HomeMy WebLinkAboutPermit Signage 1990-7-19
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Legal Description lAx., ..L. 0 1.I.d.:J.OD
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Construction Lender S.LJ-i"J'l".(-
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7(6-3753
EHERGY SOURCES: Sq. Ftg. f.~ain '.J ~:ec...-'___
Heat .&/~c... ~q. Ftg. Access,_.._ S'
Hater Heater E./I".t',. Sq, Ftg. O:her 8"
/V / t9- ...J,.W~AdWlter_p.ep.
Range,,__,_'.j----- Fenc. D.mo Change/llse
Va I ur of "ark: eIJ I Other - -- r<'>
'2l'J. ()('fV \ . . l/,.......
Buil<~no Pennit Info: Describe Work(ioe., Bui Id Single IS=~
Family ~esidence With Attached Garaae'
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lINSPECTtON LINE
726-3769
. CITY U, SPRINGfiELD
COIIBlIiATION APPLICATION/PEP.MIT
Phon!f9z-hS1tl
Address
DESIGIl TEAll
(name)
Phone
(address)
Primary \y\ lC>Zot1. t) l-~"It.- <4- I.?/'...."'d"
JZ.;.i Co ;weeN ^'t;
Structural
Electrical
Mechanical
COIlTRACTDRS
(name)
(address)
!lies. no.)
Cexoiresl
(nhoM no.)
Genera I m ~ ".:. (L \) E-FD ~
Pl umbi no ," l'>-V'V\ e.
Electrical
~1echanical
PLUIIBI NG
ELECTRICAL
MECHANICAL
110.
~ Each single fixture
Relocated building .
(new fix. additional)
FEE CHARGE tjfl
FFF r~ NO.
IOEL .cHABJiL
7.5:' 37.sa
SQ. FT.
furnace/burner to
BTU's
Residence of
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(] bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wa 11
Sn~~p hp~tpr ~nrl vpnt
'.4,,' L'/>._
(77 Storm Sewer -;)V.
Of
amps.
App 1 i ance- vent
Sp.Dara.tp
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res j ctence
multifamily, camm. or
Industrii'll
Water service
COMfI./IIlO. FEEDERS
Install/alter/relocate
distrib. feeders
Of
amps.
&Z::711'/~r 6#m~'?
. 4
~~ s:tc<:: z;::>p,-nPhY ~ ~ '7?~,;.#~
h "R/J?7/T.
ISSUANC, OF PFR!1lT
TOTAL CHARGES ~? SO TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'W REQUIRES that the Electr;cal work be done by an.Electrical Contractor, the electrical portion of this permit
shall not be val;~ until the label has been signed by.an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permi~. and do hereby certify that all infotmation 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAUCY 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 OP.S 70.1.055 will be used on this project.
IlAllE(please pdnt) mCt~o" \le"C'oe . SIGIlATURE~/fj,,0. 4-'- DAT~b~<.?
FO~ OFFICE USE OIiLY -,-7 \- / "
Zone CL.. Type/Canst. 5-N Un;ts Sq. Ftg. 11a,in ~. ~F~lue
Fire Zone Bedrooms Occy Load Sq. Ft9.~_~9"'2~~~~ue
Flood Plain Stories / Occy Group 8-2 Sq. Ftg. Other<?~;~.!: .&V....~~V..;"e
m 1 ,.,~LoLp . fo.ZQ.l1ffALUATlOtl
Plan Ck. conm/lnf" 'I y I ~ "'") Systems Development
65S/Bldo Ppr Fpp .; ).____ Charoe (1.5~)
PlanCk. Res (i()/\ \...~ -I L..I
30S/Bldo Per Fee \'.1.:. ...LULlllv.. ')YLd210,U. ~
.knA (lQXY\I\.t,-'\{)\t!JL)
\!~.:. 2J OO(),txJ
BUILDING PERf1IT
Charges an':
Surcharges
_LZ".q,-~<:?____
7-~?
..__~?-.:.:2~__
r'. ;? 2S
Fence
PLUIIBING PERMIT
Charges and
Surcharges
O~mo
ELECTRICAL PERI~IT .Sidewalk
Charges and ------------
Surcharges AIC Paving
Total Comb. Permit
11ECHANICAL PERMIT.
Charges and
Surcharges
Curb Cut
I
I TOTAL
t31. t1/
"i
.
.
..
I _ 1..11'-" I
. ,oil ",
"'
COMBINATION APPLICATION(PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. . Job Address
B. Legal Description
1. example- Tax Lot 100: lane County Map Reference
II 03 4J
2. examele- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
-I. exam~le- heat/electrical ceiling/or forced air Qas
2. example- waterheater/electrical/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 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. 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.
11, 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEOULES
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 ;s issued.
'1,IQ,qo
(l1 )'1
*
V. FOR OFFICE USE ONLY
. .
Pennit Clerk
!lUL
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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, .
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Pennit applicant exempt from registration with the Builder's Board because:
"
Addi ti ona 1 .Project. .I!l:f.onnat.i on:
,
PLANS REVIEWED BY:
name
signature
date
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