HomeMy WebLinkAboutPermit Signage 1990-8-6
1'7" ..,-
I INSPECTION LINE . CITY Uf SPRINGFIElD
726-3769 COMBINATION APPlICATION/PERMIT
Job Address :j;)L<.,IJ (,/JJ-IJiY2L l ~~;~GY SOURCES:
legal Description I'L /y::z,~? ,'L- -7;] 'ff..,.OZ:;D4> Nater Heater
. I -, ' 1 Range
.
INFDR/lATION UNc
726-3753
Sq. Ftg. 1,lain
:q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter Pep,
--Fence Demo Change/Use
-Dther- --
.~
Q
CJ
~
It-'
~
~
Owner rno \alllfJ'OL
Address ~ ~ (oC> 1'"A"r"'4frA.A) "'t
Construction lender
Phon"7I/7_II?/1
ValUE of Work:
tJlrr
BuildinQ Permit Info:
Familv nesidence With
Describe Work{i.e., Build Single
Attached Garaoel
~lpr.,
Address
Ut~ lliN If.Ar~
{namel
Phone
(address)
(1;('<;. "'0.)
(E!xoiresl
(ohone no.
Primary
Structural L
Electrical.tllIY'flev I~ fl~S F\'=ctY1c.... ~-I-rt e..-
Mechanical I '31,0 \--teCt1O\u\ l1..lQ.I '_
CONTRACTORS (name) (addressl - (lies. nn.)
10/'10
fJ:/&-ft:,/2J
(PlCO; rp"l
(ohonp no. \
Genera 1
Plumbin<l
Electric~\"t"0" / Pr^i\~ 11'("
( i
~1echanical
PlUflBI NG
ELECTRICAl
MECHANICAL
NO.
Each single fixture
FEF r:HARr;F Nn ~I='I=' fl-lA.B.G.[ Nn
Res idence of furnace/burner to
SQ. FT. BTU's
t;FF I CHAR(;F
Relocated building
(new fix. additional)
\
New circuits alts.
'f g)en~M.-
SERVICES
2:):$ .
Floor furnace
and vent
S.F. Residence
(l bathl
Duplex (1 'bath) each
Additional bath
Recessed wall
~n~rp np~tpr ~nrl vpnt
Storm Sewer
Of
amps.
App 1 i ance' vent
~PDaratp
Stationary evap.
cooler
Vent fan with
~inole duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and durt
Wood stove/heater
Water service
Temporary/Construction
Change in existing
res j d,.ence
multifamily. corrm. or
Industrial
Sewer
CO~1./IND. FEEDERS
Install/alter/relocate
dio;trih. fppdpr~
Of
amps.
ISSUANCE OF PFRllIT
Zone
Fire Zone
TOTAL CHARGES TOTAL CHARGES TOTAl CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
,
I HAVE CAREFUllY EXA~1INED the completed aprlication 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 rm OCCUPArKY 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 th .s for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7~1.055 wil e u~d ~roject.
1lAf.IE(please print)~'1 OAt-iM.c.L SIf,fIATVRE / ~ DATE g/;;./QO
\ -FOP. OFFICE USE QiILY (/
Tyoe/Const. Units So. Ftg. 11a1(
Bedrooms Occy load Sq. Ftg. Access
Stories Occy Group Sq. Ftg. Other
,
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATION
BUILDIIlG PERfllT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65%/Blrlo Ppr Fpe
------------ Plan Ck. Res
30%lBl do Per Fee
Fence
Systems Development
CharQe (1.5~l
PlUf1BING PERMIT
Charges and
Surcharges
D/l1l1o
ELECTRICAL PERI~IT
Charges and
Surcha rges
11ECHANICAL PERMIT
Charges and
Surcharges
V).,?-,5l)
--lZiT):,--
Sidewalk
A/C Paving
I Curb Cut
I
Total Comb. Permit
TOTAL
~ '
1)-:5', &:2
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Map Reference
11 U3 43
2. example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceil;n~/or forced air qas
2. examDle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project, check:ruew - if addition,
check add, etc,
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exam~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.
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. 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 permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
- ~
.
_... _"" .._.. - I ,_
PERMIT' VALIDATION
.
%lY,q\l qt; I
~ I~ I\..,~
Permit Clerk ,~vtD~
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date