HomeMy WebLinkAboutPermit Building 1990-4-11
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I INSPECTION LINE
726-3769
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CITY OF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
\~ater Heater
Range
..
INFORllATION liNt
726-3753
Sq. Ftq. I.'ain
~C]. Ftg. Access.
Sq. Ftg. Other
lIew Add Alter Rep.
--Fence Oemo Change/Use
--Other -- -
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Job Address '3 '2 7 c:> .~ 1'~ W"A-...,.. .?7""'
Legal Description /7~~~'22_~c:J 6'?~
Owne"1Z~//.c::..7"" H6Z'/~
Addres; - ~ ~ Phone BuildinQ Pernlit Info: Describe Work(i.e., Build Single
::s''?70" -..#77"'" W~ ~. Familv nesidence I~ith ~.ttached Garaoel
?'"PR..O. do/? '. ''7q'b~<?'>3'=3/1'''7.r#h'L-. :5";p#-/54C// ./,N;'~ /47
Construction LendOr A T/y"""--OS:, ~7'~'
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ValUE of I'lork:
Address
Ut~lliN TEtm
(name)
Phone
(address)
(1 ics. no.)
(exo; res)
(ohane no.
Primary
Structura 1
Electrical
I d ~ ~ <e>.!::FCJI'r6>- ,!ft>. ~d;:!.
Mechanical W~.!'a!'""RA"e-$""'U;Y~/;Z;;;_ ~,.~.~.h'~ _~. 97<Zi>/
CONTRACTORS rnamel (addre<<) ,. flies: nn.)
(pxo;r-p"l
.v~. ~"'/'/
(l"Ihnnp !'In. \
Genera 1
Plumbina
Electrical
Hechanical
PLUI1BING
ELECTRICAL
MECMANICAL
NO.
FF1=' rljl\Rr..F f,Jn
~~~ r~~ NO
t't'C {'..HARG..E..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
5.F. Residence
11 bath I
Ouplex (1 bath). ~ach.
Additional bath
SERVICES
Recessed wall
So~rp np~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance- vent
"eoar~tp
Stat; onary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatina or A.C.
I Mechanical exhaust
hood and durt
I ~1ood stove/heater
~ ,/~;~//~~.~
~.~7>/-=-,
r .. -
Sewer
Temporary Construction
Change ;n existing
rru;J d~.n('p
multifamily, camm. or
Industrial
Water service
CO~1./INO. FEEOERS
Install/alter/relocate
di<;.trih. fppder,
Of
amps.
"'-". ~ ~
/-, ~~ //~ /""-L. ~/"/ ~.
--:5... ~..cL ~7?P--/.-c/ . At'
~?,~""A, ~ ;':;~"/.r.
I SSUANC, OF PFR!IIT
TOTAL CHARGES ~.......v.
WHERE STATE'L~W REQUIRES
shall not be valli until the
. /.-5: - TOTAL CHARGES TOTAL CHARGES /77 #Y /~ _-if:>
that the Electrical work be done by an Electrical Contractor. the electricar"portion of-this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED 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 performed 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 110 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who ar in comp ance with ORS 701.055 will be used on this project.
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IIAHE(please print)
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$' 7".H'A"\Jnits
SIGII^TURE
FO~ OfFICE USE OilLY
Sq. Ftg.
Occy Load /'"'?=z:!lq. Ft~.
Occ.y Groun...4--3 Sq. Ftg.
DATE!l.dJ lo
I
f
Zone ..:::::::.::..
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
/
t1ain
Access
Other
x
,
Value
Value
Value
x
TOT^L VALUATION
BUILDIIIG PERHIT Plan Ck. COIlll1/1 nd 7."70
Charges and ------------ 65'VBl do ~"'r Fpp
Surcharges Plan Ck. Res
30%/Bldq Per F~e
PLUt~BING PERMIT _ n...6::>; _ ":.:'n Fence
Cha rges and
Surcharges ,7:;;- Oemo
ELECTR I CAL PERI~I T Sidewalk
Charges and ------------
Surfharges A/C Pavi ng
MECHANICAL PERMIT _nL~___~n Curb Cut
Charges and
Surcharges ./'5
Systems Development
Charqe (1.5~)
Tota~ Comb. Permit.
? /. :?c>
I "3? .90
- TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax lot 100, Lane County Map Reference
II oj 43
2. examele- Lot I. Block 3, 2nd Addition to
,prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examE'le'- heat/electrical ceilin...Q/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. -----
I. 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. exam21e - construct single family house with an
attaChed garage
2. examole - remodel existing garage into family r.oom
3. exa~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
O. 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. ---
Ill. 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 i.ssued.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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--.:~ .
Permit
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PERMIT VALIDATION
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
nam~ !-"~NE /~~.::-~
Signature~_-:. .
6Y
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f' /
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date
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