp nn. ,
MECHANICAL
r:r:r: . fl-lARG.E.
furnace/burner to
2 ':>/A<>_""oc> BTU's
Floor furnace
and vent
7.5iP/~
Recessed wall
Snarp hpatpr ~nd vp~t
2:::;f?J':l ///1' /~
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.Jt?~
Mechanical exhaust
hond and duct
Wood stove/heater
6. - 12. COl
-;;? 0"
,:;/.
?;..oc
~~
f~ 7..,e.
~arc G7T .5C>
~l
I SSUANCE OF PFR!1lT
DATE ::'-30-90
;lZ;/V57.?/?E'/-.r? 6'P ?LR-,If;?
.?"-=W<""w-~"?A<.Y - -:zo. ~~
Total Comb. Permit
/.1?'''3.f?t::..
TOTAL
-'3'3/1. BZ
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT. VALIDAT)ON
I. Applicant to furnish
A. Job Address
B. Legal Oescription _ - \:' :",".'
1. example- Tax Lot 100. Lane County Map Reference
17 oj 4'3
2. exam~le- Lot I. Block 3, 2nd Addition to
springtield Estates'
C. Name, etc. of owner and construction lender
O. Energy Sources ,
1. exam~le. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 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. example - 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. OESIGN TEAM ANO 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
full schedules
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES. ON THE SCHEOULES
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 b~ used as
a worksheet only, Where possible, Building Division Staff
wi 11 prepare a type wri tten copy' and feturn 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
f~es are paid. All other fees and, charges are due and
payable when the permit is issued.
'-
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880.QO
.
Cleek KiroJ
V. FOR OFFICE USE ONLY
Permit
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt, from registration with the Builder's Board because:
,..' ",
I
:'" Add.i.tional Project Infonnation:
-.' .
~ "
'.
PLANS REVIEWED BY:
"1' ..
name
~~#E h~~ft
~ign'ature /2.-=~~~date
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