HomeMy WebLinkAboutPermit Building 1990-1-19
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I INSPECTION LINE . cITY OF SPRINGFIELD . INFORl1ATlON LINE
726-3769 COMBINATION APPLICATION/PERMIT 726-3753
,.-/"~ ENERGY SOURCES: Sq. Ftg. 1.1ain
Job Address ~~O' ~~~"?' ~. Heat ~q. Ftg. Access.
Legal De<criptlon/7 A~.~~~___ Nater Heater Sq. Ftg. Other
~J ~J ~~ ..--...-~ -? </.c!>/ New Add Alter Rep.
J~fAc,siO'(l{iJ t::/Ld ~ u )o.,/WS)#cf.-.-13;;,:, Ranqe .. ' Fence_Demo_Change/Use
:r....rurr J -- - -- - Valu..5, of Ilor.... ~ Other
owner(YJIII(.I~ Fbo M-I-eri)(2htfJdu, "'2:2;),OtPC?"e> :::~
Address jd/rn /, / ,/.... flol / / 1l/{lRhone BU11<,lno Pernfit Info:~cr be Work(i.e.. Build Single
:%(/// tv. ~rft-, 1.7f" .ohnu family nesidence ISith At ched Gani'Qe'
O~e.- CA q ':)../,;(,,/ ~ l\. Q-Y\'11 j(\ r ( t :.iOrtJ (lfiltf 0 (\
Cnnffiotfe.: V" _~.",~~r "- ~ tW n !... t\Q f\ $;; t'5Y\ (\ - ~ .
Address 1~'6C() .......<(a ~ ~~;) 1'7 Phone
DESlliN 'l:.~rh {namei. 1'_ (address\ (lies. no.) (expires) (ohone no.
Primary I Vi) A P ></)n .L1>d~
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Structura 1
Electrical
Mechanical
CONTRACTORS. I name I ' .
General ~O nCJf1J.c9 l1mD:h\
Plumbinn
(address'
~
. "-
(pxoires) (ohone no.)
62c?-,~C:>
Electrical
1>lechan;cal
PLUflBlNG
ELECTRICAL MECHANICAL
FEF r.HARGF Nn~ rrr r~j'iRGE tJO, rrr r~
Residence of furnace/burner to
7.SC:> /95."- SQ. FT. :z #.......,......~BTU's ~ Q.-
New circuits alts. Floor furnace
or extensions and vent
SERVICES Recessed wall
'D~r~ h~~tpr ~nn wpnt
NO.
'26
Each Single fixture
Relocated building
(new fix. additional)
5.F. Residence
() bath)
Duplex (1 bath) each
Additional bath
~ Water service
7" ' Sewer
I Temporary Construction
~,.p Change in existing
rpc; j 4~J1C~
:$'C).- multifamily, conJll. or
lndustrial
~.... I Of 6Pt!:> amps.
7.;:5<:> COMI.I./lND. FEEDERS
6-0
-::r c..:v"p?>#/(5
I Appl iance vent
seDaratp
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent. system apart from f.1t~1 Lt~.
heatlnq or A.C. ,.7"
Mechanical exhaust
ho(\r1 ",nd dud
6-- ,...g-
'3'-
~ Storm Sewer
I P'~~ze}'l-.c!F'
I.
1S:~ 'I.'
'-::;z
:::;:.-e
~,9:> '51.-
Install/alter/relocate
.r1i<;.trih. fppdprs
~ Of z:?-'5'" ampS.~lj'2~ ~
tEL. ~c::..r;r /'C;lf-C 6/77:~.-;::<i'\
~L ~:>?J''o/ ~~S1~HZE'
~/r: I .
Wood stove/heater
OJ
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-- '
.~""l> '5- -::
~aT~~
....-
,So
::5-
ISSUANCF OF PFR!1lT
TOTAL CHARGES ? "7'?- S-~ TOTAL CHARGES -;Zc?:2..? 0 I TOTAL CHARGES 5"2./)2::>
WHERE STATE L'\H REQUIRES that tile Electrical work be done by an.-Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the nuilding 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 nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that IW OCCUPAflCY will be made
of any structure without the permission of the nuilding Division. I further certify th~t 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 711I.055 \-/ill be used on this project.
Zone .c:/
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGII^TURE Q ....U~ 'D.1 DATE ;/;.,}qO
FOr. OFFICE USE OIlLY , ~ .- - - ~
, Sq. Ftg. 11ain ~ '1<i t) Lx L\: I)~t).luer/?~_~:--
Sq. Ft9. Access x Value
Sq. Ftg. Other?/TE"'~- Value 5'2:>~~'
JQ..I:;'.~ q TOT^L VALUATIOfl-::?:<'::"-'-"-
'QQf\ "-::J...o1(1~ys,te,ms Development . ~7L'6C:>
",y I ~I J. lr,l.IChirqe (1.5n '/ J ;J.
-Ip,p/,T/AoV..4L H. 9'/\/
~(//rW rEE
s"f.//
IWIE(please print)
r?;r ~a v-J
Le",,!;,,})
,-
BUILDING PERflIT
Charges an~
Surcharges
.c Plan Ck. Conrn!lnd
__~L,-7.2__ .M!/Bldo P.er Fpp
Plan Ck. Res
30%/Bldq Per Fee
Fence
PLur~BING PERMIT
Charges and
Surcharges
~. c:>q
-:;:>-7.<"&:>
_____L.__<.l:..__
I L/. $S
D~o
ELECTRICAL PERliIT
Cha rges and
Surcharges,
MECHANICAL PERMIT
Charges and
Surcharges
____'R~~q_
'2._~3
Sidewalk <?::$'O I
AlC Paving
'-,-,;TO ....
Curb Cut /-/8.
/-:75"
47. -se;
"'4&3.. ...-
1'1'~':>O
/? _.7a
Total Comb. Permit
TOTAL
1375:7c::>
'I.8~7~ c.; I
(~.":?5'
,.. ~~. "')
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COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
II.
Applicant to furnish
A. Job Address - 1\
B. legal Description
}. ~xample- Tax Lot lOa, Lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilin<}/or forced air gas
2. examyle- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
1. example~ 1250 sq. foot house, 500 sq. foot garage
I 2. example~ if new project, checknew - if addition,
check add, etc.
F. Building pennit information:
1. example - construct Single family house with an
attached garllge
examole . remodel existing garage into family room
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. DESIGN TEN1 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.
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 avai-lable 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 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.
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. '
:~"tf)1.: ,
2.
3.
be delivered to the
by his electrical
is not authorized
IV.
I1d JL (52?~g
~
III.
"
V.
FOR OFFICE USE ONLY
Permit Clerk
/IAJY
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PROJECT CONDITIONS TO BE SATISEIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Information:
PLANS REVIEWED BY:
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na~e 'l..~~H~~
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Signat'urea-e~ ~---? date /~/~-9D
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